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Cortés-Penfield NW, Musher DM. Give Penicillin or Ceftriaxone: Neurosyphilis Does Not Deal in Absolutes. Clin Infect Dis 2024; 78:1386-1387. [PMID: 37847217 DOI: 10.1093/cid/ciad629] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Affiliation(s)
| | - Daniel M Musher
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA
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Lewis MA, Cortés-Penfield NW, Ettayebi K, Patil K, Kaur G, Neill FH, Atmar RL, Ramani S, Estes MK. Standardization of an antiviral pipeline for human norovirus in human intestinal enteroids demonstrates nitazoxanide has no to weak antiviral activity. Antimicrob Agents Chemother 2023; 67:e0063623. [PMID: 37787556 PMCID: PMC10583671 DOI: 10.1128/aac.00636-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/02/2023] [Indexed: 10/04/2023] Open
Abstract
Human noroviruses (HuNoVs) are the leading cause of acute gastroenteritis. In immunocompetent hosts, symptoms usually resolve within 3 days; however, in immunocompromised persons, HuNoV infection can become persistent, debilitating, and sometimes life-threatening. There are no licensed therapeutics for HuNoV due to a near half-century delay in its cultivation. Treatment for chronic HuNoV infection in immunosuppressed patients anecdotally includes nitazoxanide, a broad-spectrum antimicrobial licensed for treatment of parasite-induced gastroenteritis. Despite its off-label use for chronic HuNoV infection, nitazoxanide has not been clearly demonstrated to be an effective treatment. In this study, we standardized a pipeline for antiviral testing using multiple human small intestinal enteroid lines representing different intestinal segments and evaluated whether nitazoxanide inhibits replication of five HuNoV strains in vitro. Nitazoxanide did not exhibit high selective antiviral activity against any HuNoV strain tested, indicating it is not an effective antiviral for HuNoV infection. Human intestinal enteroids are further demonstrated as a model to serve as a preclinical platform to test antivirals against HuNoVs to treat gastrointestinal disease. Abstr.
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Affiliation(s)
- Miranda A. Lewis
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Nicolás W. Cortés-Penfield
- Department of Medicine, Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Khalil Ettayebi
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Ketki Patil
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Gurpreet Kaur
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Frederick H. Neill
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert L. Atmar
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sasirekha Ramani
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mary K. Estes
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Lewis MA, Cortés-Penfield NW, Ettayebi K, Patil K, Kaur G, Neill FH, Atmar RL, Ramani S, Estes MK. A Standardized Antiviral Pipeline for Human Norovirus in Human Intestinal Enteroids Demonstrates No Antiviral Activity of Nitazoxanide. bioRxiv 2023:2023.05.23.542011. [PMID: 37293103 PMCID: PMC10245936 DOI: 10.1101/2023.05.23.542011] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Human noroviruses (HuNoVs) are the leading cause of acute gastroenteritis. In immunocompetent hosts, symptoms usually resolve within three days; however, in immunocompromised persons, HuNoV infection can become persistent, debilitating, and sometimes life-threatening. There are no licensed therapeutics for HuNoV due to a near half-century delay in its cultivation. Treatment for chronic HuNoV infection in immunosuppressed patients anecdotally includes nitazoxanide, a broad-spectrum antimicrobial licensed for treatment of parasite-induced gastroenteritis. Despite its off-label use for chronic HuNoV infection, nitazoxanide has not been clearly demonstrated to be an effective treatment. In this study, we established a standardized pipeline for antiviral testing using multiple human small intestinal enteroid (HIE) lines representing different intestinal segments and evaluated whether nitazoxanide inhibits replication of 5 HuNoV strains in vitro . Nitazoxanide did not exhibit high selective antiviral activity against any HuNoV strains tested, indicating it is not an effective antiviral for norovirus infection. HIEs are further demonstrated as a model to serve as a pre-clinical platform to test antivirals against human noroviruses to treat gastrointestinal disease.
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Affiliation(s)
- Miranda A. Lewis
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
| | | | - Khalil Ettayebi
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
| | - Ketki Patil
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
| | - Gurpreet Kaur
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
| | - Frederick H. Neill
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
| | - Robert L. Atmar
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030
| | - Sasirekha Ramani
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
| | - Mary K. Estes
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX 77030
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030
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Cortés-Penfield NW, Hewlett AL, Kalil AC. Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone? Open Forum Infect Dis 2022; 9:ofac582. [PMID: 36504699 PMCID: PMC9728514 DOI: 10.1093/ofid/ofac582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
Abstract
Whether rifampin benefits retained staphylococcal prosthetic joint infection is unsettled. In a meta-analysis of 8 studies, we found greater clinical cure with fluoroquinolone-rifampin vs all other regimens (odds ratio [OR], 2.68; 95% CI, 1.43-5.02), but no greater cure with other rifampin combinations vs regimens without rifampin (OR, 1.22; 95% CI, 0.79-1.88).
