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Marais G, Moodley C, Claassen-Weitz S, Patel F, Prentice E, Tootla H, Nyakutira N, Lennard K, Reddy K, Bamford C, Niehaus A, Whitelaw A, Brink A. Carbapenem-resistant Klebsiella pneumoniae among hospitalized patients in Cape Town, South Africa: molecular epidemiology and characterization. JAC Antimicrob Resist 2024; 6:dlae050. [PMID: 38529003 PMCID: PMC10963078 DOI: 10.1093/jacamr/dlae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 03/27/2024] Open
Abstract
Background The molecular epidemiology of carbapenem-resistant Enterobacterales in Cape Town remains largely unknown. Objectives This study aimed to describe the molecular epidemiology, resistome, virulome and mobilome of carbapenem-resistant Klebsiella pneumoniae (CRKP) within Cape Town to guide therapy, antimicrobial stewardship and infection prevention and control practices. Methods Eighty-five CRKP isolates from hospitalized patients underwent WGS as part of a prospective, multicentre, cross-sectional study, conducted between 1 November 2020 and 30 November 2022, across public-sector and private-sector hospitals in Cape Town, South Africa. Results MLST revealed three novel types, ST6785, ST6786 and ST6787, while the most common were ST219, ST307, ST17, ST13 and ST2497. Different predominant clones were noted in each hospital. The most common carbapenemase gene was blaOXA-48-like, detected in 71% of isolates, with blaNDM detected in 5%. Notably, co-detection of two carbapenemase genes (blaOXA-48-like and blaNDM) occurred in 13% of isolates. The yersiniabactin siderophore was detected in 73% of isolates, and was most commonly associated with the ICEKp5 mobile element. All carbapenemases were located on plasmids. The genes blaOXA-181 and blaOXA-232 colocalized with a ColKP3 replicon type on assembled contigs in 83% and 100% of cases, respectively. Conclusions CRKP epidemiology in Cape Town reflects institutionally dominant, rather than regional, clones. The most prevalent carbapenemase gene was blaOXA-48-like, in keeping with CRKP epidemiology in South Africa in general. Emerging clones harbouring both blaOXA-48-like and blaNDM, such as ST17, ST2497 and the novel ST6787, are a concern due to the limited availability of appropriate antimicrobial agents in South Africa.
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Affiliation(s)
- Gert Marais
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
- National Health Laboratory Service Laboratory, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Clinton Moodley
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
- National Health Laboratory Service Laboratory, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Shantelle Claassen-Weitz
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Fadheela Patel
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
- National Health Laboratory Service Laboratory, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Hafsah Tootla
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
- Medical Microbiology, National Health Laboratory Service, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Nyasha Nyakutira
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Katie Lennard
- Division of Computational Biology, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Kessendri Reddy
- Division of Medical Microbiology, Stellenbosch University, Cape Town, Western Cape, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Colleen Bamford
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
- Division of Medical Microbiology, Pathcare, Cape Town, South Africa
| | - Abraham Niehaus
- Division of Medical Microbiology, Ampath, Cape Town, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Stellenbosch University, Cape Town, Western Cape, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Adrian Brink
- Division of Medical Microbiology, University of Cape Town, Cape Town, Western Cape, South Africa
- National Health Laboratory Service Laboratory, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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Tootla HD, Prentice E, Moodley C, Marais G, Nyakutira N, Reddy K, Bamford C, Niehaus A, Whitelaw A, Brink A. Carbapenem-resistant Enterobacterales among hospitalized patients in Cape Town, South Africa: clinical and microbiological epidemiology. JAC Antimicrob Resist 2024; 6:dlae051. [PMID: 38523732 PMCID: PMC10959510 DOI: 10.1093/jacamr/dlae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) are a substantial problem in Cape Town. CRE epidemiology is largely unknown and mortality remains high. Objectives To describe and characterize the clinical and microbiological epidemiology of CRE within Cape Town hospitals to better inform therapy with regard to current and novel antibiotics, as well as improve antimicrobial stewardship (AMS), and infection prevention and control (IPC). Methods This prospective, multicentre study performed between 1 November 2020 and 30 November 2022, across three public and three private hospitals included hospitalized participants with CRE from clinical cultures. Participant demographics, clinical information and microbiology results were collected and analysed. Results Ninety percent of participants were from public hospitals. The age distribution ranged from 7 days to 88 years. Notable risk factors for CRE infection included recent exposure to antibiotics, medical devices and surgery. The most prevalent species was Klebsiella pneumoniae. However, a higher proportion of Serratia marcescens compared with previous reports was identified. The detected carbapenemases were blaOXA-48-like (80%) and blaNDM (11%). With the exception of amikacin (63%), tigecycline (65%), colistin (95%) and ceftazidime/avibactam (87%), susceptibility to antibiotics was low. Conclusions This study identified common risk factors for CRE infection and generated a description of carbapenemase enzymes, species distribution and antibiograms, enabling a better understanding of CRE epidemiology. This provides insights into transmission patterns and resistance determinants of CREs, beneficial to informing data-driven regional patient management, AMS and IPC strategies.
