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El Ghali A, Morrisette T, Alosaimy S, Lucas K, Tupayachi-Ortiz MG, Vemula R, Wadle C, Philley JV, Mejia-Chew C, Hamad Y, Stevens RW, Zeuli JD, Webb AJ, Fiske CT, Simonyan A, Cimino CL, Mammadova M, Umana VE, Hasbun R, Butt S, Molina KC, Thomas M, Kaip EA, Bouchard J, Gore TW, Howard C, Cabanilla MG, Holger DJ, Frens JJ, Barger M, Ong A, Cohen KA, Rybak MJ. Long-term evaluation of clinical success and safety of omadacycline in nontuberculous mycobacteria infections: a retrospective, multicenter cohort of real-world health outcomes. Antimicrob Agents Chemother 2023; 67:e0082423. [PMID: 37768312 PMCID: PMC10583686 DOI: 10.1128/aac.00824-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/29/2023] Open
Abstract
Infections due to nontuberculous mycobacteria (NTM) continue to increase in prevalence, leading to problematic clinical outcomes. Omadacycline (OMC) is an aminomethylcycline antibiotic with FDA orphan drug and fast-track designations for pulmonary NTM infections, including Mycobacteroides abscessus (MAB). This multicenter retrospective study across 16 U.S. medical institutions from January 2020 to March 2023 examined the long-term clinical success, safety, and tolerability of OMC for NTM infections. The cohort included patients aged ≥18 yr, who were clinically evaluable, and` had been treated with OMC for ≥3 mo without a previous diagnosis of cystic fibrosis. The primary outcome was 3 mo clinical success, with secondary outcomes including clinical improvement and mortality at 6- and 12 mo, persistence or reemergence of infection, adverse effects, and reasons for OMC utilization. Seventy-five patients were included in this analysis. Most patients were female (48/75, 64.0%) or Caucasian (58/75, 77.3%), with a median (IQR) age of 59 yr (49-67). Most had NTM pulmonary disease (33/75, 44.0%), skin and soft tissue disease (19/75, 25.3%), or osteomyelitis (10/75, 13.3%), and Mycobacterium abscessus (60/75, 80%) was the most commonly isolated NTM pathogen. The median (IQR) treatment duration was 6 mo (4 - 14), and the most commonly co-administered antibiotic was azithromycin (33/70, 47.1%). Three-month clinical success was observed in 80.0% (60/75) of patients, and AEs attributable to OMC occurred in 32.0% (24/75) of patients, leading to drug discontinuation in 9.3% (7/75).
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Affiliation(s)
- Amer El Ghali
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Department of Clinical Pharmacy & Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA
- Department of Pharmacy Services, Medical University of South Carolina (MUSC) Health, Charleston, South Carolina, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kristen Lucas
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Maria G. Tupayachi-Ortiz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Raaga Vemula
- University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Carly Wadle
- University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Julie V. Philley
- University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yasir Hamad
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - John D. Zeuli
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J. Webb
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Christina T. Fiske
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anahit Simonyan
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christo L. Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mehriban Mammadova
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Virginia E. Umana
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Saira Butt
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kyle C. Molina
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Thomas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Emily A. Kaip
- Department of Pharmaceutical Services, University of California, San Francisco Medical Center, San Francisco, North Carolina, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Tristan W. Gore
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Catessa Howard
- Department of Pharmacy, West Virginia University Medicine, Morgantown, West Virginia, USA
| | - M. Gabriela Cabanilla
- Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Dana J. Holger
- Department of Pharmacy Practice, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Jeremy J. Frens
- Department of Pharmacy Services, Cone Health, Greensboro, North Carolina, USA
| | - Melissa Barger
- Department of Medicine, Ventura County Medical Center, Ventura, California, USA
| | - Aaron Ong
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Marlyand, USA
| | - Keira A. Cohen
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Marlyand, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
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Mejia-Chew C, Chavez MA, Lian M, McKee A, Garrett L, Bailey TC, Spec A, Agarwal M, Turabelidze G. Spatial Epidemiologic Analysis and Risk Factors for Nontuberculous Mycobacteria Infections, Missouri, USA, 2008-2019. Emerg Infect Dis 2023; 29:1540-1546. [PMID: 37486160 PMCID: PMC10370856 DOI: 10.3201/eid2908.230378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) infections are caused by environmental exposure. We describe spatial distribution of NTM infections and associations with sociodemographic factors and flooding in Missouri, USA. Our retrospective analysis of mycobacterial cultures reported to the Missouri Department of Health and Social Services surveillance system during January 1, 2008-December 31, 2019, detected geographic clusters of infection. Multilevel Poisson regression quantified small-area geographic variations and identified characteristics associated with risk for infection. Median county-level NTM infection rate was 66.33 (interquartile range 51-91)/100,000 persons. Risk of clustering was significantly higher in rural areas (rate ratio 2.82, 95% CI 1.90-4.19) and in counties with >5 floodings per year versus no flooding (rate ratio 1.38, 95% CI 1.26-1.52). Higher risk for NTM infection was associated with older age, rurality, and more flooding. Clinicians and public health professionals should be aware of increased risk for NTM infections, especially in similar environments.