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Affiliation(s)
| | - Angela L Hewlett
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andre C Kalil
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Ryder JH, Tong SYC, Gallagher JC, McDonald EG, Thevarajan I, Lee TC, Cortés-Penfield NW. Deconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis. Open Forum Infect Dis 2022; 9:ofac583. [PMID: 36408468 PMCID: PMC9669455 DOI: 10.1093/ofid/ofac583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Based primarily on in vitro and animal models, with little data directly addressing patient outcomes, current guidelines recommend treating staphylococcal prosthetic valve endocarditis (PVE) with antibiotic combinations including gentamicin and rifampin. Here, we synthesize the clinical data on adjunctive rifampin and gentamicin in staphylococcal PVE. METHODS We conducted a systematic review and meta-analysis of PubMed- and Cochrane-indexed studies reporting outcomes of staphylococcal PVE treated with adjunctive rifampin, gentamicin, both agents, or neither (ie, glycopeptide or β-lactam monotherapy). We recorded outcomes including mortality, relapsed infection, length of stay, nephrotoxicity, hepatotoxicity, and important drug-drug interactions (DDIs). RESULTS Four relevant studies were identified. Two studies (n = 117) suggested that adding gentamicin to rifampin-containing regimens did not reduce clinical failure (odds ratio [OR], 0.98 [95% confidence interval {CI}, .39-2.46]), and 2 studies (n = 201) suggested that adding rifampin to gentamicin-containing regimens did not reduce clinical failure (OR, 1.29 [95% CI, .71-2.33]). Neither gentamicin nor rifampin was associated with reduced infection relapse; 1 study found that rifampin treatment was associated with longer hospitalizations (mean, 31.3 vs 42.3 days; P < .001). Comparative safety outcomes were rarely reported, but 1 study found rifampin to be associated with hepatoxicity, nephrotoxicity, and DDIs, leading to treatment discontinuation in 31% of patients. CONCLUSIONS The existing clinical data do not suggest a benefit of either adjunctive gentamicin or rifampin in staphylococcal PVE. Given that other studies also suggest these agents add nephrotoxicity, hepatoxicity, and risk of DDIs without benefit in staphylococcal endovascular infections, we suggest that recommendations for gentamicin and rifampin in PVE be downgraded and primarily be used within the context of clinical trials.
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Affiliation(s)
- Jonathan H Ryder
- Correspondence: Jonathan H. Ryder, MD, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198 ()
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania, USA
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Irani Thevarajan
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Thottacherry E, Cortés-Penfield NW. Evidence of clinical impact supports a new petition for Medicare coverage of 18F-FDG-PET/CT in the evaluation of Staphylococcus aureus bacteremia: a focused literature review and call to action. Clin Infect Dis 2022; 75:1457-1461. [PMID: 35535794 DOI: 10.1093/cid/ciac363] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus bacteremia (SAB) causes considerable morbidity and mortality and requires comprehensive assessment for metastatic infection. The roles of routine imaging beyond echocardiography in SAB, including 18F-FDG-PET/CT, remain contentious. We performed a literature review of studies reporting impact of 18F-FDG-PET/CT on the clinical management or outcomes of SAB published through 3/1/2022. We identified seven observational studies, in which 18F-FDG-PET/CT frequently identified metastatic foci of infection, revealed foci undetected by prior investigations, led to additional source control procedures, and was associated with fewer infection relapses and lower mortality. Calculated numbers needed to treat (NNTs) for receipt of 18F-FDG-PET/CT were 7-9 to change antimicrobial therapy, 10-27 to lead to an additional source control procedure, and 4-8 to prevent death. These data are comparable to the evidence for clinical impact of other diagnostic modalities accepted as standard of care in SAB, and form a compelling basis for advocacy to expand access to 18F-FDG-PET/CT.
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Affiliation(s)
- Elizabeth Thottacherry
- Division of Infectious Diseases, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
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Abstract
Antibiotic treatment of osteomyelitis has evolved substantially over the past 80 years. Traditional teachings (eg, that antimicrobials must be given parenterally, selected based upon ratios of achieved bone vs serum drug levels, and continued for 4–6 weeks) are supported by limited data. New studies are challenging this dogma, however. In this review, we seek to contextualize the discussion by providing a narrative, chronologic review of osteomyelitis treatment spanning the pre-antibiotic era through the present day and by describing the quality of evidence supporting each component of traditional osteomyelitis therapy.