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Affiliation(s)
- Hafsah Deepa Tootla
- Division of Medical Microbiology, National Health Laboratory Service, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Clinton Moodley
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gert Marais
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nyasha Nyakutira
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kessendri Reddy
- Division of Medical Microbiology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Colleen Bamford
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Medical Microbiology, Pathcare, Cape Town, South Africa
| | - Abraham Niehaus
- Division of Medical Microbiology, Ampath, Cape Town, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrian Brink
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Overmeyer AJ, Prentice E, Brink A, Lennard K, Moodley C. The genomic characterization of carbapenem-resistant Serratia marcescens at a tertiary hospital in South Africa. JAC Antimicrob Resist 2023; 5:dlad089. [PMID: 37497336 PMCID: PMC10368080 DOI: 10.1093/jacamr/dlad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background Serratia marcescens is an opportunistic nosocomial pathogen, and recent reports have highlighted the rapid increase in multidrug resistance in this organism. There is a paucity in genomic data for carbapenem-resistant S. marcescens (CRSM). Methods A retrospective cohort study describing laboratory-confirmed CRSM from a tertiary academic hospital in Cape Town, South Africa, for the period 2015-20, was performed. Stored CRSM and contemporary isolates were submitted for WGS using Illumina MiSeq, with the Nextera DNA Flex Library Preparation Kit. Sequence data were analysed in-house using srst2 and Tychus, and CRSM and contemporary isolates were compared. Results Twenty-one CRSM and four contemporary isolates were sequenced and analysed. Twenty-four different resistance genes were identified, with all isolates having at least two resistance genes, and seventeen isolates harbouring three or more genes. This correlated well with phenotypic results. The blaOXA-48-like carbapenemase was the most common carbapenemase identified, in 86% (18/21) of CRSM. A core SNP difference tree indicated that the CRSM could be grouped into three clusters. Eleven isolates had shared plasmids. Several genes and SNPs were identified in the CRSM, which may putatively augment virulence, but this requires further functional characterization. Conclusions A diverse resistome was observed in CRSM, which was also reflected phenotypically, with blaOXA-48-like the most commonly carbapenemase. Though distinct clusters were observed, no clonality was noted, and a limited number of isolates shared plasmids. This study provides genomic data for emerging CRSM and highlights the importance of ongoing genomic surveillance to inform infection prevention control and antimicrobial stewardship initiatives.
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Affiliation(s)
| | - Elizabeth Prentice
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Adrian Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Katie Lennard
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Clinton Moodley
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
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Boucek K, Mastropietro CW, Beall J, Keller E, Beshish A, Flores S, Chlebowski M, Yates AR, Choudhury TA, Mueller D, Kwiatkowski DM, Migally K, Karki K, Willett R, Radman MR, Reddy C, Piggott K, Capone CA, Kapileshwarkar Y, Vijayakumar N, Prentice E, Narasimhulu SS, Martin RH, Costello JM. Staged vs Complete Repair in Tetralogy of Fallot With Pulmonary Atresia. Ann Thorac Surg 2023; 115:1463-1468. [PMID: 36739070 DOI: 10.1016/j.athoracsur.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/02/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND We sought to compare outcomes for infants with tetralogy of Fallot with pulmonary atresia (TOF/PA) and confluent pulmonary arteries who underwent staged or primary complete surgical repair. METHODS This retrospective study included infants undergoing initial surgical intervention between 0 and 60 days of age with TOF/PA without aortopulmonary collaterals from 2009 to 2018 at 20 centers. The primary outcome was days alive and out of the hospital in the first year of life (DAOH365). Secondary outcomes were mortality at 1 year of age and a composite major complication outcome. Multivariable modeling with generalized estimating equations were used to compare outcomes between groups. RESULTS Of 221 subjects, 142 underwent staged repair and 79 underwent primary complete repair. There was no significant difference in median DAOH365 between the staged and primary repair groups (317 days [interquartile range, 278-336] vs 338 days [interquartile range, 314-348], respectively; adjusted P = .13). Nine staged repair patients (7%) died in the first year of life vs 5 primary repair patients (6%; adjusted odds ratio, 1.00; 95% CI, 0.25-3.95). At least 1 major complication occurred in 37% of patients who underwent staged repair vs 41% of patients who underwent primary complete repair (P = .75), largely driven by the need for unplanned cardiac reinterventions. CONCLUSIONS For infants with TOF/PA with confluent pulmonary arteries, a surgical strategy of staged or primary complete repair resulted in statistically similar DAOH365, early mortality, and morbidity.
