1
|
Finkelstain A, Schwartz E, Lachish T. An unusual case of non-resolving lymphadenopathy due to New World leishmaniasis. J Travel Med 2023; 30:taad125. [PMID: 37802881 DOI: 10.1093/jtm/taad125] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Anna Finkelstain
- Department for Radiology, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eli Schwartz
- Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel- Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| |
Collapse
|
2
|
Cohen N, Orenbuch-Harroch E, Olshtain-Pops K, Lachish T, Korem M. Epidemiology, Clinical Characteristics and Risk Factors for Severity of Chronic Disseminated Candidiasis in Jerusalem, Israel. Mycopathologia 2023; 188:873-883. [PMID: 37326819 DOI: 10.1007/s11046-023-00755-9] [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: 04/14/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
Chronic disseminated candidiasis (CDC) occurs mostly in patients with acute hematologic malignancy and its clinical manifestations derive from immune reconstitution following neutrophil recovery. The aim of this study was to describe epidemiological and clinical characteristics of CDC and define risk factors for disease severity. Demographic and clinical data were collected from medical files of patients with CDC hospitalized in two tertiary medical centers in Jerusalem between 2005 and 2020. Associations between different variables and disease severity were evaluated, as well as characterization of Candida species. The study included 35 patients. CDC incidence slightly increased during study years and the average number of involved organs and disease duration was 3 ± 1.26 and 178 ± 123 days, respectively. Candida grew in blood in less than third of cases and the most common isolated pathogen was Candida tropicalis (50%). Histopathological or microbiological workup in patients who underwent an organ biopsy demonstrated Candida in about half of the patients. Nine months after starting antifungals, 43% of the patients still didn't have resolution of organ lesions in imaging modalities. Factors associated with protracted and extensive disease were prolonged fever prior to CDC and absence of candidemia. A C- Reactive Protein (CRP) cutoff level of 7.18 mg/dL was found to predict extensive disease. In conclusion, CDC incidence is increasing and the number of involved organs is higher than previously described. Clinical factors such as fever duration prior to CDC and absence of candidemia can predict severe course of disease and assist in treatment decisions and follow-up planning.
Collapse
Affiliation(s)
- Nerel Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Ramat-Gan, Israel
| | - Efrat Orenbuch-Harroch
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Karen Olshtain-Pops
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, P.O. Box 12000, 9112102, Jerusalem, Israel
| | - Tamar Lachish
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Maya Korem
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- The Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, P.O. Box 12000, 9112102, Jerusalem, Israel.
| |
Collapse
|
3
|
Wiener-Well Y, Levin PD, Assous MV, Algur N, Barchad OW, Lachish T, Zalut T, Yinnon AM, Ben-Chetrit E. The use of a diversion tube to reduce blood culture contamination: A "real-life" quality improvement intervention study. Am J Infect Control 2023; 51:999-1003. [PMID: 36905985 DOI: 10.1016/j.ajic.2023.02.015] [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: 01/03/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Blood culture contamination is associated with health care costs and potential patient harm. Diversion of the initial blood specimen reduces blood culture contamination. We report results of the "real-life" clinical implementation of this technique. METHODS Following an educational campaign, use of a dedicated diversion tube was recommended prior to all blood cultures. Blood culture sets taken from adults using a diversion tube were defined as "diversion sets," those without, "non-diversion" sets. Blood culture contamination and true positive rates were compared for diversion and nondiversion sets and to nondiversion historical controls. A secondary analysis investigated efficacy of diversion by patient age. RESULTS Out of 20,107 blood culture sets drawn, the diversion group included 12,774 (60.5%) and the nondiversion group 8,333 (39.5%) sets. The historical control group included 32,472 sets. Comparing nondiversion to diversion, contamination decreased by 31% (5.5% [461/8333] to 3.8% [489/12744], P < .0001]. Contamination was also 12% lower in diversion than historical controls [3.8% (489/12744) vs 4.3% (1,396/33,174) P = .02)]. The rate of true bacteremia was similar. In older patients, contamination rate was higher, and the relative reduction associated with diversion decreased (54.3% amongst 20-40-year-olds vs 14.5% amongst >80-year-olds). CONCLUSIONS Use of a diversion tube in the ED reduced blood culture contamination in this large real life observational study. Efficacy decreased with increasing age, which requires further investigation.