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Affiliation(s)
| | - Prathit A Kulkarni
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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Zhang HH, Cortés-Penfield NW, Mandayam S, Niu J, Atmar RL, Wu E, Chen D, Zamani R, Shah MK. Dialysis Catheter-related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-only Basis: A Retrospective Cohort Analysis. Clin Infect Dis 2019; 68:1011-1016. [PMID: 29986016 PMCID: PMC6399430 DOI: 10.1093/cid/ciy555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/01/2018] [Accepted: 07/07/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND An estimated 6500 undocumented immigrants with end-stage renal disease (ESRD) live in the United States. Those living in states that do not provide undocumented immigrants scheduled hemodialysis receive intermittent hemodialysis only when life-threatening conditions arise. Little is known about catheter-related bloodstream infections (CRBSIs) in this population. METHODS We conducted a retrospective cohort study of emergency-only hemodialysis patients in the Harris Health System in Houston, Texas, between January 2012 and December 2015. We assessed CRBSI risk factors including demographics, comorbidities, and duration and frequency of hemodialysis. We investigated the microbiologic etiology of these infections, rates of recurrent CRBSI, and associated morbidity and mortality. RESULTS The cohort included 329 patients; 90% were Hispanic, 60% had diabetes, and the average age was 51 years. A total of 101 CRBSIs occurred, with a rate of 0.84 infections per 1000 catheter-days. Cirrhosis and duration of hemodialysis during the study period were associated with increased risk of CRBSI. Seventeen CRBSIs were recurrent; infection with gram-positive bacteria predicted recurrence. Adherence to catheter-related infection guidelines was improved by infectious diseases consultation and associated with fewer recurrent infections. CRBSI was associated with prolonged hospitalization (mean, 15 days), composite complication rate of 8%, and a 4% mortality rate. CONCLUSIONS Patients receiving emergency-only hemodialysis via tunneled catheters have a high CRBSI rate compared with infection rates previously reported in patients receiving scheduled maintenance hemodialysis. Increased CRSBI risk likely contributes to the increased morbidity and mortality seen in ESRD patients receiving emergency-only hemodialysis.
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Affiliation(s)
- Hal H Zhang
- Department of Medicine, Baylor College of Medicine, Houston
| | | | - Sreedhar Mandayam
- Department of Medicine, Baylor College of Medicine, Houston
- Department of Medicine, Section of Nephrology, Baylor College of Medicine, Houston
| | - Jingbo Niu
- Department of Medicine, Section of Nephrology, Baylor College of Medicine, Houston
| | - Robert L Atmar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston
| | - Eric Wu
- Department of Medicine, Baylor College of Medicine, Houston
| | - Daniel Chen
- Department of Pediatrics, University of Texas Southwestern, Dallas
| | - Roya Zamani
- Department of Medicine, Baylor College of Medicine, Houston
| | - Maulin K Shah
- Department of Medicine, Section of Nephrology, Baylor College of Medicine, Houston
- Section of Nephrology, Veterans Affairs Medical Center, Houston, Texas
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Kumar D, Cortés-Penfield NW, El-Haddad H, Musher DM. Bowel Perforation Resulting in Necrotizing Soft-Tissue Infection of the Abdomen, Flank, and Lower Extremities. Surg Infect (Larchmt) 2018; 19:467-472. [PMID: 29893614 DOI: 10.1089/sur.2018.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Fournier's gangrene is a necrotizing soft-tissue infection (NSTI) that often originates from a break in bowel integrity and affects the perineum, anus, or genitalia. Although the pathogenesis is similar, NSTI caused by a break in bowel integrity less commonly presents as infection of other sites. OBJECTIVE To characterize NSTIs originating from bowel perforation and presenting as infection of the abdominal wall, flank, or thigh but that largely spare the perineum, anus, and genitalia. METHODS We describe a characteristic case and summarize findings from 67 reported cases. RESULTS The causes of bowel injury included trauma (29%), perforated appendicitis (23%), perforated diverticulitis (16%), and perforation of a gastrointestinal tract cancer (16%). The symptomatic prodrome is indolent and nondescript. Most patients have polymicrobial infections and require antibiotic therapy combined with serial surgical debridements. Because the presentation differs from that of typical Fournier's gangrene, recognition of NSTI was delayed in the reported cases, and the associated bowel perforation often was overlooked, leading to delayed surgical treatment. As a result, the mortality rate was >33%, far exceeding that of typical Fournier's gangrene. Delays in diagnosis or surgical intervention predict a poor outcome. CONCLUSIONS An NSTI resulting from bowel perforation can present in an atypical fashion carrying significant morbidity and mortality rates. Delayed diagnosis and treatment of this condition is associated with a poor outcome.
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Affiliation(s)
- Disha Kumar
- 1 School of Medicine, Baylor College of Medicine , Houston, Texas
| | - Nicolás W Cortés-Penfield
- 2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas
| | - Hanine El-Haddad
- 2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas.,3 Division of Infectious Diseases, University of Kentucky College of Medicine , Lexington, Kentucky
| | - Daniel M Musher
- 2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas.,4 Medical Care Line, Section of Infectious Diseases, Micheal E. DeBakey Veterans Affairs Medical Center , Houston, Texas
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