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Gregory MH, Spec A, Stwalley D, Gremida A, Mejia-Chew C, Nickel KB, Ciorba MA, Rood RP, Olsen MA, Deepak P. Corticosteroids Increase the Risk of Invasive Fungal Infections More Than Tumor Necrosis Factor-Alpha Inhibitors in Patients With Inflammatory Bowel Disease. Crohns Colitis 360 2023; 5:otad010. [PMID: 36911593 PMCID: PMC9999356 DOI: 10.1093/crocol/otad010] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 02/21/2023] Open
Abstract
Background Invasive fungal infections are a devastating complication of inflammatory bowel disease (IBD) treatment. We aimed to determine the incidence of fungal infections in IBD patients and examine the risk with tumor necrosis factor-alpha inhibitors (anti-TNF) compared with corticosteroids. Methods In a retrospective cohort study using the IBM MarketScan Commercial Database we identified US patients with IBD and at least 6 months enrollment from 2006 to 2018. The primary outcome was a composite of invasive fungal infections, identified by ICD-9/10-CM codes plus antifungal treatment. Tuberculosis (TB) infections were a secondary outcome, with infections presented as cases/100 000 person-years (PY). A proportional hazards model was used to determine the association of IBD medications (as time-dependent variables) and invasive fungal infections, controlling for comorbidities and IBD severity. Results Among 652 920 patients with IBD, the rate of invasive fungal infections was 47.9 cases per 100 000 PY (95% CI 44.7-51.4), which was more than double the TB rate (22 cases [CI 20-24], per 100 000 PY). Histoplasmosis was the most common invasive fungal infection (12.0 cases [CI 10.4-13.8] per 100 000 PY). After controlling for comorbidities and IBD severity, corticosteroids (hazard ratio [HR] 5.4; CI 4.6-6.2) and anti-TNFs (HR 1.6; CI 1.3-2.1) were associated with invasive fungal infections. Conclusions Invasive fungal infections are more common than TB in patients with IBD. The risk of invasive fungal infections with corticosteroids is more than double that of anti-TNFs. Minimizing corticosteroid use in IBD patients may decrease the risk of fungal infections.
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Affiliation(s)
- Martin H Gregory
- Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Dustin Stwalley
- Institute for Informatics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Anas Gremida
- Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Matthew A Ciorba
- Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Richard P Rood
- Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Parakkal Deepak
- Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA
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Mejia-Chew C, Carver PL, Rutjanawech S, Camargo LFA, Fernandes R, Belga S, Daniels SA, Müller NJ, Burkhard S, Theodoropoulos NM, Postma DF, van Duijn PJ, Fariñas MC, González-Rico C, Hand J, Lowe A, Bodro M, Vanino E, Cruz AF, Ramos A, Makek MJ, Mjahed RB, Manuel O, Kamar N, Calvo-Cano A, Carrasco LR, Muñoz P, Rodríguez S, Pérez-Recio S, Sabé N, Álvarez RR, Silva JT, Mularoni A, Vidal E, Alonso-Titos J, Del Rosal T, Classen AY, Goss CW, Agarwal M, López-Medrano F. Risk Factors for Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients: A Multinational Case-Control Study. Clin Infect Dis 2023; 76:e995-e1003. [PMID: 35879465 DOI: 10.1093/cid/ciac608] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk factors for nontuberculous mycobacteria (NTM) infections after solid organ transplant (SOT) are not well characterized. Here we aimed to describe these factors. METHODS Retrospective, multinational, 1:2 matched case-control study that included SOT recipients ≥12 years old diagnosed with NTM infection from 1 January 2008 to 31 December 2018. Controls were matched on transplanted organ, NTM treatment center, and post-transplant survival greater than or equal to the time to NTM diagnosis. Logistic regression on matched pairs was used to assess associations between risk factors and NTM infections. RESULTS Analyses included 85 cases and 169 controls (59% male, 88% White, median age at time of SOT of 54 years [interquartile range {IQR} 40-62]). NTM infection occurred in kidney (42%), lung (35%), heart and liver (11% each), and pancreas transplant recipients (1%). Median time from transplant to infection was 21.6 months (IQR 5.3-55.2). Most underlying comorbidities were evenly distributed between groups; however, cases were older at the time of NTM diagnosis, more frequently on systemic corticosteroids and had a lower lymphocyte count (all P < .05). In the multivariable model, older age at transplant (adjusted odds ratio [aOR] 1.04; 95 confidence interval [CI], 1.01-1.07), hospital admission within 90 days (aOR, 3.14; 95% CI, 1.41-6.98), receipt of antifungals (aOR, 5.35; 95% CI, 1.7-16.91), and lymphocyte-specific antibodies (aOR, 7.73; 95% CI, 1.07-56.14), were associated with NTM infection. CONCLUSIONS Risk of NTM infection in SOT recipients was associated with older age at SOT, prior hospital admission, receipt of antifungals or lymphocyte-specific antibodies. NTM infection should be considered in SOT patients with these risk factors.
