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Carugati M, Arif S, Yarrington ME, King LY, Harris M, Evans K, Barbas AS, Sudan DL, Perfect JR, Miller RA, Alexander BD. Limitations of antifungal prophylaxis in preventing invasive Candida surgical site infections after liver transplant surgery. Antimicrob Agents Chemother 2024; 68:e0127923. [PMID: 38299818 PMCID: PMC10916370 DOI: 10.1128/aac.01279-23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024] Open
Abstract
Invasive primary Candida surgical site infections (IP-SSIs) are a common complication of liver transplantation, and targeted antifungal prophylaxis is an efficient strategy to limit their occurrence. We performed a retrospective single-center cohort study among adult single liver transplant recipients at Duke University Hospital in the period between 1 January 2015 and 31 December 2020. The study aimed to determine the rate of Candida IP-SSI according to the peri-transplant antifungal prophylaxis received. Of 470 adult single liver transplant recipients, 53 (11.3%) received micafungin prophylaxis, 100 (21.3%) received fluconazole prophylaxis, and 317 (67.4%) did not receive systemic antifungal prophylaxis in the peri-transplant period. Ten Candida IP-SSIs occurred among 5 of 53 (9.4%) micafungin recipients, 1 of 100 (1.0%) fluconazole recipients, and 4 of 317 (1.3%) recipients who did not receive antifungal prophylaxis. Our study highlights the limitations of antifungal prophylaxis in preventing invasive Candida IP-SSI after liver transplant surgery. We hypothesize that pathogen, host, and pharmacokinetic-related factors contributed to the occurrence of Candida IP-SSI despite antifungal prophylaxis. Our study reinforces the need for a risk-based, multi-pronged approach to fungal prevention, including targeted antifungal administration in patients with risks for invasive candidiasis and close monitoring, especially among patients with surgically complex procedures, with timely control of surgical leaks.
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Affiliation(s)
- M. Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - S. Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - M. E. Yarrington
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - L. Y. King
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - M. Harris
- Department of Pharmacy, Duke University, Durham, North Carolina, USA
| | - K. Evans
- Department of Pharmacy, Duke University, Durham, North Carolina, USA
| | - A. S. Barbas
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - D. L. Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - J. R. Perfect
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - R. A. Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - B. D. Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
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Villa S, Carugati M, Rubach MP, Cleaveland S, Mpagama SG, Khan SS, Mfinanga S, Mmbaga BT, Crump JA, Raviglione MC. 'One Health´ approach to end zoonotic TB. Int J Tuberc Lung Dis 2023; 27:101-105. [PMID: 36853111 DOI: 10.5588/ijtld.22.0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Mycobacterium bovis has a wide host range causing TB in animals, both in wildlife and cattle (bovine TB bTB), and in humans (zoonotic TB zTB). The real burden of bovine and zoonotic TB (b/zTB) remains unknown due to diagnostic challenges. Although progress has been made to reduce the burden of TB, b/zTB has been neglected in low- and middle-income countries (LMICs) with little improvement in prevention, diagnosis or treatment. Using Tanzania as a case study, because of its high TB burden, large wildlife diversity and wide reliance on livestock, we developed an approach to comprehensively estimate the burden and implement multidisciplinary actions against b/zTB. We performed a review of the literature on b/zTB, but there is a lack of available data on the b/zTB burden in Tanzania and, notably, on epidemiological indicators other than incidence. We propose a five-action programme to address b/zTB in Tanzania, and we believe our proposed approach could benefit other LMICs as it operates by implementing and strengthening surveillance and health delivery. The resulting knowledge and system organisation could further prevent and mitigate the effects of such conditions on human and animal health, livestock production, population livelihood and the economy.