Collapse
Affiliation(s)
- Yonit Wiener-Well
- Infectious Diseases Unit, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Phillip D Levin
- Intensive Care Unit, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marc V Assous
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nurit Algur
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orit Wolfovitz Barchad
- Infectious Diseases Unit, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Lachish
- Infectious Diseases Unit, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Todd Zalut
- Emergency Department, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amos M Yinnon
- Infectious Diseases Unit, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center and faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
4
|
Itzkowitz E, Alpert EA, Farojeh AZ, Zimmerman DR, Schwartz E, Lachish T. Morbidity of Returning Travelers Seen in Community Urgent Care Centers throughout Israel. Trop Med Infect Dis 2023; 8:319. [PMID: 37368737 DOI: 10.3390/tropicalmed8060319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Information regarding post-travel morbidity is usually reported via dedicated post-travel clinics and mainly relates to travelers returning from low-middle-income countries (LMIC), however, the spectrum of morbidity seen within the community setting is scarcely reported. This prospective observational study among visitors to 17 community Urgent Care Centers (UCC) was designed to evaluate the reasons for post-travel community clinic visits and to compare travelers returning from LMIC to high-income countries (HIC). All visitors within one-month post-travel to all destinations were included. A total of 1580 post-travel visits were analyzed during 25 months. Travelers to LMICs were younger (mean 36.8 years old vs. 41.4 in the HIC group) and stayed longer periods abroad (30.1 ± 41.2 vs. 10.0 ± 10.6 in the HIC group) but more of them had pre-travel vaccines (35.5% vs. 6.6%). Travel-related morbidity was significantly more common in the LMIC group 58.3% (253/434) vs. 34.1% (391/1146) in the HIC group, (p < 0.001). Acute diarrhea was the leading cause of morbidity after visiting LMIC (28.8%) and was significantly more common than in the HIC (6.6%, p < 0.001). Other common morbidities in the LMIC cohort were respiratory (23.3%), cutaneous (15.8%), and injuries (9.9%). In the HIC group, the common morbidities were respiratory (37.3%), and diarrhea composed only 6.6% of the complaints. Our study group represents a less biased sample of travelers to LMIC as well as HIC, therefore, data from the UCC setting and at the specialized travel clinics complete each other in understanding the true extent of morbidity in travelers.
Collapse
Affiliation(s)
- Eyal Itzkowitz
- Nephrology Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Evan A Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9101001, Israel
| | | | - Deena R Zimmerman
- TEREM Urgent Care Centers, Jerusalem 9439029, Israel
- Maternal Child and Adolescent Department, Public Health Division, Israel Ministry of Health, Jerusalem 9446724, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, The Chaim Sheba Medical Center, Tel Hashomer 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Tamar Lachish
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9101001, Israel
- The Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| |
Collapse
|
5
|
Fteiha B, Rub TA, Schwartz E, Lachish T. Morbidity among Arab-Israeli and Palestinian Hajj Pilgrims: A Prospective Study. Am J Trop Med Hyg 2021; 104:1596-1601. [PMID: 33534767 DOI: 10.4269/ajtmh.20-1460] [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] [Received: 11/12/2020] [Accepted: 12/13/2020] [Indexed: 11/07/2022] Open
Abstract
Thousands of Palestinian and Arab-Israeli pilgrims travel to Mecca each year to complete their pilgrimage. To the best of our knowledge, no previous studies have characterized the infectious and noninfectious morbidity among Arab-Israeli or Palestinian Hajj pilgrims. Thus, we designed and conducted an observational questionnaire-based study to prospectively investigate the occurrence of health problems among these Hajjis who traveled to complete their Pilgrimage during 2019 Hajj season. For the purpose of the study, questionnaires were distributed to Hajj pilgrims at three different time occasions-before travel, inquiring on demographics and medical comorbidities; and 1 and 4 weeks after returning recording any health problems encountered during or after travel. Initial recruitment included 111 Hajjis. The mean age of responders was 49.5 (±9.1) years, with an M:F ratio of 1.3:1. The mean travel duration was 18.7 (13-36) days. Altogether, 66.3% of the pilgrims reported at least one health problem during and after the trip, of which 38.6% sought medical attention. Five (4.8%) hajjis were hospitalized, including life-threatening conditions. Cough was the most common complaint (53.8%), and 11.5% also reported fever. Pretravel counseling was associated with reduced outpatient and emergency room visits. We therefore concluded that a high rate of morbidity was reported among this cohort of Hajj pilgrims with a morbidity spectrum similar to pilgrims from other countries. Pretravel consultation with the purpose of educating the pilgrims on the health risks of Hajj may help reduce the morbidity for future Hajj seasons.
Collapse
Affiliation(s)
- Bashar Fteiha
- 1Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tawfiq Abul Rub
- 2The Internal Medicine Ward, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eli Schwartz
- 3The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Lachish
- 4The Infectious Diseases Unit, Shaare-Zedek Medical Center, and the Hebrew University School of Medicine, Jerusalem, Israel
| |
Collapse
|
6
|
Lev D, Biber A, Lachish T, Leshem E, Schwartz E. Malaria in travellers in the time of corona. J Travel Med 2020; 27:5831126. [PMID: 32374840 PMCID: PMC7337765 DOI: 10.1093/jtm/taaa067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Dana Lev
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Biber
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Lachish
- Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eyal Leshem
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
7
|
Lachish T, Lustig Y, Leshem E, Katz-Likvornik S, Biber A, Nadir E, Schwartz E. High incidence of dengue in Israel travelers to Kathmandu, Nepal, in 2019. J Travel Med 2020; 27:5693887. [PMID: 31897487 DOI: 10.1093/jtm/taz105] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/08/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022]
Abstract
We describe the emergence of dengue in Kathmandu in Nepal in 2019. We found a high incidence in Israeli travelers. The circulating serotypes were identified as DENV-2 and DENV-3 with phylogenetic analysis suggesting that the latter serotype originated from India. Travelers to Nepal should be aware of the potential dengue risk beyond the Terai.