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Affiliation(s)
- Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peggy L Carver
- College of Pharmacy, The University of Michigan, Ann Arbor, Michigan, USA
| | - Sasinuch Rutjanawech
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Shay-Anne Daniels
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Nicolas J Müller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Sara Burkhard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Nicole M Theodoropoulos
- Department of Medicine, Division of Infectious Diseases & Immunology, UMass Chan Medical School, Worchester, Massachusetts, USA
| | - Douwe F Postma
- Department of Internal Medicine and Infectious Diseases, University Medical Center Groningen, The Netherlands
| | - Pleun J van Duijn
- Department of Clinical Microbiology, University Medical Center Groningen, The Netherlands
| | - María Carmen Fariñas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Spain.,CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Claudia González-Rico
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Spain.,CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Adam Lowe
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | | | - Elisa Vanino
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Italy.,Infectious Diseases Unit, Ravenna Hospital, AUSL Romagna, Italy
| | - Ana Fernández Cruz
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Ribal Bou Mjahed
- Lausanne University Hospital (CHUV), University of Lausanne, Switzerland
| | - Oriol Manuel
- Lausanne University Hospital (CHUV), University of Lausanne, Switzerland
| | - Nassim Kamar
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Paul Sabatier University, Toulouse, France
| | - Antonia Calvo-Cano
- Infectious Disease Department, University Hospital Badajoz, Badajoz, Spain
| | | | | | | | - Sandra Pérez-Recio
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sabé
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Alessandra Mularoni
- IRCC-ISMETT, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Elisa Vidal
- Infectious Diseases Service, Reina Sofia University Hospital, Madrid, Spain
| | - Juana Alonso-Titos
- Nephrology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Teresa Del Rosal
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Charles W Goss
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mansi Agarwal
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
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Simmons N, Olsen MA, Buss J, Bailey TC, Mejia-Chew C. Missed Opportunities in the Diagnosis of Tuberculosis Meningitis. Open Forum Infect Dis 2023; 10:ofad050. [PMID: 36861091 PMCID: PMC9969738 DOI: 10.1093/ofid/ofad050] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Background Tuberculosis meningitis (TBM) has high mortality and morbidity. Diagnostic delays can impact TBM outcomes. We aimed to estimate the number of potentially missed opportunities (MOs) to diagnose TBM and determine its impact on 90-day mortality. Methods This is a retrospective cohort of adult patients with a central nervous system (CNS) TB International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis code (013*, A17*) identified in the Healthcare Cost and Utilization Project, State Inpatient and State Emergency Department (ED) Databases from 8 states. Missed opportunity was defined as composite of ICD-9/10 diagnosis/procedure codes that included CNS signs/symptoms, systemic illness, or non-CNS TB diagnosis during a hospital/ED visit 180 days before the index TBM admission. Demographics, comorbidities, admission characteristics, mortality, and admission costs were compared between those with and without a MO, and 90-day in-hospital mortality, using univariate and multivariable analyses. Results Of 893 patients with TBM, median age at diagnosis was 50 years (interquartile range, 37-64), 61.3% were male, and 35.2% had Medicaid as primary payer. Overall, 407 (45.6%) had a prior hospital or ED visit with an MO code. In-hospital 90-day mortality was not different between those with and without an MO, regardless of the MO coded during an ED visit (13.7% vs 15.2%, P = .73) or a hospitalization (28.2% vs 30.9%, P = .74). Independent risk of 90-day in-hospital mortality was associated with older age, hyponatremia (relative risk [RR], 1.62; 95% confidence interval [CI], 1.1-2.4; P = .01), septicemia (RR, 1.6; 95% CI, 1.03-2.45; P = .03), and mechanical ventilation (RR, 3.4; 95% CI, 2.25-5.3; P < .001) during the index admission. Conclusions Approximately half the patients coded for TBM had a hospital or ED visit in the previous 6 months meeting the MO definition. We found no association between having an MO for TBM and 90-day in-hospital mortality.