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Affiliation(s)
- Katerina Boucek
- Division of Cardiology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina.
| | - Christopher W Mastropietro
- Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Jonathan Beall
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Everette Keller
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Asaad Beshish
- Division of Cardiology, Emory School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Saul Flores
- Division of Cardiac Critical Care, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Meghan Chlebowski
- Division of Cardiac Critical Care, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew R Yates
- Divisions of Cardiology and Critical Care, Nationwide Children's Hospital, Columbus, Ohio
| | - Tarif A Choudhury
- Divisions of Critical Care and Cardiology, Columbia University College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York, New York, New York
| | - Dana Mueller
- Division of Cardiology, Rady Children's Hospital, San Diego, California
| | - David M Kwiatkowski
- Division of Cardiology, Stanford University, Lucille Packard Children's Hospital, Palo Alto, California
| | - Karl Migally
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Karan Karki
- Division of Cardiology, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Renee Willett
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC
| | - Monique R Radman
- Division of Cardiac Critical Care, Seattle Children's Hospital, Seattle, Washngton
| | - Chetana Reddy
- Division of Pediatric Cardiology, SSM Health Cardinal Glennon Children's Hospital-St Louis University, St Louis, Missouri
| | - Kurt Piggott
- Division of Cardiac Critical Care, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Christine A Capone
- Division of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of NY, New Hyde Park, New York
| | - Yamini Kapileshwarkar
- Division of Critical Care, OSF HealthCare Children's Hospital of Illinois, Peoria, Illinois
| | - Niranjan Vijayakumar
- Division of Pediatric Cardiology, University of Iowa, Stead Family Children's Hospital, Iowa City, Iowa
| | - Elizabeth Prentice
- Division of Pediatric Critical Care, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Sukumar Suguna Narasimhulu
- Division of Cardiac Intensive Care, University of Central Florida College of Medicine, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida
| | - Renee H Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - John M Costello
- Division of Cardiology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina
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5
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Brink AJ, Richards G, Tootla H, Prentice E. Epidemiology of Gram-negative bacteria during coronavirus disease 2019. What is the real pandemic? Curr Opin Infect Dis 2022; 35:595-604. [PMID: 36345854 DOI: 10.1097/qco.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Bacterial infections play a key role in hospital outcomes during the coronavirus disease 2019 (COVID-19) pandemic. Nonetheless, the global impact on the epidemiology of Gram-negative bacteria (GNB) and antibiotic resistance has not been clearly established. RECENT FINDINGS Multiple limitations exist in the current literature, in that substantial variability was observed with regard to methodology. Notwithstanding the heterogeneity, the evidence suggests that the COVID-19 pandemic had a substantial negative impact on global epidemiology with an increase in hospital-onset infections, associated with GNB. Similarly, an alarming increase in resistant GNB compared to prepandemic rates, was apparent. This was most evident for carbapenemase-producing Klebsiella pneumoniae (bloodstream infections), carbapenem-resistant Pseudomonas aeruginosa (ventilator-associated pneumonia), and carbapenem-resistant Acinetobacter baumannii (all infections). Significant variations were most apparent in the large, system-wide regional or national comparative assessments, vs. single-centre studies. Categorizing concurrent bacteria as co- or secondary-infections may be paramount to optimize standard of care. SUMMARY The data from most studies signal the probability that COVID-19 accelerated resistance. However, multiple limitations intrinsic to interpretation of current COVID-19 data, prevents accurately quantifying collateral damage on the global epidemiology and antibiotic resistance amongst GNB. It is likely to be substantial and renewed efforts to limit further increases is warranted.
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Affiliation(s)
- Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town
| | - Guy Richards
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Hafsah Tootla
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town.,National Health Laboratory Service, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town
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Karsies T, Tarquinio K, Shein SL, Beardsley AL, Prentice E, Karam O, Fontela P, Moore-Clingenpeel M, Willson DF. Compliance With an Antibiotic Guideline for Suspected Ventilator-Associated Infection: The Ventilator-Associated INfection (VAIN2) Study. Pediatr Crit Care Med 2021; 22:859-869. [PMID: 33965989 DOI: 10.1097/pcc.0000000000002761] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate a guideline for antibiotic decisions in children with suspected ventilator-associated infection. DESIGN Prospective, observational cohort study conducted in 22 PICUs in the United States and Canada. SETTING PICUs in 22 hospitals from April 2017 to January 2019. SUBJECTS Children less than 3 years old on mechanical ventilation greater than 48 hours who had respiratory secretions cultured and antibiotics initiated for suspected ventilator-associated infection. INTERVENTIONS After baseline data collection in children with suspected ventilator-associated infection (Phase 1), a consensus guideline was developed for advising antibiotic continuation or stopping at 48-72 hours (Phase 2) and implemented (Phase 3). Guideline-based antibiotic recommendations were provided to the treating clinicians once clinical and microbiologic data were available. Demographic and outcome data were collected, and guideline compliance and antibiotic utilization evaluated for Phase 1 and Phase 3. MEASUREMENTS AND MAIN RESULTS Despite education and implementation efforts, guideline-concordant antibiotic management occurred in 158 of 227 (70%) Phase 3 subjects compared with 213 of 281 (76%) in Phase 1. Illness severity and positive respiratory cultures were the primary determinants of antibiotic continuation. For subjects with a positive respiratory culture but a score for which antibiotic discontinuation was recommended (score ≤ 2), only 27% of Phase 3 subjects had antibiotics discontinued. Antibiotic continuation was not associated with improved outcomes in these subjects and was associated with significantly longer duration of ventilation (median 5.5 d longer) and PICU stay (5 d longer) in the overall study population. Positive respiratory cultures were not associated with outcomes irrespective of antibiotic treatment. CONCLUSIONS Antibiotic guideline efficacy and safety remain uncertain due to clinician failure to follow the guideline, instead primarily relying on respiratory culture results. Strategies to overcome clinician perceptions of respiratory cultures and other barriers will be vital for improving guideline adherence and antibiotic use in suspected ventilator-associated infection in future studies.