Collapse
Affiliation(s)
- Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center and the Hebrew University School of Medicine, Jerusalem, Israel.,Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical center, Tel-Hashomer, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical center, Tel-Hashomer, Israel
| | - Eyal Leshem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Shiri Katz-Likvornik
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical center, Tel-Hashomer, Israel
| | - Asaf Biber
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Nadir
- Clalit Health Services, Jerusalem, Israel
| | - Eli Schwartz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
8
|
Ruchlemer R, Ben-Ami R, Bar-Meir M, Brown JR, Malphettes M, Mous R, Tonino SH, Soussain C, Barzic N, Messina JA, Jain P, Cohen R, Hill B, Mulligan SP, Nijland M, Herishanu Y, Benjamini O, Tadmor T, Okamoto K, Arthurs B, Gottesman B, Kater AP, Talha M, Eichhorst B, Korem M, Bogot N, De Boer F, Rowe JM, Lachish T. Ibrutinib-associated invasive fungal diseases in patients with chronic lymphocytic leukaemia and non-Hodgkin lymphoma: An observational study. Mycoses 2019; 62:1140-1147. [PMID: 31520441 DOI: 10.1111/myc.13001] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 06/12/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Invasive fungal diseases (IFD) are life-threatening infections most commonly diagnosed in acute leukaemia patients with prolonged neutropenia and are uncommonly diagnosed in patients with lymphoproliferative diseases. OBJECTIVES Following the initial report of aspergillosis diagnosed shortly after beginning ibrutinib for chronic lymphocytic leukaemia, a survey was developed to seek additional cases of IFD during ibrutinib treatment. METHODS Local and international physicians and groups were approached for relevant cases. Patients were included if they met the following criteria: diagnosis of chronic lymphocytic leukaemia/non-Hodgkin lymphoma; proven or probable IFD; and ibrutinib treatment on the date IFD were diagnosed. Clinical and laboratory data were captured using REDCap software. RESULT Thirty-five patients with IFD were reported from 22 centres in eight countries: 26 (74%) had chronic lymphocytic leukaemia. The median duration of ibrutinib treatment before the onset of IFD was 45 days (range 1-540). Aspergillus species were identified in 22 (63%) of the patients and Cryptococcus species in 9 (26%). Pulmonary involvement occurred in 69% of patients, cranial in 60% and disseminated disease in 60%. A definite diagnosis was made in 21 patients (69%), and the mortality rate was 69%. Data from Israel regarding ibrutinib treated patients were used to evaluate a prevalence of 2.4% IFD. CONCLUSIONS The prevalence of IFD among chronic lymphocytic leukaemia/non-Hodgkin lymphoma patients treated with ibrutinib appears to be higher than expected. These patients often present with unusual clinical features. Mortality from IFD in this study was high, indicating that additional studies are urgently needed to identify patients at risk for ibrutinib-associated IFD.
Collapse
Affiliation(s)
- Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maskit Bar-Meir
- Infectious Diseases Unit, Shaare-Zedek Medical Center, affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Jennifer R Brown
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Rogier Mous
- UMC Cancer Center, Hematologie, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sanne H Tonino
- Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Carole Soussain
- Institut Curie-Site de Saint-Cloud, Hematologie, Saint-Cloud, France
| | | | | | - Preetesh Jain
- Department of Leukemia, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Regev Cohen
- Infectious Diseases Unit, Laniado Hospital, Netanya, Israel
| | - Brian Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Stephen P Mulligan
- Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Marcel Nijland
- Department of Hematology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Benjamini
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Tadmor
- Department of Hematology, Bnai Zion Medical Center, Haifa, Israel
| | - Koh Okamoto
- Division of Infectious Diseases, Rush University Medical Center, affiliated with the University of Tokyo Hospital, Chicago, IL, USA, Japan
| | - Benjamin Arthurs
- Division of Pulmonary & Critical Care Medicine, Veterans Affairs Portland Health Care System, Oregon Health & Science University, Portland, OR, USA
| | | | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Munir Talha
- Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | | | - Maya Korem
- The Infectious Diseases Unit, Hadassah Medical Center, affiliated with Hebrew University Medical School, Jerusalem, Israel
| | - Naama Bogot
- CT Institute, Shaare-Zedek Medical Center, affiliated with Hebrew University Medical School, Jerusalem, Israel
| | | | - Jacob M Rowe
- Department of Hematology, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center, affiliated with Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
9
|
Einav S, Raveh D, Lachish T, Baumstarck K, Martin C, Martin-Loeches I, Leone M. Candida Prophylaxis and Treatment in Critically Ill Patients after Abdominal Surgery: A Survey of Practice. Surg Infect (Larchmt) 2019; 20:510-518. [PMID: 31099715 DOI: 10.1089/sur.2018.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/05/2023] Open
Abstract
Purpose: To survey current intensive care unit (ICU) practice in initiating antifungal therapy for prophylaxis and treatment of suspected candidiasis after abdominal surgery. The goal was to establish the need to prioritize research toward standardized care of such patients. Methods: Online questionnaire survey of clinical practice based on theoretical case scenarios. These were structured with expert input to investigate management of: hemodynamically stable/unstable patient after urgent upper/lower gastrointestinal surgery with/without fungal growth in culture. The link to the survey was sent to all active members of the European Society of Intensive Care Medicine (ESICM). Results: The survey was completed by 101 respondents from 29 countries. Fewer than half (48.5%) stated that in their center, ICU antibiotic and antifungal therapy is managed by a dedicated specialist physician/team that manages all ICU patients. Respondents exhibited a greater tendency toward administering antifungal agents, mainly fluconazole, to hemodynamically unstable patients. One week after surgery for a perforated duodenal ulcer, only half responded they would use antifungal agents when a patient develops septic shock. Most respondents chose to administer antifungal therapy in patients with septic shock if Candida had been identified in any culture. The source of infection, location of surgery, or type of Candida were not viewed as triggers for therapeutic decisions. Conclusion: The current survey demonstrates large variability in antifungal use. Decisions are made irrespective of existing guidelines and seem to be driven by patient hemodynamic condition and identification of any Candida in any culture alone.