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Affiliation(s)
- Niamh Simmons
- UCD School of Medicine, University College Dublin, Dublin, Ireland
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Joanna Buss
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Thomas C Bailey
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Carlos Mejia-Chew
- Correspondence: Carlos Mejia-Chew, MD, Assistant Professor in Medicine, Infectious Disease, Washington University School of Medicine, 4523 Clayton Ave., Campus Box 8051, St. Louis, MO 63110-0193 (); Margaret Olsen, PhD, MPH, Professor of Medicine and Surgery, Infectious Disease, Washington University School of Medicine, 4523 Clayton Ave., Campus Box 8051, St. Louis, MO 63110-0193 ()
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Ortíz DW, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Metabolic syndrome in people with HIV from Guatemala: analysis of components and risk factors. Int J STD AIDS 2022; 33:987-994. [PMID: 35978450 DOI: 10.1177/09564624221119321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with HIV (PWH) in Latin America are at a greater risk of developing comorbidities due to the increasing burden of obesity and metabolic syndrome in the region. We explored the associations between social, cardiovascular and HIV-related risk factors with metabolic syndrome in PWH from Guatemala. METHODS Cross-sectional study analyzing demographic, clinical and laboratory data from PWH. Metabolic syndrome diagnosis and components are defined by the harmonized Joint Scientific Statement criteria. Data were collected from July 2019 to March 2020 and analyzed using correlations and logistic regression. RESULTS Median age was 39 years [IQR 31-48], 56.8% of participants were male and 31.5% (n = 266, 95% CI 0.28-0.34) had metabolic syndrome. Age (adjusted odds ratio (aOR): 1.03, 95% CI 1.02-1.05, p <0.001), urban dweller (aOR: 1.48, 95% CI 1.00-2.18, p = 0.049), low physical activity (aOR: 1.45, 95% CI 1.01-2.08, p = 0.046), hyperuricemia (aOR: 3.31, 95% CI 1.93-5.67, p <0.001), current CD4+ T cell count < 200 cells/mm3 (aOR: 1.96, 95% CI 1.19-3.23, p = 0.009), 6 months of efavirenz (aOR: 1.89, 95% CI 1.29-2.77, p = 0.001), and obesity (aOR: 37.0, 95% CI 7.70-178.2, p < 0.001) were independently associated with metabolic syndrome. CONCLUSIONS Prevalence of metabolic syndrome in this study was high and driven mainly by social and cardiovascular risk factors such as age, urban dwelling, obesity, hyperuricemia and low physical activity. Efavirenz use and CD4 count were the only HIV-related factors associated with metabolic syndrome.
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Affiliation(s)
- Dean W Ortíz
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Hugo E Marroquin
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
| | - Katherine B Franco
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
| | - Johanna R Melendez
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Rodolfo Pinzón
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Ana J Samayoa
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
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7
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Morrisette T, Alosaimy S, Lagnf AM, Philley JV, Sigler C, Butt S, Kaip EA, MacDougall C, Mejia-Chew C, Bouchard J, Frens JJ, Gore T, Hamad Y, Howard C, Barger M, Gabriela Cabanilla M, Ong A, Veve MP, Webb AJ, Stevens RW, Cohen KA, Rybak MJ. 1082. Real-World Experience with Omadacycline for Nontuberculous Mycobacterial Infections: A Multicenter Evaluation. Open Forum Infect Dis 2021. [PMCID: PMC8644900 DOI: 10.1093/ofid/ofab466.1276] [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: 11/12/2022] Open
Abstract
Abstract
Background
Nontuberculous mycobacteria (NTM) are resistant to numerous antibiotics and lead to significant morbidity and mortality. Omadacycline (OMC) is an aminomethylcycline antibiotic that is Food and Drug Administration-approved for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. Furthermore, OMC has shown in vitro activity against NTM. Given that real-world evidence is lacking, our primary objective was to evaluate the clinical success and tolerability of OMC when used for a variety of NTM infections.
Methods
This was a multicenter, retrospective, observational study conducted from January 2020 to June 2021. We included all patients ≥ 18 years of age that received OMC of any indication for Mycobacterium spp. The primary outcome was clinical success, defined as a lack of all-cause mortality, lack of persistence or re-emergence of infection during or after therapy, and lack of alteration of OMC. Incidence of adverse effects potentially attributable to OMC and reasons for OMC utilization were also analyzed.
Results
A total of 31 patients were included from 12 geographically distinct academic health systems (median age: 57 (IQR, 45-63) years; 45% male; 81% Caucasian). The majority of isolated pathogens were Mycobacterium abscessus complex (84%) and of those with subspeciation performed (54%), the majority (86%) were subsp. abscessus. The primary infections were of pulmonary origin (67%) and the median (IQR) duration of OMC therapy was 5.3 (3.2-9.4) months. Most isolates did not have OMC susceptibility conducted (87%), while the majority did for tigecycline (90%). Clinical success was reported in 81% of the population. Most patients were on combination antimicrobial therapy, and 39% of patients reported an adverse effect while on OMC (58% gastrointestinal distress). The majority of patients were prescribed OMC due to ease of administration (61%) and antimicrobial resistance to previous antibiotics (42%).
Conclusion
OMC may be a potential option for the therapy of NTM infections. Prospective, randomized clinical trials are needed to confirm our preliminary findings.