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Affiliation(s)
- Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, OH
| | - Keiko Tarquinio
- Division of Pediatric Critical Care, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Steven L Shein
- Division of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Andrew L Beardsley
- Division of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Elizabeth Prentice
- Division of Pediatric Critical Care, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Oliver Karam
- Division of Pediatric Critical Care, Children's Hospital of Richmond at VCU, Richmond, VA
| | - Patricia Fontela
- Division of Pediatric Critical Care, McGill University Children's Hospital, Montreal, QC, Canada
| | - Melissa Moore-Clingenpeel
- Biostatistics Resource at Nationwide Children's Hospital and Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Douglas F Willson
- Division of Pediatric Critical Care, Children's Hospital of Richmond at VCU, Richmond, VA
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Shuping L, Mpembe R, Mhlanga M, Naicker SD, Maphanga TG, Tsotetsi E, Wadula J, Velaphi S, Nakwa F, Chibabhai V, Mahabeer P, Moncho M, Prentice E, Bamford C, Reddy K, Maluleka C, Mawela D, Modise M, Govender NP. Epidemiology of Culture-confirmed Candidemia Among Hospitalized Children in South Africa, 2012-2017. Pediatr Infect Dis J 2021; 40:730-737. [PMID: 33872278 DOI: 10.1097/inf.0000000000003151] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND We aimed to describe the epidemiology of candidemia among children in South Africa. METHODS We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates. RESULTS Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004). CONCLUSIONS Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.
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Affiliation(s)
- Liliwe Shuping
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ruth Mpembe
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mabatho Mhlanga
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Serisha D Naicker
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Tsidiso G Maphanga
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ernest Tsotetsi
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jeannette Wadula
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, National Health Laboratory Service, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Firdose Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Prasha Mahabeer
- Department of Microbiology, National Health Laboratory Service, King Edward VIII Hospital, KZN Academic Complex, Durban, South Africa
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Masego Moncho
- Department of Medical Microbiology, Faculty of Health Sciences, Universitas Hospital, National Health Laboratory Service, University of Free State, Bloemfontein, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Groote Schuur Microbiology Laboratory, National Health Laboratory Service, Cape Town, South Africa
| | - Colleen Bamford
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University/National Health Laboratory Services, Tygerberg, Cape Town, South Africa
| | - Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University/National Health Laboratory Services, Tygerberg, Cape Town, South Africa
| | - Caroline Maluleka
- Department of Microbiology, National health Laboratory Service, Dr George Mukhari Hospital, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Dini Mawela
- Department of Microbiology, National health Laboratory Service, Dr George Mukhari Hospital, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Motshabi Modise
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of National Health Laboratory Service, Johannesburg, South Africa
| | - Nelesh P Govender
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Qin H, Sanders C, Prasetyo Y, Syukron M, Prentice E. Exploring the dynamic relationships between risk perception and behavior in response to the Coronavirus Disease 2019 (COVID-19) outbreak. Soc Sci Med 2021; 285:114267. [PMID: 34388619 PMCID: PMC8305223 DOI: 10.1016/j.socscimed.2021.114267] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 04/15/2021] [Revised: 06/29/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022]
Abstract
The relationships between risk perception and related behavior form a fundamental theme in risk analysis. Despite increasing attentions on the temporal dimension of risk perception and behavior in recent literature, the dynamic relationships between these two constructs remain understudied. Infectious disease outbreaks, such as the Coronavirus Disease 2019 (COVID-19) pandemic, provide a key setting for analyzing evolving perceptions of and responses to natural or human-induced hazards. The main objectives of this research are: (1) to assess temporal changes in cognitive and affective dimensions of perceived COVID-19 risk as well as related protective behavior; and (2) to explore the dynamic relationships between COVID-19 risk perception and behavioral responses. Timely data on changing risk perception and behavior related to the COVID-19 outbreak were collected through two series of online surveys from four major cities (Seattle, Los Angeles, Chicago, and New York City; N = 736) and the central Midwest region of the United States (N = 1240) respectively during March–August 2020. The analysis revealed that: (1) the cognitive and affective dimensions of perceived COVID-19 risk and preventive behavior all changed over time; (2) there were both within- and across-time correlations between COVID-19 risk perception indicators and preventive actions; and (3) preventive actions showed varied feedback effects on individual aspects of perceived COVID-19 risk over time. Findings from this research support and expand major conceptual approaches to changing relationships between risk perception and behavior, particularly the risk reappraisal hypothesis. The study also has useful implications for health risk management and future research directions.