Collapse
Affiliation(s)
- Sharon Einav
- 1General and Surgical Intensive Care Unit, Shaare Zedek Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - David Raveh
- 2Infectious Diseases Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Tamar Lachish
- 3Infectious Diseases Unit, Shaare Zedek Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Karine Baumstarck
- 4Maladies Chroniques et Qualité de Vie, School of Medicine, Aix Marseille Université, Marseille, France
| | - Claude Martin
- 5Service d'Anesthésie et de Réanimation, Chemin des Bourrely, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Ignacio Martin-Loeches
- 6Multidisciplinary Intensive Care, St. James's University Hospital, Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Dublin, Ireland
| | - Marc Leone
- 5Service d'Anesthésie et de Réanimation, Chemin des Bourrely, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| |
Collapse
|
10
|
Nissan B, Lachish T, Schwartz E. The effectiveness of empirical anti-parasitic treatment in returning travellers with persistent abdominal symptoms. J Travel Med 2018; 25:4711104. [PMID: 29232458 DOI: 10.1093/jtm/tax083] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/14/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persistent abdominal symptoms (PAS) are common among returning-travellers. In the absence of sensitive tests to identify intestinal parasites, gastrointestinal (GI) symptoms often remain a diagnostic challenge. In this study we examined the effectiveness of empirical anti-parasitic treatment in returning-travellers with PAS despite no positive stool-test. METHODS A retrospective study among returning travellers who approached the clinic between the years 2014 and 2016 with GI complaints without a positive stool-test. The empirical treatment included broad-spectrum anti-parasitic agents-oral Tinidazole and Albendazole. A follow-up questionnaire was performed at least 6 months post-treatment. RESULTS A total of 102 patients responded the questionnaire-50% women; average age 31.14 (±12.20) years. The average duration of complaints before treatment was 16.52 (±30.06) months. Common GI symptoms included abdominal pain (83.3%) and diarrhoea (78.4%); 67.6% of the patients complained of extreme fatigue. Overall, 69% of the patients reported an improvement in GI symptoms, 37% of them reported full recovery within a few weeks post-treatment. Furthermore, there was an improvement in the energy level and general well-being in 68% and 70% of the patients, respectively. Only 33% of the patients reported minor side effects related to the treatment. CONCLUSIONS The improvement in GI symptoms, energy level and general well-being shortly after anti-parasitic treatment justifies this empirical approach in returning-travellers with PAS despite negative stool-tests. The association between fatigue and PAS post-travel and the improvement in both as a response to treatment defines fatigue as part of a new syndrome-'Post-travel fatigue and abdominal symptoms'.
Collapse
Affiliation(s)
- Batel Nissan
- The Faculty of Medicine, the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine, the Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
11
|
Lachish T, Bar A, Alalouf H, Merin O, Schwartz E. Morbidity among the Israeli Defense Force response team during Nepal, post-earthquake mission, 2015. J Travel Med 2017; 24:2739118. [PMID: 28395091 DOI: 10.1093/jtm/taw083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND On 25 April 2015, a 7.8-magnitude earthquake struck Nepal. Soon after, the Israel Defense Force (IDF) dispatched a rapid-response team and opened a tertiary field hospital in Kathmandu. There is limited data regarding the spectrum of diseases among rescue teams to disease-stricken areas. The aim of this study was to assess the morbidity among the field-hospital staff during the mission. METHODS The rescue team was deployed for a 2-week mission in Kathmandu. Pre-travel vaccinations were given prior to departure. The field-hospital was self-equipped including food and drinking water supply with a self-serving kitchen, yet had a shortage of running water. A Public Healthcare and Infectious-Diseases team was present and active during the entire mission. A survey assessing the morbidities and risk-factors throughout the mission was performed at the last day. RESULTS One hundred thirty-seven (69%) team members completed the questionnaire. Medical complaints were recorded in 87 of them (64%). The most common symptoms were gastrointestinal (GI) (53% of all responders, 84% of the 87 with symptoms). Respiratory symptoms were recorded in 16% and fever in only 8%. There was no significant difference in the rate or spectrum of morbidity between the medical and the non-medical staff. CONCLUSIONS The Israeli field hospital was a stand-alone facility, yet 53% of its' staff suffered from GI complaints. Prevention of morbidity and specifically of GI complaints upon arrival to a disaster-stricken area in a developing country is difficult. Medical teams in such missions should be acquainted with treating GI complaints.
Collapse
Affiliation(s)
- Tamar Lachish
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel.,The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Aviad Bar
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Heli Alalouf
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Ofer Merin
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel.,The Trauma Unit, Shaare-Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Eli Schwartz
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel.,The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel-Hashomer, Israel, And Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
Affiliation(s)
- Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eli Schwartz
- Center for Geographic Medicine the Chaim Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
13
|
Erez-Granat O, Lachish T, Daudi N, Shouval D, Schwartz E. Hepatitis E in Israel: A nation-wide retrospective study. World J Gastroenterol 2016; 22:5568-5577. [PMID: 27350735 PMCID: PMC4917617 DOI: 10.3748/wjg.v22.i24.5568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/11/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the epidemiology, risk factors and clinical course of acute hepatitis E virus (HEV) infection in Israel, an industrialized country.