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Affiliation(s)
- S Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - M Carugati
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
| | - M P Rubach
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA, Duke Global Health Institute, Duke University, Durham, NC, USA, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - S Cleaveland
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - S G Mpagama
- Kilimanjaro Christian Medical University College, Moshi, Tanzania, Kibong´oto Infectious Diseases Hospital, Moshi, Tanzania
| | - S S Khan
- Humanitas University, Milan, Italy
| | - S Mfinanga
- National Institute for Medical Research - Muhimbili Centre, Dar es Salaam, Tanzania, Liverpool School Tropical Medicine, Liverpool, UK
| | - B T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - J A Crump
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA, Duke Global Health Institute, Duke University, Durham, NC, USA, Kilimanjaro Christian Medical University College, Moshi, Tanzania, Centre for International Health, University of Otago, Dunedin, New Zealand
| | - M C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
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Zhuang Y, Mah M, Chen Y, Crump J, Carugati M, Bonnewell J, Maro V, Smith G, Linster M, Rubach M. Respiratory pathogens in a febrile cohort from Tanzania and associated risks for severe disease outcome. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Carugati M, Piazza A, Peri AM, Cariani L, Brilli M, Girelli D, Di Carlo D, Gramegna A, Pappalettera M, Comandatore F, Grasselli G, Cantù AP, Arghittu M, Gori A, Bandi C, Blasi F, Bandera A. Fatal respiratory infection due to ST308 VIM-1-producing Pseudomonas aeruginosa in a lung transplant recipient: case report and review of the literature. BMC Infect Dis 2020; 20:635. [PMID: 32847524 PMCID: PMC7450578 DOI: 10.1186/s12879-020-05338-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/11/2020] [Indexed: 01/16/2023] Open
Abstract
Background Data regarding the prevalence of metallo-β-lactamases (MBLs) among Pseudomonas aeruginosa isolates in cystic fibrosis patients are scarce. Furthermore, there is limited knowledge on the effect of MBL production on patient outcomes. Here we describe a fatal respiratory infection due to P. aeruginosa producing VIM-type MBLs in a lung transplant recipient and the results of the subsequent epidemiological investigation. Case presentation P. aeruginosa isolates collected in the index patient and among patients temporally or spatially linked with the index patient were analyzed in terms of antibiotic susceptibility profile and MBL production. Whole-genome sequencing and phylogenetic reconstruction were also performed for all P. aeruginosa isolates producing VIM-type MBLs. A VIM-producing P. aeruginosa strain was identified in a lung biopsy of a lung transplant recipient with cystic fibrosis. The strain was VIM-1-producer and belonged to the ST308. Despite aggressive treatment, the transplant patient succumbed to the pulmonary infection due to the ST308 strain. A VIM-producing P. aeruginosa strain was also collected from the respiratory samples of a different cystic fibrosis patient attending the same cystic fibrosis center. This isolate harbored the blaVIM-2 gene and belonged to the clone ST175. This patient did not experience an adverse outcome. Conclusions This is the first description of a fatal infection due to P. aeruginosa producing VIM-type MBLs in a lung transplant recipient. The circulation of P. aeruginosa isolates harboring MBLs pose a substantial risk to the cystic fibrosis population due to the limited therapeutic options available and their spreading potential.
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Affiliation(s)
- M Carugati
- Division of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. .,Division of Infectious Diseases and International Health, Duke University, 181 Hanes House, 300 Trent Drive, Durham, 27710, USA.
| | - A Piazza
- Romeo and Enrica Invernizzi Pediatric Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - A M Peri
- Division of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - L Cariani
- Cystic Fibrosis Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - M Brilli
- Romeo and Enrica Invernizzi Pediatric CRC, Department of Biosciences, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - D Girelli
- Cystic Fibrosis Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - D Di Carlo
- Romeo and Enrica Invernizzi Pediatric Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - A Gramegna
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - M Pappalettera
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - F Comandatore
- Romeo and Enrica Invernizzi Pediatric Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - G Grasselli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - A P Cantù
- Direzione Medica di Presidio, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - M Arghittu
- Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - A Gori
- Division of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - C Bandi
- Romeo and Enrica Invernizzi Pediatric CRC, Department of Biosciences, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - F Blasi
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - A Bandera
- Division of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
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Pericàs JM, Messina JA, Garcia-de-la-Mària C, Park L, Sharma-Kuinkel BK, Marco F, Wray D, Kanafani ZA, Carugati M, Durante-Mangoni E, Tattevin P, Chu VH, Moreno A, Fowler VG, Miró JM. Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis. Clin Microbiol Infect 2017; 23:544-549. [PMID: 28159672 DOI: 10.1016/j.cmi.2017.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. METHODS All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. RESULTS Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively). CONCLUSIONS In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.
