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Nukaya T, Ishikawa K, Takahara K, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. A case of Legionella pneumonia after robot-assisted radical prostatectomy. IJU Case Rep 2024; 7:213-216. [PMID: 38686064 PMCID: PMC11056255 DOI: 10.1002/iju5.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Postoperative Legionella pneumonia is very rare. Case presentation A 71-year-old male patient with prostate cancer (cT2bN0M0) underwent a robotic-assisted radical prostatectomy. On the 5th postoperative day, the patient developed chills and a fever of 39.2°C. Chest radiography revealed decreased permeability in the right middle lung field, leading to the diagnosis of postoperative pneumonia. Antimicrobial therapy was initiated immediately. Blood tests on postoperative day 10 revealed mild liver function abnormalities, electrolyte abnormalities, and a markedly elevated inflammatory response. Legionella pneumonia was suspected based on blood sample results and systemic symptoms, such as diarrhea and nausea. Furthermore, Legionella antigens were detected in the patient's urine, prompting further administration of levofloxacin. The patient's subsequent clinical course was favorable. Conclusion When bacterial pneumonia fails to respond to antimicrobial therapy and systemic symptoms develop, atypical pneumonia, caused by pathogens such as Legionella pneumophila, should be considered even in cases of postoperative pneumonia.
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Affiliation(s)
- Takuhisa Nukaya
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Kiyohito Ishikawa
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Kiyoshi Takahara
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Masashi Takenaka
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Kenji Zennami
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Manabu Ichino
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Hitomi Sasaki
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Makoto Sumitomo
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Ryoichi Shiroki
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
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2
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Garin N, Marti C, Skali Lami A, Prendki V. Atypical Pathogens in Adult Community-Acquired Pneumonia and Implications for Empiric Antibiotic Treatment: A Narrative Review. Microorganisms 2022; 10:microorganisms10122326. [PMID: 36557579 PMCID: PMC9783917 DOI: 10.3390/microorganisms10122326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Atypical pathogens are intracellular bacteria causing community-acquired pneumonia (CAP) in a significant minority of patients. Legionella spp., Chlamydia pneumoniae and psittaci, Mycoplasma pneumoniae, and Coxiella burnetii are commonly included in this category. M. pneumoniae is present in 5-8% of CAP, being the second most frequent pathogen after Streptococcus pneumoniae. Legionella pneumophila is found in 3-5% of inpatients. Chlamydia spp. and Coxiella burnetii are present in less than 1% of patients. Legionella longbeachae is relatively frequent in New Zealand and Australia and might also be present in other parts of the world. Uncertainty remains on the prevalence of atypical pathogens, due to limitations in diagnostic means and methodological issues in epidemiological studies. Despite differences between CAP caused by typical and atypical pathogens, the clinical presentation alone does not allow accurate discrimination. Hence, antibiotics active against atypical pathogens (macrolides, tetracyclines and fluoroquinolones) should be included in the empiric antibiotic treatment of all patients with severe CAP. For patients with milder disease, evidence is lacking and recommendations differ between guidelines. Use of clinical prediction rules to identify patients most likely to be infected with atypical pathogens, and strategies of narrowing the antibiotic spectrum according to initial microbiologic investigations, should be the focus of future investigations.
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Affiliation(s)
- Nicolas Garin
- Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland
- Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Correspondence: ; Tel.: +41-79-900-54-74
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Aicha Skali Lami
- Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Division of Infectious Disease, Geneva University Hospital, 1211 Geneva, Switzerland
- Division of Internal Medicine for the Aged, Geneva University Hospital, 1211 Geneva, Switzerland
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3
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Rothberg MB, Imrey PB, Guo N, Deshpande A, Higgins TL, Lindenauer PK. A risk model to identify Legionella among patients admitted with community-acquired pneumonia: A retrospective cohort study. J Hosp Med 2022; 17:624-632. [PMID: 35880811 PMCID: PMC9531289 DOI: 10.1002/jhm.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Guidelines recommend testing hospitalized patients with community-acquired pneumonia (CAP) for Legionella pneumophila only if the infection is severe or risk factors are present. There are no validated models for predicting Legionella. OBJECTIVE To derive and externally validate a model to predict a positive Legionella test. DESIGN, SETTING AND PARTICIPANTS Diagnostic study of adult inpatients with pneumonia using data from 177 US hospitals in the Premier Healthcare Database (training and hold-out validation sets) and 12 Cleveland Clinic Health System (CCHS) hospitals (external validation set). We used multiple logistic regression to predict positive Legionella tests in the training set, and evaluated performance in both validation sets. MAIN OUTCOME AND MEASURES The outcome was a positive Legionella test. Potential predictors included demographics and co-morbidities, disease severity indicators, season, region, and presence of a local outbreak. RESULTS Of 166,689 patients hospitalized for pneumonia, 43,070 were tested for Legionella and 642 (1.5%) tested positive. The strongest predictors of a positive test were a local outbreak (odds ratio [OR], 3.4), June-October occurrence (OR, 3.4), hyponatremia (OR, 3.3), smoking (OR, 2.4), and diarrhea (OR, 2.0); prior admission within 6 months (OR, 0.27) and chronic pulmonary disease (OR, 0.49) were associated with a negative test. Model c-statistics were 0.79 in the Premier and 0.77 in the CCHS validation samples. High-risk patients were only slightly more likely to have been tested than lower-risk patients. Compared to actual practice, the model-based testing strategy detected twice as many cases. CONCLUSIONS Although Legionella is an uncommon cause of pneumonia, patient characteristics can identify individuals at high risk, allowing for more efficient testing.