METHODS: A retrospective analysis of acute HEV cases diagnosed in Israel from 1993 to 2013. Acute HEV was defined by ALT/AST elevation and a positive HEV PCR test or positive anti-HEV-IgM serology. HEV RNA was tested by quantitative reverse transcription PCR. Antibodies to HEV were tested retrospectively using an ELISA assay. HEV-RNA was sequenced using RT-PCR of ORF1 and ORF2 regions to diagnose genotype of the virus. Epidemiologic and clinical data were collected by reviewing the clinical files and through a telephone interview according to a structured questionnaire.
RESULTS: Acute HEV was diagnosed in 68 patients. Among the 59 patients who gave an informed consent and were interviewed, 41% of infections were autochthonous (acquired in Israel), 44% travel-related and 15% imported by foreign workers. Autochthonous patients were mainly females (62.5%), more than half of them pregnant, 26% recalled consuming food or water in areas with poor sanitation, 44% ate non-kosher meat. Fulminant hepatitis developed in 3 patients (5%), all of them were females, two of them with post-partum infection, all acquired the disease in Israel (autochthonous). Israeli travelers with imported infection were predominantly males (73%), acquired the disease in the Indian subcontinent (81%), with 100% reporting having consumed fresh vegetables and drinks with ice cubes abroad. Six patients’ sera were tested for genotype and revealed HEV genotype 1 (all cases acquired in the Indian subcontinent).
CONCLUSION: This is the first report which highlights the existence of hepatitis E as an autochthonous infection in Israel. Imported HEV originates mostly from the Indian subcontinent.
Collapse
|
14
|
Lachish T, Bar-Meir M, Eisenberg N, Schwartz E. Effectiveness of twice a week prophylaxis with atovaquone-proguanil (Malarone®) in long-term travellers to West Africa. J Travel Med 2016; 23:taw064. [PMID: 27625401 DOI: 10.1093/jtm/taw064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Current guidelines recommend daily dosing of atovaquone-proguanil (AP), beginning a day before travel to endemic areas and continuing for 7 days after departure. Adherence of long-term travellers to daily malaria chemoprophylaxis tends to be poor, even when residing in highly endemic malaria regions. Evidence from a volunteer challenging study suggests that non-daily, longer intervals dosing of AP provides effective protection against Plasmodium falciparum This study examines the effectiveness of twice weekly AP prophylaxis in long-term travellers to highly endemic P. falciparum areas in West Africa. METHODS An observational surveillance study aimed to detect prophylactic failures associated with twice weekly AP, during the years 2013-2014, among long-term expatriates in two sites in West Africa. The expatriates were divided according to the malaria prophylaxis regimen taken: AP twice weekly; mefloquine once weekly and a group refusing to take prophylaxis. Malaria events were recorded for each group. The incidence-density of malaria was calculated by dividing malaria events per number of person-months at risk. RESULTS Among 122 expatriates to West Africa the malaria rates were: 11.7/1000 person-months in the group with no-prophylaxis (n = 63); 2.06/1000 person-months in the 40 expatriates taking mefloquine (P = 0.006) and no cases of malaria (0/391 person-months, P = 0.01) in the twice weekly AP group (n = 33). CONCLUSIONS No prophylaxis failures were detected among the group of expatriates taking AP prophylaxis twice weekly compared with 11.7/1000 person-months among the no-prophylaxis group. Twice weekly AP prophylaxis may be an acceptable approach for long-term travellers who are unwilling to adhere to malaria chemoprophylaxis guidelines.
Collapse
Affiliation(s)
- Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, P.O.B 3235, Jerusalem 91301, Israel
| | - Maskit Bar-Meir
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, P.O.B 3235, Jerusalem 91301, Israel
| | | | - Eli Schwartz
- The Center for Geographic Medicine, the Chaim Sheba Medical Center, Tel-Hashomer, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
15
|
Lachish T, Wieder-Finesod A, Schwartz E. Amebic Liver Abscess in Israeli Travelers: A Retrospective Study. Am J Trop Med Hyg 2016; 94:1015-9. [PMID: 26928829 DOI: 10.4269/ajtmh.15-0576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/14/2015] [Indexed: 01/21/2023] Open
Abstract
Amebic liver abscess (ALA) is endemic in developing countries. The epidemiology and clinical characteristics of the disease in developing countries are well described. Travelers from nonendemic countries can serve as a model for the natural history of ALA. Currently, the available literature on travelers is limited. This is a retrospective observational study on Israeli travelers diagnosed with ALA. Data regarding travel history, clinical presentation, imaging, and treatment were collected and analyzed. Among 6,867 ill returning Israeli travelers, amebiasis was diagnosed in 53 travelers (0.77%), of whom 14 were with ALA (0.2%). Twelve ALA cases (86%) had an exposure in the Indian subcontinent. The male to female ratio was 1:1, with no significant clinical differences between the sexes. The average lag period between exposure and onset of symptoms was 17.1 months. The lack of male predominance and the prolonged lag period may imply that behavioral factors are pivotal in the development of ALA. Larger case series of travelers are required.