Disclosures
Julie V. Philley, MD, Paratek Pharmaceuticals (Advisor or Review Panel member)Paratek Pharmaceuticals, Inc. (Consultant) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support) Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Wayne State University, Detroit, Michigan
| | | | | | | | - Carly Sigler
- The University of Texas Health Science Center, Tyler, Texas
| | - Saira Butt
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily A Kaip
- University of California, San Francisco Medical Center, San Francisco, California
| | - Conan MacDougall
- University of California San Francisco School of Pharmacy, San Francisco, California
| | | | | | | | - Tristan Gore
- Univeristy of South Carolina, Columbia, South Carolina
| | | | | | | | | | - Aaron Ong
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Keira A Cohen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
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Montes K, Atluri H, Silvestre Tuch H, Ramirez L, Paiz J, Hesse Lopez A, Bailey TC, Spec A, Mejia-Chew C. Risk factors for mortality and multidrug resistance in pulmonary tuberculosis in Guatemala: A retrospective analysis of mandatory reporting. J Clin Tuberc Other Mycobact Dis 2021; 25:100287. [PMID: 34849409 PMCID: PMC8608588 DOI: 10.1016/j.jctube.2021.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
National TB cohort analyzing risk factors associated with MDR-TB and mortality in Guatemala. Indigenous ethnicity and prior TB treatment were associated with increased risk of mortality and MDR-TB. HIV/Unknown HIV status were associated with increased mortality and diabetes with risk for MDR-TB.
Background Risk factors for mortality and MDR-TB in Guatemala are poorly understood. We aimed to identify risk factors to assist in targeting public health interventions. Methods We performed a retrospective study of adults with pulmonary TB reported to the Guatemalan TB Program between January 1, 2016 and December 31, 2017. The primary objective was to determine risk factors for mortality in pulmonary TB. The secondary objective was to determine risk factors associated with MDR-TB. Results Among 3,945 patients with pulmonary TB, median age was 39 years (IQR 25–54), 59% were male, 25% of indigenous ethnicity, 1.1% had MDR-TB and 3.9% died. On multivariable analysis, previous TB treatment (odds ratio [OR] 3.57, CI 2.24–5.68 [p < 0.001]), living with HIV (OR 3.98, CI 2.4–6.17 [p < 0.001]), unknown HIV diagnosis (OR 2.65, CI 1.68–4.18 [p < 0.001]), indigenous ethnicity (OR 1.79, CI 1.18–2.7 [p = 0.005]), malnutrition (OR 7.33, CI 3.24–16.59 [p < 0.001]), and lower educational attainment (OR 2.86, CI 1.43–5.88 [p = 0.003]) were associated with mortality. Prior treatment (OR 53.76, CI 25.04–115.43 [p < 0.001]), diabetes (OR 4.13, CI 2.04–8.35 [p < 0.001]), and indigenous ethnicity (OR 11.83, CI 1.46–95.73 [p = 0.02]) were associated with MDR-TB. Conclusions In Guatemala, both previous TB treatment and indigenous ethnicity were associated with higher TB mortality and MDR-TB risk among patients with pulmonary TB.
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Affiliation(s)
- Kevin Montes
- Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - Himachandana Atluri
- Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - Hibeb Silvestre Tuch
- Tuberculosis Program, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Lucrecia Ramirez
- Tuberculosis Program, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Juan Paiz
- Tuberculosis Program, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Ana Hesse Lopez
- Tuberculosis Program, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Thomas C Bailey
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, USA
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9
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Ortíz DW, Roberts-Sano O, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala. AIDS Res Ther 2021; 18:79. [PMID: 34706742 PMCID: PMC8554948 DOI: 10.1186/s12981-021-00400-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.
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Affiliation(s)
- Dean W Ortíz
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala.
| | - Olivia Roberts-Sano
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Hugo E Marroquin
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Katherine B Franco
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Johanna R Melendez
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Rodolfo Pinzón
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Ana J Samayoa
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
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10
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Rutjanawech S, Mejia-Chew C, Ayres C, Spec A. A Canker Barking at the Wrong Knee: Thyronectria austroamericana Septic Arthritis. Open Forum Infect Dis 2021; 8:ofab381. [PMID: 34458393 PMCID: PMC8387459 DOI: 10.1093/ofid/ofab381] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
The mold Thyronectria austroamericana is a plant pathogen that causes canker in honey locust trees. We describe the first case of this mold causing septic arthritis in humans.
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Affiliation(s)
- Sasinuch Rutjanawech
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Chapelle Ayres
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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11
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Turnbull IR, Mazer MB, Hoofnagle MH, Kirby JP, Leonard JM, Mejia-Chew C, Spec A, Blood J, Miles SM, Ransom EM, Potter RF, Gaut JP, Remy KE, Hotchkiss RS. IL-7 Immunotherapy in a Nonimmunocompromised Patient With Intractable Fungal Wound Sepsis. Open Forum Infect Dis 2021; 8:ofab256. [PMID: 34189174 PMCID: PMC8231366 DOI: 10.1093/ofid/ofab256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
A nonimmunocompromised patient developed life-threatening soft tissue infection with Trichosporon asahii, Fusarium, and Saksenaea that progressed despite maximum antifungal therapies and aggressive debridement. Interleukin-7 immunotherapy resulted in clinical improvement, fungal clearance, reversal of lymphopenia, and improved T-cell function. Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening fungal infections.