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Affiliation(s)
- Michael B. Rothberg
- Center for Value‐Based Care Research, Community Care, Cleveland ClinicClevelandOhioUSA
| | - Peter B. Imrey
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
- Cleveland Clinic's Medical SchoolCleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOhioUSA
| | - Ning Guo
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - Abhishek Deshpande
- Center for Value‐Based Care Research, Community Care, Cleveland ClinicClevelandOhioUSA
- Department of Infectious DiseaseRespiratory InstituteClevelandOhioUSA
| | - Thomas L. Higgins
- Department of MedicineUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Peter K. Lindenauer
- Department of MedicineUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
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4
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Li X, Wei S, Ma X, Li H, Jing M, Liu H, Zhao Y. Efficacy and safety of Tanreqing injection combined with antibiotics against Streptococcus pneumoniae pneumonia: A systematic review and meta-analysis. J Clin Pharm Ther 2022; 47:1159-1172. [PMID: 35712904 DOI: 10.1111/jcpt.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tanreqing injection (TRQ) is a traditional Chinese medicine injection. The goal of this study was to assess the clinical efficacy and safety of TRQ injection in combination with azithromycin or ceftriaxone, as well as azithromycin or ceftriaxone alone, in treating Streptococcus pneumoniae pneumonia (SPP). METHODS The randomized controlled trial (RCT) of TRQ injection combined with antibiotics versus antibiotics alone in the treatment of SPP was retrieved from Chinese and English databases (the control group was treated with antibiotics alone, while the experimental group received TRQ injection combined with antibiotics). The retrieval period was from the database's inception through February 2022. The data was extracted using the Cochrane Collaboration Network Quality Evaluation Standards, the methodological quality of the included literature was assessed, and the outcome indicators were calculated using RevMan5.4.1 software. RESULTS AND DISCUSSION A total of 25 RCTs were collected, including 2057 patients. TRQ injection combined with antibiotics significantly improved clinical efficacy and reduced defervescence time, lung rale disappearance time, cough disappearance time, disappearance time of chest pain, and average hospitalization time when compared to control group, according to meta-analysis results (p < 0.05). WHAT IS NEW AND CONCLUSION In the treatment of SPP, TRQ injection combination with antibiotics can significantly improve the total effect rate when compared to standard western medicine. Due to the low quality of the randomized controlled trials included in this investigation, more high-quality, multi-center, large-sample, prospective, randomized, double-blind clinical studies are needed to confirm the aforementioned conclusions.
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Affiliation(s)
- Xing Li
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China.,School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Shizhang Wei
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Xiao Ma
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haotian Li
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Manyi Jing
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Honghong Liu
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanling Zhao
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
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Chauffard A, Bridevaux PO, Carballo S, Prendki V, Reny JL, Stirnemann J, Garin N. Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia. BMC Infect Dis 2022; 22:424. [PMID: 35505308 PMCID: PMC9066797 DOI: 10.1186/s12879-022-07423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit. METHODS This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity. RESULTS Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2-6.2), heart failure (OR 2.6, 95% CI 1.1-6.1), absence of chest pain (OR 3.0, 95% CI 1.1-8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4-6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3-5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71-0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity. CONCLUSION Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects. TRIAL REGISTRATION NCT00818610.
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Affiliation(s)
- Aline Chauffard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre-Olivier Bridevaux
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Service de Pneumologie, Centre Hospitalier du Valais Romand, Hôpital du Valais, Sion, Switzerland
| | - Sebastian Carballo
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jérôme Stirnemann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Nicolas Garin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. .,Division of Internal Medicine, Hôpital Riviera Chablais, Rennaz, Switzerland. .,Service de Médecine Interne, Centre Hospitalier de Rennaz, Rte du Vieux Séquoia 20, 1847, Rennaz, Switzerland.