Collapse
Affiliation(s)
- Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wieder-Finesod
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Schwartz
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
16
|
Schwartz E, Lachish T. Artemisinin-based combination therapy (ACT) versus atovaquone-proguanil: do not choose between but, rather, combine them. ACTA ACUST UNITED AC 2016; 21:64. [PMID: 26759150 DOI: 10.1136/ebmed-2015-110183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Eli Schwartz
- The Chaim Sheba Medical Center, The Center for Geographic Medicine, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
17
|
Lachish T, Erez O, Daudi N, Shouval D, Schwartz E. Acute hepatitis E virus in pregnant women in Israel and in other industrialized countries. J Clin Virol 2015; 73:20-24. [PMID: 26521225 DOI: 10.1016/j.jcv.2015.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/10/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Acute hepatitis E virus (HEV) is the most common etiology of viral hepatitis in adults in developing countries. HEV is rare in industrialized countries but its incidence is rising both in returning travelers and through autochthonous infection. In developing countries HEV is associated with a high rate of fulminant hepatitis and mortality during pregnancy and contributes to poor obstetric and fetal outcomes. There are no reliable data on the outcome of HEV during pregnancy in industrialized countries. STUDY DESIGN A retrospective analysis of acute HEV cases diagnosed in Israel were examined. The clinical course of the disease among pregnant women was retrieved. A systematic review of the literature was performed for cases of HEV and pregnancy, originating or treated in industrialized countries RESULTS Between the years 1993-2013, 68 cases of acute HEV were diagnosed in Israel, including 9 pregnant women (13%). An additional 6 reported cases were found from a literature search. From the 15 women (10 autochthonous cases and 5 imported cases), the outcome was favorable in 10 cases, however, 5 cases (33%) resulted in fulminant hepatitis and two women underwent an urgent liver transplantation. No fatality occurred in the mothers and all babies were born alive and healthy. DISCUSSION This is the first case series of acute HEV infection in pregnant women in industrialized countries. Acute HEV infection poses a significant risk in pregnancy, irrespective of patients' country of origin. In contrast to reports from developing countries, all babies and mothers survived.
Collapse
Affiliation(s)
- Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel.
| | - Ortal Erez
- The Hebrew University, Hadassah Medical School, Jerusalem, Israel.
| | - Nili Daudi
- The Liver Unit, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Daniel Shouval
- The Liver Unit, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Eli Schwartz
- The Center for Geographic Medicine and Department of Medicine C, Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
18
|
Lachish T, Marhoom E, Mumcuoglu KY, Tandlich M, Schwartz E. Myiasis in Travelers. J Travel Med 2015; 22:232-6. [PMID: 25827950 DOI: 10.1111/jtm.12203] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 12/27/2014] [Revised: 02/13/2015] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous myiasis is a well-established diagnosis in returning travelers from tropical countries. The most common form of myiasis seen in this population is localized furuncular myiasis caused by Dermatobia hominis and Cordylobia anthropophaga. There are limited data on the disease course and outcome in travelers to tropical countries. METHODS A retrospective observational study of patients who presented with myiasis was conducted between 1999 and July 2014 in the post-travel clinics in Israel. Data regarding exposure history, travel duration, clinical presentation, treatment, and parasitological identification were collected and analyzed. RESULTS Among 6,867 ill returning Israeli travelers, 1,419 (21%) had a dermatologic complaint, 90 (6.3%) of them were diagnosed with myiasis. Myiasis was acquired in Latin America by 72 (80%) patients, mainly (54%) in the Madidi National Park, Amazonas Basin, Bolivia; 18 cases (20%) were acquired in Africa. In 76% of cases, manual extraction was sufficient to remove the larva; 24% required surgical intervention. Despite the fact that most patients did not receive antibiotic treatment, only one developed secondary infection, upon partial removal of the larva. CONCLUSIONS This is the largest myiasis case series in ill returning travelers. Myiasis is not a rare dermatologic complaint with most Israeli cases imported from Latin America and specifically the Madidi National Park in Bolivia. Treatment is based on full extraction of the larva after which no antibiotic treatment is needed. Myiasis is a preventable disease and travelers should be informed of the different preventive measures according to their travel destination.
Collapse
Affiliation(s)
- Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Enbal Marhoom
- The Emergency Department, The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Kosta Y Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University, Jerusalem, Israel
| | - Moshik Tandlich
- Periodontology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
19
|
Abstract
During January 2008–October 2013, a total of 12 cases of giardiasis at the Chaim Sheba and Shaare Zedek Medical Centers, Israel, did not respond to nitroimidazole; 83.3% were associated with travel and 33% with immunoglobulin deficiency. Among 110 published cases, the most effective treatment was quinacrine (efficacy 90%–100%), but its availability is limited.
Collapse
|
20
|
Segel MJ, Rozenman J, Lindsley MD, Lachish T, Berkman N, Neuberger A, Schwartz E. Histoplasmosis in Israeli travelers. Am J Trop Med Hyg 2015; 92:1168-72. [PMID: 25918200 DOI: 10.4269/ajtmh.14-0509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/09/2015] [Indexed: 11/07/2022] Open
Abstract
Histoplasmosis is a common endemic human mycoses acquired mostly in the Americas. We reviewed 23 cases of histoplasmosis in Israeli travelers; 22 had traveled to Central or South America and one to North America. Fourteen cases had been exposed to bat habitats and were symptomatic, presenting ≤ 3 months after their return. Asymptomatic patients (N = 9) were diagnosed during the evaluation of incidental radiological findings or because a travel partner had been suspected of Histoplasma infection, 16-120 months after their return. Serological testing was positive in 75% of symptomatic cases but only 22% of asymptomatic cases. Histoplasmosis should be considered in travelers returning from the Americas with respiratory or febrile illness within weeks of return, particularly if exposed to bat habitats. Travel history is essential in patients presenting with pulmonary nodules, even years after travel to endemic countries.
