1
|
Pandrowala A, Khan S, Kataria D, Kakunje M, Mishra V, Mamtora D, Mudaliar S, Bodhanwala M, Agarwal B, Hiwarkar P. The role of graft T-cell size in patients receiving alemtuzumab serotherapy for non-malignant disorders: results of an institutional protocol. Sci Rep 2024; 14:988. [PMID: 38200046 PMCID: PMC10781954 DOI: 10.1038/s41598-023-50416-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Although graft T cells assist in engraftment, mediate antiviral immune-reconstitution, and cause graft-versus-host disease, graft size is not determined by T-cell content of the graft. The conventional method of graft size determination based on CD34+ cells with alemtuzumab serotherapy is associated with delayed immune reconstitution, contributing to an increased risk of viral infections and graft failure. Alemtuzumab, a long half-life anti-CD52 monoclonal antibody is a robust T-cell depleting serotherapy, and relatively spares memory-effector T cells compared to naïve T cells. We therefore hypothesized that graft size based on T-cell content in patients receiving peripheral blood stem cell graft with alemtuzumab serotherapy would facilitate immune-reconstitution without increasing the risk of graft-versus-host disease. We retrospectively analysed twenty-six consecutive patients with non-malignant disorders grafted using alemtuzumab serotherapy and capping of graft T cells to a maximum of 600 million/kg. The graft T-cell capping protocol resulted in early immune-reconstitution without increasing the risk of severe graft-versus-host disease. Graft T-cell content correlated with CD4+ T-cell reconstitution and acute graft-versus-host disease. The course of CMV viraemia was predictable without recurrence and associated with early T-cell recovery. No patient developed chronic graft-versus-host disease. Overall survival at one year was 100% and disease-free survival was 96% at a median of 899 days (range: 243-1562). Graft size determined by peripheral blood stem cell graft T-cell content in patients receiving alemtuzumab serotherapy for non-malignant disorders is safe and leads to early T-cell immune-reconstitution with excellent survival outcomes.
Collapse
Affiliation(s)
- Ambreen Pandrowala
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India
| | - Sanna Khan
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India
| | - Darshan Kataria
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India
| | - Manasa Kakunje
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India
| | - Varsha Mishra
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India
| | - Dhruv Mamtora
- Department of Pathology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Sangeeta Mudaliar
- Department of Paediatric Haematology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Minnie Bodhanwala
- Department of Paediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Bharat Agarwal
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India
- Department of Paediatric Haematology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Prashant Hiwarkar
- Department of Blood and Marrow Transplantation, Bai Jerbai Wadia Hospital for Children, Mumbai, 400012, India.
| |
Collapse
|
4
|
El-Sokkary R, Uysal S, Erdem H, Kullar R, Pekok AU, Amer F, Grgić S, Carevic B, El-Kholy A, Liskova A, Özdemir M, Khan EA, Uygun-Kizmaz Y, Pandak N, Pandya N, Arapović J, Karaali R, Oztoprak N, Petrov MM, Alabadla R, Alay H, Kholy JAE, Landelle C, Khedr R, Mamtora D, Dragovac G, Fernandez R, Evren EU, Raka L, Cascio A, Dauby N, Oncul A, Balin SO, Cag Y, Dirani N, Dogan M, Dumitru IM, Gad MA, Darazam IA, Naghili B, Del Vecchio RF, Licker M, Marino A, Akhtar N, Kamal M, Angioni G, Medić D, Esmaoğlu A, Gergely SB, Silva-Pinto A, Santos L, Miftode IL, Tekin R, Wongsurakiat P, Khan MA, Kurekci Y, Pilli HP, Grozdanovski K, Miftode E, Baljic R, Vahabolgu H, Rello J. Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey. Eur J Clin Microbiol Infect Dis 2021; 40:2323-2334. [PMID: 34155547 DOI: 10.1007/s10096-021-04288-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.