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Affiliation(s)
- Isaiah R Turnbull
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Monty B Mazer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark H Hoofnagle
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John P Kirby
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer M Leonard
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carlos Mejia-Chew
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrej Spec
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jane Blood
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sydney M Miles
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric M Ransom
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert F Potter
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph P Gaut
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth E Remy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Richard S Hotchkiss
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Mejia-Chew C, Yaeger L, Montes K, Bailey TC, Olsen MA. Diagnostic Accuracy of Health Care Administrative Diagnosis Codes to Identify Nontuberculous Mycobacteria Disease: A Systematic Review. Open Forum Infect Dis 2021; 8:ofab035. [PMID: 34041304 PMCID: PMC8134528 DOI: 10.1093/ofid/ofab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Health care administrative database research frequently uses standard medical codes to identify diagnoses or procedures. The aim of this review was to establish the diagnostic accuracy of codes used in administrative data research to identify nontuberculous mycobacterial (NTM) disease, including lung disease (NTMLD). Methods We searched Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to April 2019. We included studies assessing the diagnostic accuracy of International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis codes to identify NTM disease and NTMLD. Studies were independently assessed by 2 researchers, and the Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess bias and quality. Results We identified 5549 unique citations. Of the 96 full-text articles reviewed, 7 eligible studies of moderate quality (3730 participants) were included in our review. The diagnostic accuracy of ICD-9-CM diagnosis codes to identify NTM disease varied widely across studies, with positive predictive values ranging from 38.2% to 100% and sensitivity ranging from 21% to 93%. For NTMLD, 4 studies reported diagnostic accuracy, with positive predictive values ranging from 57% to 64.6% and sensitivity ranging from 21% to 26.9%. Conclusions Diagnostic accuracy measures of codes used in health care administrative data to identify patients with NTM varied across studies. Overall the positive predictive value of ICD-9-CM diagnosis codes alone is good, but the sensitivity is low; this method is likely to underestimate case numbers, reflecting the current limitations of coding systems to capture NTM diagnoses.
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Affiliation(s)
- Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Lauren Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin Montes
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Thomas C Bailey
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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13
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Morrisette T, Alosaimy S, Philley JV, Wadle C, Howard C, Webb AJ, Veve MP, Barger ML, Bouchard J, Gore TW, Lagnf AM, Ansari I, Mejia-Chew C, Cohen KA, Rybak MJ. Preliminary, Real-world, Multicenter Experience With Omadacycline for Mycobacterium abscessus Infections. Open Forum Infect Dis 2021; 8:ofab002. [PMID: 33628856 PMCID: PMC7890947 DOI: 10.1093/ofid/ofab002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/06/2021] [Indexed: 11/12/2022] Open
Abstract
Twelve patients were treated with omadacycline (OMC) as part of a multidrug regimen for Mycobacterium abscessus. The majority of infections were of pulmonary origin (7/12; 58.3%). The median (interquartile range) duration of OMC was 6.2 (4.2-11.0) months. Clinical success occurred in 9/12 (75.0%) patients. Three patients experienced a possible adverse effect while on therapy.
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Julie V Philley
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Carly Wadle
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Catessa Howard
- Department of Pharmacy, West Virginia University Medicine, Morgantown, West Virginia, USA
| | - Andrew J Webb
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael P Veve
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, Tennessee, USA
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Melissa L Barger
- Department of Medicine, Ventura County Medical Center, Ventura, California, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Tristan W Gore
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Iman Ansari
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keira A Cohen
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Marlyand, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
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14
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Marroquín HE, Ortiz D, Larson L, Franco K, Spec A, Melendez J, Pinzon R, Mejia-Chew C, Samayoa J, O’Halloran JA. 937. Factors Associated with Metabolic Syndrome in People with HIV under 40 Years in Guatemala. Open Forum Infect Dis 2020. [PMCID: PMC7776721 DOI: 10.1093/ofid/ofaa439.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background HIV infection and antiretroviral therapy (ART) can lead to metabolic abnormalities associated with increased cardiovascular disease risk, some of these abnormalities (central obesity, elevated fasting glucose, triglycerides, and blood pressure and low HDL cholesterol) are in metabolic syndrome (MetS). The prevalence of MetS increases with age. Currently, the status of MetS in people with HIV (PWH) Guatemala is unknown. We assessed the prevalence of MetS and potential predictors in PWH participating in prospective cohort study at Hospital Roosevelt in Guatemala City. Methods We performed a cross-sectional analysis of PWH under 40 years old receiving ART for at least 6 months from July 2019 to March 2020. The harmonized criteria for MetS and the cut-off for waist circumference recommended by the Latin American Diabetes Association were used. Association between MetS and gender, place of residency, ethnicity, educational level, baseline and current CD4 count, smoking, alcohol consumption, physical activity, viral load, body mass index (BMI) and ART exposure was assessed in bivariate analysis. Potential predictors (p-value < 0.1) were included in a multivariate binary logistic regression model. Results Of total cohort of 757 participants enrolled390 (51.5%) were younger than 40 years. Of those under < 40 years, 150 (38.5%) were women, 59 (15.1%) Mayan, median age was 32 years (IQR 27, 37). 