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Affiliation(s)
- J M Pericàs
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J A Messina
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - C Garcia-de-la-Mària
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Park
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - B K Sharma-Kuinkel
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - F Marco
- Department of Microbiology, Institute for Global Health, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - D Wray
- Infectious Disease Division, Medical University of South Carolina, Charleston, SC, USA
| | - Z A Kanafani
- Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - M Carugati
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - E Durante-Mangoni
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Campania 'Luigi Vanvitelli', Italy; Unit of Infectious and Transplant Medicine, 'V. Monaldi' Hospital, AORN dei Colli, Naples, Italy
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - V H Chu
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - V G Fowler
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Carugati M, Franzetti F, Wiemken T, Kelley R, Peyrani P, Blasi F, Ramirez J, Aliberti S. Corrigendum to “De-escalation therapy among bacteraemic patients with community-acquired pneumonia” [Clin Microbiol Infect 21 (2015) 936.e11–936.e18]. Clin Microbiol Infect 2015. [DOI: 10.1016/j.cmi.2015.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carugati M, Franzetti F, Wiemken T, Kelley RR, Kelly R, Peyrani P, Blasi F, Ramirez J, Aliberti S. De-escalation therapy among bacteraemic patients with community-acquired pneumonia. Clin Microbiol Infect 2015; 21:936.e11-8. [PMID: 26115864 DOI: 10.1016/j.cmi.2015.06.015] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/05/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
There is no evidence supporting the use of de-escalation therapy (DET) among patients with community-acquired pneumonia (CAP). We assessed the outcomes associated with DET among bacteraemic CAP patients. We performed a secondary analysis of the Community-Acquired Pneumonia Organization database, which contains data on 660 bacteraemic patients hospitalized because of CAP in 35 countries (2001-2013). Exclusion criteria were death within 72 h from admission and an inappropriate empirical antibiotic regimen. DET was defined as changing an appropriate empirical broad-spectrum regimen to a narrower-spectrum regimen according to culture results within 7 days from hospital admission. Two study groups were identified: patients whose antibiotic therapy was de-escalated (the DET group), and patients whose antibiotic therapy was not de-escalated (the N-DET group). The primary study outcome was 30-day mortality. Two hundred and sixty-one bacteraemic CAP patients were included. Gram-positive bacteria were responsible for 88.1% of the cases (Streptococcus pneumoniae, 75.9%). Gram-negative bacteria were responsible for for 7.3% of the cases. DET was performed in 165 patients (63.2%). The N-DET group was characterized by a more severe presentation at admission. After adjustment for confounders, DET was not associated with an increased risk of 30-day mortality. DET seems to be safe among bacteraemic patients with CAP. Randomized clinical trials are warranted to further explore these findings.
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Affiliation(s)
- M Carugati
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.
| | - F Franzetti
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - T Wiemken
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | | | - R Kelly
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - P Peyrani
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - F Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - J Ramirez
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - S Aliberti
- Department of Health Sciences, University of Milano - Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy
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Carugati M, Schiroli C, Zanini F, Vanoni N, Galli M, Adorni F, Franzetti F. A new predictive model for an improved respiratory isolation strategy in HIV-infected patients with PTB. Int J Tuberc Lung Dis 2014; 18:831-6. [PMID: 24902560 DOI: 10.5588/ijtld.13.0588] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Luigi Sacco Hospital, Milan, Italy, 1 January 2000-31 December 2010. OBJECTIVES To develop a predictive score for identifying human immunodeficiency virus (HIV) infected patients with pulmonary tuberculosis (PTB). DESIGN Retrospective study based on the medical charts of HIV-infected patients admitted consecutively on presumption of PTB. Patients with culture-positive TB were included in the TB group. Culture-negative subjects formed the non-TB group. Risk factors for PTB were identified and a predictive model was developed. The diagnostic test accuracy of the derived score and that of previously developed scores were analysed. RESULTS A total of 65 patients were included in the TB group and 505 subjects in the non-TB group. An eight-variable model (age, origin, alcohol use, respiratory rate, weight loss, haemoglobin, white blood cell count, typical chest X-ray) was derived. When compared with the different scores, this model showed the greatest area under the receiver operating characteristic curve (0.880). This score was the only one to present a negative likelihood ratio of <0.2, which is the threshold for giving strong diagnostic evidence against TB. CONCLUSIONS This model may be useful in predicting PTB in HIV patients in low-endemic countries. A validation study is necessary.
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Affiliation(s)
- M Carugati
- Department of Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milan, Italy
| | - C Schiroli
- Department of Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milan, Italy
| | - F Zanini
- Department of Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milan, Italy
| | - N Vanoni
- Department of Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milan, Italy
| | - M Galli
- Department of Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milan, Italy
| | - F Adorni
- Institute of Biomedical Technologies, National Research Council Milano, Milan, Italy
| | - F Franzetti
- Department of Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, University of Milano, Milan, Italy
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