Collapse
Affiliation(s)
- Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Serhat Uysal
- Department of Infectious Diseases and Clinical Microbiology, Kanuni Research and Training Hospital, Trabzon, Turkey
| | | | | | | | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Svjetlana Grgić
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Mehmet Özdemir
- Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ejaz Ahmed Khan
- Shifa International Hospital, Islamabad, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Yesim Uygun-Kizmaz
- Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | | | | | - Jurica Arapović
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.,School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Rıdvan Karaali
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nefise Oztoprak
- Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Michael M Petrov
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv & "St. George" University Hospital, Plovdiv, Bulgaria
| | | | - Handan Alay
- School of Medicine, Ataturk University, Erzurum, Turkey
| | - Jehan Ali El Kholy
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University / Children Cancer Hospital Egypt, Cairo, 57357, Egypt
| | | | - Gorana Dragovac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia & University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | | | - Emine Unal Evren
- Dr. Suat Gunsel Hospital, University of Kyrenia, Kyrenia, Cyprus
| | - Lul Raka
- National Institute of Public Health of Kosova & University "Hasan Prishtina", Prishtina, Kosova
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone" - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - University of Palermo, 90127 , Palermo, Italy
| | - Nicolas Dauby
- Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Ahsen Oncul
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | | | - Yasemin Cag
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Mustafa Dogan
- Namık Kemal University School of Medicine, Tekirdag, Turkey
| | - Irina Magdalena Dumitru
- Clinical Infectious Diseases Hospital Constanta, Ovidius University of Constanta, Constanța, Romania
| | - Maha Ali Gad
- Faculty of Medicine (Kasr Al-Ainy), Cairo University, Cairo, Egypt
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Naghili
- Imam Reza Hospital of Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Monica Licker
- Multidisciplinary Research Center on Antimicrobial Resistance, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Marino
- ARNAS Garibaldi, Unit of Infectious diseases, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | | | - Deana Medić
- Institute for Public Health of Vojvodina and University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Aliye Esmaoğlu
- Erciyes University Medical Faculty Hospital, Kayseri, Turkey
| | - Szabo Balint Gergely
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - André Silva-Pinto
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Recep Tekin
- School of Medicine, Dicle University, Diyarbakir, Turkey
| | | | | | | | - Hema Prakash Pilli
- GITAM Institute of Medical Sciences and Research, Department of Microbiology, Rushikonda, Visakhapatnam, India
| | | | - Egidia Miftode
- St. Parascheva" Clinical Hospital of Infectious Diseases, Iasi, Romania
| | | | - Haluk Vahabolgu
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Jordi Rello
- Clinical Research CHRU (Nimes, France) and Vall d'Hebron Institute of Research, Barcelona, Spain
| |
Collapse
|
5
|
Mamtora D, Saseedharan S, Rampal R, Joshi P, Bhalekar P, Ahdal J, Jain R. In Vitro activity of a Novel Benzoquinolizine Antibiotic, Levonadifloxacin (WCK 771) against Blood Stream Gram-Positive Isolates from a Tertiary Care Hospital. J Lab Physicians 2020; 12:230-232. [PMID: 33268943 PMCID: PMC7684988 DOI: 10.1055/s-0040-1720944] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background
Blood stream infections (BSIs) due to Gram-positive pathogens such as methicillin-resistant
Staphylococcus aureus
(MRSA) are associated with high mortality ranging from 10 to 60%. The current anti-MRSA agents have limitations with regards to safety and tolerability profile which limits their prolonged usage. Levonadifloxacin and its oral prodrug alalevonadifloxacin, a novel benzoquinolizine antibiotic, have recently been approved for acute bacterial skin and skin structure infections including diabetic foot infections and concurrent bacteremia in India.
Methods
The present study assessed the potency of levonadifloxacin, a novel benzoquinolizine antibiotic, against Gram-positive blood stream clinical isolates (
n
= 31) collected from January to June 2019 at a tertiary care hospital in Mumbai, India. The susceptibility of isolates to antibacterial agents was defined following the Clinical and Laboratory Standard Institute interpretive criteria (M100 E29).
Results
High prevalence of MRSA (62.5%), quinolone-resistant
Staphylococcus aureus
(QRSA) (87.5%), and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) (82.35%) were observed among bacteremic isolates. Levonadifloxacin demonstrated potent activity against MRSA, QRSA, and MR-CoNS strains with significantly lower minimum inhibitory concentration MIC
50/90
values of 0.5/1 mg/L as compared with levofloxacin (8/32 mg/L) and moxifloxacin (2/8 mg/L).
Conclusion
Potent bactericidal activity coupled with low MICs support usage of levonadifloxacin for the management of BSIs caused by multidrug resistant Gram-positive bacteria.