Collapse
Affiliation(s)
- Michael J Segel
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Judith Rozenman
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Mark D Lindsley
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Tamar Lachish
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Neville Berkman
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Ami Neuberger
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Eli Schwartz
- Institute of Pulmonology, Department of Imaging, Internal Medicine "C" and Center for Geographic Medicine, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Unit of Infectious Diseases, Internal Medicine B, Rambam Medical Center, Haifa, Israel
| |
Collapse
|
21
|
Raveh-Brawer D, Wiener-Well Y, Lachish T, Ben-Chetrit E, Megged O, Bar-Meir M, Dahan M, Shraber T, Bukatman E, Yinnon AM. [Effect of a computer application on appropriate use and control of broad spectrum antibiotics]. Harefuah 2015; 154:166-212. [PMID: 25962245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Antibiotics are among the greatest contributions of modern medicine. However, since the onset of the antibiotic age, resistance has emerged, threatening the future usability of these drugs. The complexity of antibiotic prescribing and associated expense has led to the development of infectious disease (ID) expert stewardship programs. PURPOSE To describe an in-house created computer application, in use since 2005 with which all restricted antimicrobials are ordered and approved by ID physicians before being supplied by the pharmacy. RESULTS In the nine years since the application was adopted by the entire hospital, 173,436 prescriptions for restricted antibiotics have been ordered through the application, of which 52% were for male patients, 8% for children ≤ 20 years, 31% for adults 21-70 years old and 61% for patients > 70. All prescriptions were reviewed by ID physicians; their response included approval (mean 87%, range 82-92%), rejection (7%, 3-12%), or change (6%, 4-18%). The latter two decisions always involved written and/or oral interaction with the prescribing physicians. The result analysis showed that: by clinical diagnoses, the approval rate ranged from 82% (for central line associated infection) to 94% (for tuberculosis); by class of antimicrobial, the approval rate ranged from 71% (IV ciprofloxacin) to 95% (IV amoxicillin-calvulanate). Overall hospital expenditure on antimicrobials, corrected by 100 admissions and 100 admission days, did not change significantly. CONCLUSIONS During the nine years of its use, the described computer program has significantly contributed to physician awareness of appropriate antibiotic use, provided tools to assist physicians in their choice of antimicrobial treatment, allowed ID supervision with unprecedented scope and depth and has significantly contributed to cost control.
Collapse
|
22
|
Ben-Chetrit E, Lachish T, Mørch K, Atias D, Maguire C, Schwartz E. Schistosomiasis in pregnant travelers: a case series. J Travel Med 2015; 22:94-8. [PMID: 25306906 DOI: 10.1111/jtm.12165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Received: 03/22/2014] [Revised: 07/01/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Travel-related acquisition of schistosomiasis in Africa is well established. Data concerning Schistosoma infection in pregnant travelers are lacking and treatment derives from studies in endemic regions. METHODS This study was a retrospective case-series of pregnant patients who were infected with Schistosoma species. Data regarding exposure history, clinical presentation, diagnosis, treatment, and fetal outcomes were collected and analyzed. Diagnosis of schistosomiasis was based on serology tests and/or ova recovery. RESULTS Travel-related schistosomiasis during pregnancy was diagnosed in 10 travelers (with 20 pregnancies). Of the 10 women, 4 pregnant travelers with recent exposure were treated during their pregnancy with praziquantel (PZQ). The course and outcome of pregnancy in these patients was uneventful, and treatment had no apparent adverse effects on either the mothers or their babies. Six asymptomatic women were diagnosed years after exposure. During this period, they gave birth to 13 babies. They were never treated with PZQ. Birth weights of their infants were significantly smaller as compared with those of the infants of the women who were treated during their pregnancy (median 2.8 vs 3.5 kg). One baby was born preterm. One patient had three miscarriages. CONCLUSION This is the first case-series of pregnant travelers with schistosomiasis. Although a small case-series with possible confounders, it suggests that schistosomiasis in pregnant travelers can be treated. A trend of lower birth weights was observed in the infants of the pregnant travelers who were not treated. PZQ therapy during pregnancy was not associated with adverse pregnancy or fetal outcomes in those four cases. Our results emphasize the importance of screening female travelers of childbearing age with a relevant history of freshwater exposure. Further studies are needed to reinforce these recommendations.