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Affiliation(s)
- Hua Qin
- University of Missouri-Columbia, Division of Applied Social Sciences, Columbia, MO, USA.
| | - Christine Sanders
- University of Missouri-Columbia, Division of Applied Social Sciences, Columbia, MO, USA
| | - Yanu Prasetyo
- University of Missouri-Columbia, Division of Applied Social Sciences, Columbia, MO, USA
| | - Muh Syukron
- University of Missouri-Columbia, Division of Applied Social Sciences, Columbia, MO, USA
| | - Elizabeth Prentice
- Columbia/Boone County Department of Public Health and Human Services, Columbia, MO, USA
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Ullman AJ, Bernstein SJ, Brown E, Aiyagari R, Doellman D, Faustino EVS, Gore B, Jacobs JP, Jaffray J, Kleidon T, Mahajan PV, McBride CA, Morton K, Pitts S, Prentice E, Rivard DC, Shaughnessy E, Stranz M, Wolf J, Cooper DS, Cooke M, Rickard CM, Chopra V. The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC. Pediatrics 2020; 145:S269-S284. [PMID: 32482739 DOI: 10.1542/peds.2019-3474i] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. RESULTS The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. CONCLUSIONS In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of General Medicine and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ranjit Aiyagari
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - Darcy Doellman
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - E Vincent S Faustino
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Section of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Beth Gore
- Association for Vascular Access, Herriman, Utah
| | | | - Julie Jaffray
- Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Prashant V Mahajan
- Department of Emergency Medicine and Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Craig A McBride
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kayce Morton
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Stephanie Pitts
- St Joseph's Children's Hospital, Tampa, Florida.,B. Braun Medical, Bethlehem, Pennsylvania
| | - Elizabeth Prentice
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Victoria, Australia
| | - Douglas C Rivard
- Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Erin Shaughnessy
- College of Medicine, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Marc Stranz
- Stranz Crossley Inc, Philadelphia, Pennsylvania
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David S Cooper
- Department of Pediatrics, College of Medicine, University of Cincinnati and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Division of Hospital Medicine, Department of Internal Medicine
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Perovic O, Ismail H, Van Schalkwyk E, Lowman W, Prentice E, Senekal M, Govind CN. Antimicrobial resistance surveillance in the South African private sector report for 2016. S Afr J Infect Dis 2018. [DOI: 10.4102/sajid.v33i4.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Aim: The relevance of surveillance for antimicrobial resistance is increasingly recognised in the light of a global action plan to combat resistance. This report presents antimicrobial susceptibility testing on ESKAPE pathogens from private sector laboratories in South Africa for 2016.Methods: Antimicrobial susceptibility testing (AST) performed on ESKAPE organisms (Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae and Escherichia coli) isolated from blood cultures at four private pathology laboratories in 2016 were analysed. Analysis and reporting of data were done via a uniform platform created by the NICD for national AST data.Results: AST were reported on 9 029 ESKAPE organisms including 58% Enterobacteriaceae, 28% Gram-positive bacteria and 14% Gram-negative bacteria and drug-bug combination was performed following the Global Antimicrobial Surveillance System (GLASS) guidelines by the World Health Organization.Conclusions: The most important resistance to address is a high level of ESBL in Enterobacteriaceae, which necessitates the use of carbapenems for treatment. Resistance to carbapenems is recorded in this report but not confirmation of genes by genotypic methods. During this period, no increase in vancomycin-resistant Enterococci was observed.