93 (23.8%) had MetS. Between group differences in Table 1. Of those with Met, 51 (54.8%) had elevated waist circumference, 87 (93.5%) elevated triglycerides, 83 (89.2%) low HDL-c, 56 (60.2%) elevated blood pressure and 35 (37.6%) elevated fasting glucose. Body mass index (BMI) ≥ 25 kg/m2 or higher and 2 years or more of cumulative non-nucleoside reverse transcription inhibitors (NNRTI) where more common in those < 40 years with MetS compared to those without MetS. On multivariable regression, MetS was associated with current CD4 count < 200 (OR 3.1; IC 1.51, 6.34; p-value < 0.01) and BMI ≥ 25 kg/m2 (OR; 6.53; IC 3.64, 11.73; p-value < 0.01). Table1. Between group differences (No MetS vs MetS) ![]()
Conclusion Nearly one in every four PWH under 40 years old in our cohort was affected by MetS. Dyslipidemia (elevated triglycerides and low HDL-c) was the main driver of MetS. Lower CD4 count and overweight were predictors for MetS in PWH under 40. Disclosures Andrej Spec, MD, MSCI, Astellas (Grant/Research Support)Mayne (Consultant)Scynexis (Consultant)
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Affiliation(s)
| | - Dean Ortiz
- Hospital Roosevelt, Mixco, Sacatepequez, Guatemala
| | | | | | - Andrej Spec
- Division of Infectious Diseases Washington University in St. Louis, ST LOUIS, MO
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15
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Mejia-Chew C, Sung A, Larson L, Powderly WG, Spec A. Treatment and mortality outcomes in patients with other extrapulmonary cryptococcal disease compared with central nervous system disease. Mycoses 2020; 64:174-180. [PMID: 33065769 DOI: 10.1111/myc.13199] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Determining the extent of cryptococcal disease (CD) is key to therapeutic management. Treatment with fluconazole is only recommended for localised pulmonary disease. Induction therapy with amphotericin B (AmB) and flucytosine is recommended for disease at other sites, irrespective of central nervous system (CNS) involvement, but this is not often followed in patients without meningitis. In this study, we compared treatment and mortality between patients with CD of the CNS and other extrapulmonary (OE) sites. METHODS This is a retrospective, single-centre study of all hospitalised patients with nonpulmonary cryptococcal infection from 2002 to 2015 who underwent lumbar puncture. Demographics, predisposing factors, comorbidities, clinical presentation, laboratory values, antifungal treatment and mortality data were collected to evaluate 90-day mortality and treatment differences between patients with OE and CNS CD. Survival analysis was performed using multivariable Cox regression analysis. RESULTS Of 193 patients analysed, 143 (74%) had CNS CD and 50 (26%) had OE CD. Ninety-day mortality was 23% and similar between the OE and CNS CD groups (22% vs 23%, p = .9). In the comorbidity-adjusted multivariable Cox regression model, mortality risk was similar in the OE and CNS groups. Fewer patients with OE CD received induction therapy with AmB and flucytosine compared to those with CNS disease (28% vs 71.3%, p < .001). CONCLUSION Patients with OE CD had similar 90-day mortality compared to those with CNS disease. Despite current guideline recommendations, patients with OE disease were less likely to receive appropriate induction therapy with AmB and flucytosine compared to patients with CNS disease.
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Affiliation(s)
- Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Abby Sung
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindsey Larson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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16
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Mejia-Chew C, O'Halloran JA, Olsen MA, Stwalley D, Salter A, Powderly WG, Spec A. Infectious disease consultation for candidaemia – Authors' reply. The Lancet Infectious Diseases 2020; 20:165-166. [DOI: 10.1016/s1473-3099(20)30005-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/15/2022]
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17
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Mejia-Chew C, O'Halloran JA, Olsen MA, Stwalley D, Kronen R, Lin C, Salazar AS, Larson L, Hsueh K, Powderly WG, Spec A. Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study. Lancet Infect Dis 2019; 19:1336-1344. [PMID: 31562024 DOI: 10.1016/s1473-3099(19)30405-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/30/2019] [Accepted: 06/24/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Candida bloodstream infection is associated with high mortality. Infectious disease consultation improves outcomes in several infections, including Staphylococcus aureus and cryptococcosis, as well as multidrug-resistant organisms. We aimed to examine the association between infectious disease consultation and differences in management with mortality in candida bloodstream infections. METHODS In this retrospective, single-centre cohort study, we reviewed the medical charts of all patients admitted to Barnes-Jewish Hospital (St Louis, MO, USA), a tertiary referral centre, aged 18 years or older with candida bloodstream infection from 2002 to 2015. We collected data for demographics, comorbidities, predisposing factors, all-cause mortality, antifungal use, central-line removal, and ophthalmological and echocardiographic evaluation to assess 90-day all-cause mortality between individuals with and without an infectious disease consultation. For the survival analysis we used Cox proportional hazards model with inverse weighting by propensity score to assess the effects of infectious disease consultation on mortality and differences in management. FINDINGS Between Jan 1, 2002, and Dec 31, 2015, of 1794 patients assessed for eligibility, we analysed 1691 patients with candida bloodstream infection; 776 (45·9%) who had an infectious disease consultation and 915 (54·1%) who did not have an infectious disease consultation. All 1691 patients were included in the analysis. None were missing data. Most underlying comorbidities were evenly distributed between groups. 