Collapse
Affiliation(s)
- Dhruv Mamtora
- Department of Microbiology, S.L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Sanjith Saseedharan
- Department of Critical Care Medicine, S.L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Ritika Rampal
- Department of Medical Affairs, Wockhardt Ltd., Mumbai, Maharashtra, India
| | - Prashant Joshi
- Drug Discovery Research, Wockhardt Research Center, Aurangabad, Maharashtra, India
| | - Pallavi Bhalekar
- Department of Microbiology, S.L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Jaishid Ahdal
- Department of Medical Affairs, Wockhardt Ltd., Mumbai, Maharashtra, India
| | - Rishi Jain
- Department of Medical Affairs, Wockhardt Ltd., Mumbai, Maharashtra, India
| |
Collapse
|
6
|
Mamtora D, Saseedharan S, Bhalekar P, Katakdhond S. Microbiological profile and antibiotic susceptibility pattern of Gram-positive isolates at a tertiary care hospital. J Lab Physicians 2020; 11:144-148. [PMID: 31160854 PMCID: PMC6543942 DOI: 10.4103/jlp.jlp_173_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES: Gram-positive infections such as those by Staphylococcus aureus have contributed to the disease burden by increasing the morbidity and mortality rates in India. This study aims to determine the prevalence and the antibiotic susceptibility pattern of Gram-positive pathogens at a tertiary care hospital, Mumbai, Maharashtra, India. MATERIALS AND METHODS: This retrospective cross-sectional study was carried out from January, 2015 to December, 2017, at a tertiary care hospital in Mumbai, India. The clinical isolates were cultured, and identification was done using Vitek 2 culture system. The antibiotic susceptibility testing was done as per the Clinical Laboratory Standard Institute guidelines. RESULTS: Out of 2132 (29%) Gram-positive isolates, S. aureus (49%) was the most common encountered pathogen, followed by Enterococcus spp. (24.5%) and coagulase-negative Staphylococcus (16%). Majority of the S. aureus were observed in patients with skin and soft-tissue infections (61.2%) followed by those suffering from respiratory (41%) and bloodstream infections (35%). Among the infections caused by S. aureus, the prevalence of methicillin resistance was 30%. While the MRSA isolates showed lower sensitivity toward co-trimoxazole (39%), clindamycin (30%), erythromycin (23%), and ciprofloxacin (10%), they showed higher susceptibility to linezolid (98%), vancomycin (98%), and teicoplanin (98%). All the isolates were found to be sensitive to daptomycin and tigecycline. While vancomycin-resistant enterococci (VRE) formed 7.5%, the linezolid-resistant enterococcus species was as high as 4.1%. CONCLUSION: The study showed a high prevalence of MRSA and VRE, thereby emphasizing the increasing antimicrobial resistance pattern of the Gram-positive pathogens. Therefore, there is an urgent need for novel antimicrobial stewardship to restrict the ongoing resistance rate among the isolates.
Collapse
Affiliation(s)
- Dhruv Mamtora
- Department of Microbiology, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Sanjith Saseedharan
- Department of Critical Care Medicine, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Pallavi Bhalekar
- Department of Microbiology, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Surekha Katakdhond
- Department of Microbiology, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
7
|
Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V, Sharma A, Sahu S, Nirkhiwale S, Gupta S, Rohit A, Sharma S, Raghavan V, Barman P, Sood S, Mamtora D, Rengaswamy S, Arora A, Goossens H, Versporten A. Variations in antibiotic use across India: multi-centre study through Global Point Prevalence survey. J Hosp Infect 2019; 103:280-283. [PMID: 31170422 DOI: 10.1016/j.jhin.2019.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
The aim of the study was to assess antimicrobial prescribing patterns, and variation in practice, in India. A point prevalence survey (PPS) was conducted in October to December 2017 in 16 tertiary care hospitals across India. The survey included all inpatients receiving an antimicrobial on the day of PPS and collected data were analysed using a web-based application of the University of Antwerp. In all, 1750 patients were surveyed, of whom 1005 were receiving a total of 1578 antimicrobials. Among the antimicrobials prescribed, 26.87% were for community-acquired infections; 19.20% for hospital-acquired infections; 17.24% for medical prophylaxis; 28.70% for surgical prophylaxis; and 7.99% for other or undetermined reasons. Antibiotic prescribing quality indicators, such as reason in notes and post-prescription review score, were low. This PPS showed widespread antibiotic usage, underlining the need for antibiotic stewardship to promote evidence-based practice.
Collapse
Affiliation(s)
- S K Singh
- Amrita Institute of Medical Sciences, Kochi, India.
| | - S Sengupta
- Medanta - The Medicity Hospital, Gurgaon, India
| | - R Antony
- Amrita Institute of Medical Sciences, Kochi, India
| | | | | | | | | | - S Sahu
- Apollo Hospital, Bhubaneswar, India
| | | | - S Gupta
- Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - A Rohit
- Madras Medical Mission Hospital, Chennai, India
| | - S Sharma
- Indian Spinal Injuries Centre, Delhi, India
| | - V Raghavan
- Sundaram Medical Foundation, Chennai, India
| | - P Barman
- BLK Super Speciality Hospital, Delhi, India
| | - S Sood
- CK Birla Hospitals - Rukmani Birla Hospital, Jaipur, India
| | | | | | - A Arora
- Fortis Hospital, New Delhi, India
| | | | | |
Collapse
|