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Perovic O, Ismail H, Van Schalkwyk E, Lowman W, Prentice E, Senekal M, Govind CN. Antimicrobial resistance surveillance in the South African private sector report for 2016. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1482646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Olga Perovic
- Centre for Healthcare-Associated Infections (HAIs), Antimicrobial Resistance (AMR) and Mycoses, National Institute for Communicable Diseases, a division in the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Husna Ismail
- Centre for Healthcare-Associated Infections (HAIs), Antimicrobial Resistance (AMR) and Mycoses, National Institute for Communicable Diseases, a division in the National Health Laboratory Service, Johannesburg, South Africa
| | - Erika Van Schalkwyk
- Centre for Healthcare-Associated Infections (HAIs), Antimicrobial Resistance (AMR) and Mycoses, National Institute for Communicable Diseases, a division in the National Health Laboratory Service, Johannesburg, South Africa
| | - Warren Lowman
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Vermaak and Partners/Pathcare Pathologists, Pretoria, South Africa
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Elizabeth Prentice
- Ampath Microbiology National Reference Laboratory, Centurion, South Africa
| | - Marthinus Senekal
- Pathcare Pathology Group Reference Laboratory, Goodwood, Western Cape, South Africa
| | - Chetna N Govind
- Department of Clinical Microbiology, Lancet Laboratories, Durban, South Africa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Nguku P, Mosha F, Prentice E, Galgalo T, Olayinka A, Nsubuga P. Field Epidemiology and Laboratory Training Programs have been in Africa for 10 years, what is their effect on laboratory-based surveillance? Reflections from a panel at the African Society of Laboratory Medicine December 2014 Cape Town meeting. Pan Afr Med J 2015; 20:451. [PMID: 26309482 PMCID: PMC4537889 DOI: 10.11604/pamj.2015.20.451.6787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Program, Nigeria
| | | | | | - Tura Galgalo
- Kenya Field Epidemiology and Laboratory Training Program, Kenya
| | - Adebola Olayinka
- Department of Medical Microbiology, Ahmadu Bello University Zaria, Nigeria
| | - Peter Nsubuga
- Medical Epidemiologist, Global Public Health Solutions, Atlanta, Georgia, USA
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13
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Chauhan M, Prentice E, Zidan M, Walters HL, Delius RE, Mastropietro CW. Necessity of temporary epicardial pacing wires after surgery for congenital heart disease. Ann Thorac Surg 2014; 97:2148-53. [PMID: 24681035 DOI: 10.1016/j.athoracsur.2014.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/21/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Temporary epicardial pacing wires are commonly placed in patients undergoing surgery for congenital heart disease. Though often helpful, these wires are not without risk. We aimed to identify characteristics that would obviate placement of temporary epicardial pacing wires in this patient population. METHODS A prospective observational study was performed on patients admitted to the pediatric intensive care unit after surgery for congenital heart disease between October 2011 and October 2012. Logistic regression analysis was performed to identify independent predictors of patients in whom wires were not helpful postoperatively. RESULTS Wires were placed in 213 of 249 patients. Wires were helpful in 50 patients; 23 for diagnostic purposes only, 17 for therapeutic purposes only, and 10 for both. On logistic regression analysis, absence of intraoperative arrhythmias (p < 0.01), lower arteriovenous O2 difference (p < 0.01), and shorter duration of cardiopulmonary bypass (p = 0.050) were significant predictors of patients in whom wires were not helpful postoperatively. Further, the predicted probability based on logistic regression model using these 3 variables correctly identified 93% of patients who did not need pacing wires. Four complications (1.9%) related to wires occurred, including 1 episode of life-threatening bleeding that was found, during emergent exploration, to be due to atrial perforation at the wire insertion site. CONCLUSIONS Temporary epicardial pacing wires are not necessary in many patients recovering from surgery for congenital heart disease. A conservative approach to their use may therefore be warranted.
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Affiliation(s)
- Monika Chauhan
- Department of Pediatrics, Division of Critical Care, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
| | - Elizabeth Prentice
- Department of Pediatrics, Division of Critical Care, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Marwan Zidan
- Department of Pediatrics, Children's Research Center of Michigan, Detroit, Michigan
| | - Henry L Walters
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Ralph E Delius
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
The UK National Guidelines on HIV testing (2008) recommend routinely offering an HIV test to patients in certain clinical settings. We wished to investigate the acceptability of implementing these guidelines in a population with a low HIV prevalence. Patients accessing primary and secondary care were asked to circle one of the five responses to a series of statements regarding HIV testing. Of the 616 respondents, 579 (94%) stated they would be willing to be tested if presenting with a condition known to be associated with HIV. Four hundred and forty out of 616 (71%) stated they would be willing to be tested as part of their routine care, while 445/616 (72%) stated they would be willing to have the result in their main medical notes. Although the patients' responses were largely receptive to increased testing, we encountered notable negative attitudes to the project from professional and administrative staff. Resistance to increased HIV testing may be related to health-care workers rather than patients.
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Affiliation(s)
- R Drayton
- Department of Integrated Sexual Health, Cardiff Royal Infirmary, Cardiff, UK.