90-day mortality was lower in the infectious disease consultation group than in patients who did not receive an infectious disease consultation (29% [222/776] vs 51% [468/915]; p<0·0001). In the model with inverse weighting by the propensity score, infectious disease consultation was associated with a hazard ratio of 0·81 (95% CI 0·73-0·91; p<0·0001) for mortality. In the consultation group, median duration of antifungal therapy was longer (18 [IQR 14-35] vs 14 [6-20] days; p<0·0001) and central-line removal (587 [76%] of 776 vs 538 [59%] of 915; p<0·0001), echocardiography use (442 [57%] of 776 vs 305 [33%] of 915; p<0·0001), and ophthalmological examination (412 [53%] of 776 vs 160 [17%] of 915; p<0·0001) were more frequently done. Fewer patients in the infectious disease consultation group were not treated (13 [2%] of 776 vs 128 [14%] of 915; p<0·0001). INTERPRETATION Patients with candida bloodstream infection receiving an infectious disease consultation have lower mortality. This finding might be attributable to these individuals receiving a higher number of non-pharmacological, evidence-based interventions and lower amounts of non-treatment. These data suggest that an infectious disease consultation should be an integral part of clinical care of patients with candida bloodstream infection. FUNDING Astellas Global Development Pharma, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality.
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Affiliation(s)
- Carlos Mejia-Chew
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Jane A O'Halloran
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Margaret A Olsen
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Dustin Stwalley
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Ryan Kronen
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Charlotte Lin
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Ana S Salazar
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Lindsey Larson
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Kevin Hsueh
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - William G Powderly
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Andrej Spec
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA.
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Spec A, Mejia-Chew C, Powderly WG, Cornely OA. EQUAL Cryptococcus Score 2018: A European Confederation of Medical Mycology Score Derived From Current Guidelines to Measure QUALity of Clinical Cryptococcosis Management. Open Forum Infect Dis 2018; 5:ofy299. [PMID: 30515434 PMCID: PMC6262117 DOI: 10.1093/ofid/ofy299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 08/24/2018] [Accepted: 11/07/2018] [Indexed: 12/22/2022] Open
Abstract
Cryptococcocis is an opportunistic fungal infection with high morbidity and mortality. Guidelines to aid clinicians regarding diagnosis, management, and treatment can be extensive and challenging to comply with. There is no tool to measure guideline adherence. To create such a tool, we reviewed current guidelines from the Infectious Diseases Society of America, the World Health Organization, the American Society of Transplantation, and recent significant publications to select the strongest recommendations as vital components of our scoring tool. Items included diagnostic tests (blood, tissue, and cerebrospinal fluid cultures, Cryptococcus antigen, India ink, histopathology with special fungal stains, central nervous system imaging), pharmacological (amphotericin B, flucytosine, azoles) and nonpharmacological treatments (intracranial pressure management, immunomodulation, infectious disease consultation), and follow-up of central nervous system complications. The EQUAL Cryptococcus Score 2018 weighs and aggregates the recommendations for the optimal management of cryptococcosis. Providing a tool that could measure guideline adherence or facilitate clinical decision-making.
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Affiliation(s)
- Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), and Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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Abstract
INTRODUCTION Clostridium difficile is the most common cause of healthcare associated infection, and C. difficile infection (CDI) is associated with significant costs, morbidity, and mortality. One obstacle to preventing CDI is lack of high quality data on interventions to prevent CDI. This has led some to focus on areas, such as method of hand hygiene, unlikely to impact CDI incidence as much as others, such as contact precautions. In addition, existing strategies, although effective, do have limitations. Another challenge is the ability to rapidly, and accurately, diagnose CDI. Given these obstacles, new strategies to effectively prevent CDI are imperative to improve patient outcomes. Areas covered: Evidence of the interventions recommended by international scientific societies will be reviewed, as well as ongoing research on new strategies, such as screening for asymptomatic C. difficile carriage, microbiota sparing agents, bacteriocins and vaccines. Expert commentary: Current measures to prevent CDI are effective, but have significant limitations. Contact precautions and antimicrobial stewardship are likely the most effective of current prevention recommendations. Diagnostic assay utilization plays a role as well. New strategies to prevent CDI are needed, and, fortunately, several are being studied. Most likely a combination of approaches will be necessary to optimize CDI prevention.
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Affiliation(s)
- Carlos Mejia-Chew
- a Division of Infectious Disease , Washington University School of Medicine , St Louis , MO , USA
| | - Erik R Dubberke
- a Division of Infectious Disease , Washington University School of Medicine , St Louis , MO , USA
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