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Ishiwada N. Current situation and need for prevention of invasive pneumococcal disease and pneumococcal pneumonia in 6- to 64-year-olds in Japan. J Infect Chemother 2020; 27:7-18. [PMID: 33011068 DOI: 10.1016/j.jiac.2020.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 01/28/2023]
Abstract
We conducted a systematic review of the literature to evaluate the reported epidemiology and burden of invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) among children and adults aged 6-64 years in Japan. Studies published from Japan between September 2009 and September 2019 and indexed in the MEDLINE/PubMed or ICHUSHI databases were evaluated. A majority of the studies reported overlapping age ranges, including children aged <6 years and adults aged >64 years. According to the national surveillance data, 19% of the IPD cases were patients aged 5-59 years, and an increasing trend in IPD cases was reported from 2013 to 2017. Comorbidities were consistent with those reported by the Advisory Committee on Immunization Practices. Deaths from IPD appeared to increase nearly 3-fold between 2013 and 2017. Overall, both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) coverage was higher for IPD compared with PP. All the serotypes known to be prominent in Japan were also identified as common serotypes (3, 6A, 19A: PCV13 serotypes; 12F: outbreak serotype; 15A, 35B: drug-resistant serotypes). This systematic literature review suggests a substantial burden of IPD and PP in Japanese children and adults aged 6-64 years. The burden of comorbidities, hospitalizations, and mortality was particularly high among adults. Concerted pneumococcal vaccination strategies may help to reduce the incidence and burden of IPD and PP in this large proportion of the Japanese population.
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Affiliation(s)
- Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8673, Japan.
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7
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Królicka AL, Kruczkowska A, Krajewska M, Kusztal MA. Hyponatremia in Infectious Diseases-A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5320. [PMID: 32718076 PMCID: PMC7432506 DOI: 10.3390/ijerph17155320] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
Hyponatremia is one of the most common water-electrolyte imbalances in the human organism. A serum sodium concentration threshold of less than 135 mmol/L is diagnostic for hyponatremia. The disorder is usually secondary to various diseases, including infections. Our review aims to summarize the diagnostic value and impact of hyponatremia on the prognosis, length of the hospitalization, and mortality among patients with active infection. The scientific literature regarding hyponatremia was reviewed using PubMed, ClinicalKey, and Web of Science databases. Studies published between 2011 and 2020 were screened and eligible studies were selected according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and specific inclusion criteria. The most common infections that were associated with hyponatremia were viral and bacterial infections, including COVID-19 (coronavirus disease 2019). The etiology varied according to the infection site, setting and patient cohort it concerned. In several studies, hyponatremia was associated with prolonged hospitalization, worse outcomes, and higher mortality rates. Hyponatremia can also play a diagnostic role in differentiating pathogens that cause a certain infection type, as it was observed in community-acquired pneumonia. Although many mechanisms leading to hyponatremia have already been described, it is impossible with any certainty to ascribe the etiology of hyponatremia to any of them.
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Affiliation(s)
- Anna L. Królicka
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | | | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.K.); (M.A.K.)
| | - Mariusz A. Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.K.); (M.A.K.)
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8
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Puri S, Boudreaux-Kelly M, Walker JD, Clancy CJ, Decker BK. Clinical Presentation of Community-Acquired Legionella Pneumonia Identified by Universal Testing in an Endemic Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E533. [PMID: 31952117 PMCID: PMC7013928 DOI: 10.3390/ijerph17020533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 11/16/2022]
Abstract
The rapid identification of Legionella pneumonia is essential to optimize patient treatment and outcomes, and to identify potential public health risks. Previous studies have identified clinical factors which are more common in Legionella than non-Legionella pneumonia, and scores have been developed to assist in diagnosing cases. Since a Legionella pneumonia outbreak at VA Pittsburgh in 2012, nearly all patients with pneumonia have been tested for Legionella. The purpose of this study was to evaluate distinguishing characteristics between Legionella and non-Legionella pneumonia with the application of universal testing for Legionella in all cases of community-acquired pneumonia. We performed a retrospective case-control study matching Legionella and non-Legionella pneumonia cases occurring in the same month. Between January 2013 and February 2016, 17 Legionella and 54 non-Legionella cases were identified and reviewed. No tested characteristics were significantly associated with Legionella cases after Bonferroni correction. Outcomes of Legionella and non-Legionella pneumonia were comparable. Therefore, in veterans who underwent routine Legionella testing in an endemic area, factors typically associated with Legionella pneumonia were non-discriminatory.
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Affiliation(s)
- Shruti Puri
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Monique Boudreaux-Kelly
- Statcore, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA; (M.B.-K.); (J.D.W.); (C.J.C.)
| | - Jon D. Walker
- Statcore, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA; (M.B.-K.); (J.D.W.); (C.J.C.)
| | - Cornelius J. Clancy
- Statcore, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA; (M.B.-K.); (J.D.W.); (C.J.C.)
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Brooke K. Decker
- Statcore, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA; (M.B.-K.); (J.D.W.); (C.J.C.)
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA 15261, USA
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