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15
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von Gottberg A, du Plessis M, Cohen C, Prentice E, Schrag S, de Gouveia L, Coulson G, de Jong G, Klugman K. Emergence of Endemic Serogroup W135 Meningococcal Disease Associated with a High Mortality Rate in South Africa. Clin Infect Dis 2008; 46:377-86. [DOI: 10.1086/525260] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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16
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Cohen C, Karstaedt A, Frean J, Thomas J, Govender N, Prentice E, Dini L, Galpin J, Crewe-Brown H. Increased prevalence of severe malaria in HIV-infected adults in South Africa. Clin Infect Dis 2005; 41:1631-7. [PMID: 16267737 DOI: 10.1086/498023] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 07/11/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Conflicting reports exist regarding the impact of human immunodeficiency virus (HIV) infection on the risk of severe malaria. We aimed to assess the effect of HIV infection status, advancing immunosuppression, and antimalarial immunity on the severity of malaria. METHODS A prospective cohort study was conducted. Consecutive hospitalized adult patients with falciparum malaria were tested for HIV antibodies and to determine CD4+ T cell count. Immunity to malaria was assessed by obtaining a history of childhood residence in an area where malaria is endemic. Patients were assessed for features of severe malaria. RESULTS Three hundred thirty-six patients were enrolled in the study, of whom 32 (10%) had severe malaria. The prevalence of HIV infection was 33%, and 111 patients (33%) were nonimmune to malaria. HIV-infected patients complained more frequently about respiratory and abdominal symptoms and less frequently about rigors and headache. Risk factors for severe malaria determined by multivariate analysis included being nonimmune to malaria, having a positive HIV serostatus, having an elevated parasite count, and having an increased white blood cell count. Risk of severe malaria was increased in HIV-infected patients with a CD4+ T cell count of < 200 x 10(6) cells/L (P < or = .001). Nonimmune HIV-infected patients were significantly more likely to have severe malaria (13 [36%] of 36 patients) than were nonimmune non-HIV-infected patients (9 [12%] of 75 patients; odds ratio, 4.15 [95% confidence interval, 1.57-10.97]; P = .003). HIV serostatus did not affect risk of severe malaria in the group from an area with endemicity (5 [7%] of 74 HIV-infected patients had severe malaria, and 5 [3%] of 151 non-HIV-infected patients had malaria; P = .248). CONCLUSIONS HIV-infected nonimmune adults are at increased risk of severe malaria. This risk is associated with a low CD4+ T cell count. This interaction is of great public health importance.
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Affiliation(s)
- Cheryl Cohen
- Division of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
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17
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Abstract
The ability to obtain entire volume data on infected cells will allow us to define much more accurately the interactions of viral proteins with host cell structures such as ER, Golgi, and cytoskeletal elements. In addition, the demonstrated ability to express viral proteins fused to fluorescent markers in in live cells will allow us to follow specific proteins or complexes during the course of infection and to determine if exogenously expressed proteins are able to target to sites of active viral replication. This in turn will allow new approaches to the study of viral and cellular protein-protein interactions, as methods to study the biology and pathogenesis of MHV infection at a cellular level. Finally, the approaches described here will allow us to define protein complementation of defective viruses at a cellular level, rather than being dependent on population measurements of RNA, protein, or progeny virus. By combining these approaches with available biochemical and molecular biological approaches and the emerging reverse genetic and recombinant genetic approaches, rapid progress in understanding the details of coronavirus-cell interactions should be possible.
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Affiliation(s)
- E Prentice
- Departments of Microbiology & Immunology and Pediatrics, Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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18
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Bost AG, Prentice E, Denison MR. Mouse hepatitis virus replicase protein complexes are translocated to sites of M protein accumulation in the ERGIC at late times of infection. Virology 2001; 285:21-9. [PMID: 11414802 PMCID: PMC7130751 DOI: 10.1006/viro.2001.0932] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The coronavirus mouse hepatitis virus (MHV) directs the synthesis of viral RNA on discrete membranous complexes that are distributed throughout the cell cytoplasm. These putative replication complexes are composed of intimately associated but biochemically distinct membrane populations, each of which contains proteins processed from the replicase (gene 1) polyprotein. Specifically, one membrane population contains the gene 1 proteins p65 and p1a-22, while the other contains the gene 1 proteins p28 and helicase, as well as the structural nucleocapsid (N) protein and newly synthesized viral RNA. In this study, immunofluorescence confocal microscopy was used to define the relationship of the membrane populations comprising the putative replication complexes at different times of infection in MHV-A59-infected delayed brain tumor cells. At 5.5 h postinfection (p.i.) the membranes containing N and helicase colocalized with the membranes containing p1a-22/p65 at foci distinct from sites of M accumulation. By 8 to 12 h p.i., however, the membranes containing helicase and N had a predominantly perinuclear distribution and colocalized with M. In contrast, the p1a-22/p65-containing membranes retained a peripheral, punctate distribution at all times of infection and did not colocalize with M. By late times of infection, helicase, N, and M each also colocalized with ERGIC p53, a specific marker for the endoplasmic reticulum-Golgi-intermediate compartment. These data demonstrated that the putative replication complexes separated into component membranes that relocalized during the course of infection. These results suggest that the membrane populations within the MHV replication complex serve distinct functions both in RNA synthesis and in delivery of replication products to sites of virus assembly.
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Affiliation(s)
- A G Bost
- Department of Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee 37232, USA
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19
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Gordon B, Prentice E, Anderson J. Conflict between research design and minimization of risks in pediatric research. IRB 2000; 22:1-6. [PMID: 11697384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- B Gordon
- University of Nebraska Medical Center, Omaha, USA
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Prentice E, Tsao W. Denial of service: should I worry? CDS Rev 2000; 93:26. [PMID: 11276777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- E Prentice
- Chicago Dental Society, 401 N. Michigan Ave., Suite 300, Chicago, IL 60611-4205, USA
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Prentice E, Tsao W. Today's technology at your fingertips. CDS Rev 2000; 93:20. [PMID: 11276586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Prentice E, Tsao W. Is your browser Y2K ready? CDS Rev 2000; 93:70-1. [PMID: 11276790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Denison MR, Spaan WJ, van der Meer Y, Gibson CA, Sims AC, Prentice E, Lu XT. The putative helicase of the coronavirus mouse hepatitis virus is processed from the replicase gene polyprotein and localizes in complexes that are active in viral RNA synthesis. J Virol 1999; 73:6862-71. [PMID: 10400784 PMCID: PMC112771 DOI: 10.1128/jvi.73.8.6862-6871.1999] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/1999] [Accepted: 04/20/1999] [Indexed: 11/20/2022] Open
Abstract
The coronavirus mouse hepatitis virus (MHV) translates its replicase gene (gene 1) into two co-amino-terminal polyproteins, polyprotein 1a and polyprotein 1ab. The gene 1 polyproteins are processed by viral proteinases to yield at least 15 mature products, including a putative RNA helicase from polyprotein 1ab that is presumed to be involved in viral RNA synthesis. Antibodies directed against polypeptides encoded by open reading frame 1b were used to characterize the expression and processing of the MHV helicase and to define the relationship of helicase to the viral nucleocapsid protein (N) and to sites of viral RNA synthesis in MHV-infected cells. The antihelicase antibodies detected a 67-kDa protein in MHV-infected cells that was translated and processed throughout the virus life cycle. Processing of the 67-kDa helicase from polyprotein 1ab was abolished by E64d, a known inhibitor of the MHV 3C-like proteinase. When infected cells were probed for helicase by immunofluorescence laser confocal microscopy, the protein was detected in patterns that varied from punctate perinuclear complexes to large structures that occupied much of the cell cytoplasm. Dual-labeling studies of infected cells for helicase and bromo-UTP-labeled RNA demonstrated that the vast majority of helicase-containing complexes were active in viral RNA synthesis. Dual-labeling studies for helicase and the MHV N protein showed that the two proteins almost completely colocalized, indicating that N was associated with the helicase-containing complexes. This study demonstrates that the putative RNA helicase is closely associated with MHV RNA synthesis and suggests that complexes containing helicase, N, and new viral RNA are the viral replication complexes.
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Affiliation(s)
- M R Denison
- Department of Pediatrics, Department of Microbiology and Immunology, and The Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University, Nashville, Tennessee, USA.
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Prentice E, Jameton A, Antonson D, Zucker I. Prior ethical review of animal versus human subjects research. Invest Radiol 1988; 23:695-7. [PMID: 3182217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
During the last decade the animal rights movement has garnered widespread support that now threatens the existence of animal research. Current public sentiment demands researcher accountability and documentation of the potential value of animal research that was largely assumed in the past. One way this can be accomplished is through prior review and approval of animal research protocols by the federally mandated institutional animal care and use committee (IACUC). IACUCs, however, face more difficulty in arriving at consistent and ethically correct decisions than human subject review committees or institutional review boards (IRBs). This article explains why and draws a comparison between animal and human subjects review.
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Affiliation(s)
- E Prentice
- University of Nebraska Medical Center, Omaha 68105
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Abstract
The least cost allocation of sure-fit machine tolerances for Speckhart’s exponential cost model is solved in closed form, without numerical iteration, as a geometric program with zero degrees of difficulty. The results show the importance of an exponential cost sensitivity parameter defined as the “characteristic tolerance”. The theoretical minimum cost can be determined without specifying the corresponding tolerances. Specific minimum cost tolerances can be computed later in closed form if potential cost savings are significant.
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Affiliation(s)
- D. Wilde
- Design Division, Mechanical Engineering Department, School of Engineering, Stanford University, Stanford, Calif
| | - E. Prentice
- Design Division, Mechanical Engineering Department, School of Engineering, Stanford University, Stanford, Calif
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Holmes AM, Young J, Marrott PK, Prentice E. Pseudohyperaldosteronism induced by habitual ingestion of liquorice. Postgrad Med J 1970; 46:625-9. [PMID: 5488223 PMCID: PMC2466780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Brown JJ, Gleadle RI, Lawson DH, Lever AF, Linton AL, Macadam RF, Prentice E, Tree M, Robertson JI. Renin and acute renal failure: studies in man. Br Med J 1970; 1:253-8. [PMID: 4313590 PMCID: PMC1699373 DOI: 10.1136/bmj.1.5691.253] [Citation(s) in RCA: 93] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Plasma renin concentration was increased, usually appreciably, in 22 out of 25 patients with acute renal failure, the average value being 226 units/litre (mean for normal subjects 8.2 units/1.). The highest renin values were found in the first 10 days of the disease; lower and sometimes normal values were found subsequently. Unequivocal acute tubular necrosis was present in only two of the eight cases examined post mortem.These findings are compatible with Goormaghtigh's proposal that an excess of renin and angiotensin may act within the kidney to produce acute renal failure.
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