Collapse
Affiliation(s)
- Eli Ben-Chetrit
- Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | | | | |
Collapse
|
23
|
Grynberg S, Lachish T, Kopel E, Meltzer E, Schwartz E. Artemether-lumefantrine compared to atovaquone-proguanil as a treatment for uncomplicated Plasmodium falciparum malaria in travelers. Am J Trop Med Hyg 2014; 92:13-7. [PMID: 25371188 DOI: 10.4269/ajtmh.14-0249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Atovaquone-proguanil (AP) and artemether-lumefantrine (AL) are both treatments for uncomplicated Plasmodium falciparum malaria, but comparative clinical trials are lacking. We performed a retrospective analysis, comparing treatment failure and fever clearance time in non-immune travelers with uncomplicated P. falciparum malaria, treated with AP or AL. Sixty-nine patients were included during 2001-2013: 44 in the AP group and 25 in the AL group. Treatment failure was observed in 6 of 44 (13.6%) and 1 of 25 (4.0%) patients in the AP and AL groups, respectively. Six treatment failures were observed in travelers from West Africa. Fever clearance time was 44 ± 23 h in AL group versus 77 ± 28 h in AP group, (P < 0.001). Hospitalization time was significantly shorter in the AL group; 3.8 + 1.3 versus 5.1 + 2.8 days in the AP group (P = 0.04) In conclusion, travelers with uncomplicated P. falciparum malaria recover faster on AL than on AP. The AL should probably be the drug of choice for this population.
Collapse
Affiliation(s)
- Shirly Grynberg
- The Center of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Lachish
- The Center of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kopel
- The Center of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Meltzer
- The Center of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Schwartz
- The Center of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
24
|
Lachish T, Schwartz E. HBV and HCV infections in travelers. J Travel Med 2013; 20:408. [PMID: 24165387 DOI: 10.1111/jtm.12068_1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | | |
Collapse
|
25
|
Lachish T, Tandlich M, Grossman T, Schwartz E. High rate of schistosomiasis in travelers after a brief exposure to the high-altitude Nyinambuga crater lake, Uganda. Clin Infect Dis 2013; 57:1461-4. [PMID: 24021485 DOI: 10.1093/cid/cit559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Travel-related schistosomiasis is usually associated with prolonged freshwater exposure. Until recently, Uganda's crater lakes were considered schistosomiasis free due to their high-altitude location. We describe an outbreak of acute schistosomiasis after a brief exposure (mean, 22 ± 9.5 minutes) to a high-altitude crater lake.
Collapse
Affiliation(s)
- Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center
| | | | | | | |
Collapse
|
26
|
Abstract
BACKGROUND Acute hepatitis is a well-described cause of morbidity and sporadic mortality in travelers. Data regarding the epidemiology of hepatitis in travelers are lacking. The aim of this study is to describe the epidemiology of acute viral hepatitis among travelers returning from tropical countries, with particular attention to enterically transmitted hepatitis. METHODS This study is a prospective observational study of ill-returned travelers who presented at two travel medicine clinics in Israel between the years 1997 and 2012. Data of patients with acute hepatitis were summarized. Only travelers were included, immigrants and foreign workers were excluded. RESULTS Among 4,970 Israeli travelers who were seen during this period, 49 (1%) were diagnosed with acute hepatitis. Among them, hepatitis E virus (HEV) was the etiology in 19 (39%) cases and hepatitis A virus (HAV) was the etiology in 13 (27%) cases, demonstrating that 65% of all cases were due to enterically transmitted hepatitis. Acquiring acute hepatitis B (two cases) or acute hepatitis C (one case) was uncommon (6.1%). In 27% of the cases, no diagnosis was determined. Fifty-five percent of cases were imported from the Indian subcontinent, with a predominance of HEV infection (84%). A significant male predominance was seen in all groups regardless of etiology. Pre-travel consultation was documented in only 7% of those with vaccine preventable hepatitis (hepatitis A & B) compared to 89% in those with hepatitis E. CONCLUSIONS Enterically transmitted hepatitis is the main causes of viral hepatitis among travelers. HEV is an emerging disease and has become the most common hepatitis among Israeli travelers. Although an efficacious vaccine has been developed, no licensed HEV vaccine is yet available. Although hepatitis A vaccine is highly efficacious, safe, and easily available, there is a stable number of HAV cases.
Collapse
Affiliation(s)
- Tamar Lachish
- The Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | | | | |
Collapse
|
27
|
Zimmerman FS, Assous MV, Bdolah-Abram T, Lachish T, Yinnon AM, Wiener-Well Y. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. Am J Infect Control 2013; 41:190-4. [PMID: 23449280 DOI: 10.1016/j.ajic.2012.09.020] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) are cohorted under contact precautions, including in the days between rehospitalization and surveillance culture results. This study investigates duration of CRE carriage to define populations requiring precautions upon readmission. METHODS Patients with CRE-positive culture during 2009-2010 were followed up by rectal swab cultures taken retrospectively and prospectively for the study or as part of clinical follow-up. RESULTS One hundred thirty-seven patients met the inclusion criteria, with follow-up cultures obtained from 97. Mean time to CRE negativity was 387 days (95% confidence interval: 312-463). Seventy-eight percent of patients (64/82) had positive culture at 3 months, 65% (38/58) at 6 months, and 39% (12/30) at 1 year. Duration of carriage was affected by repeat hospitalization (P = .001) and clinical, as opposed to surveillance, culture (P = .002). CONCLUSION CRE carriers from a previous hospitalization have a lower probability of CRE carriage upon readmission if the index specimen was a surveillance culture and 1 year passed without further hospitalization. Multiple hospitalizations and CRE disease extend duration of carriage. This study better defines patients requiring cohorting and isolation, thus limiting spread of CRE and allowing for improved allocation of infection control measures.
Collapse
|
28
|
Wiener-Well Y, Gofman I, Assous MV, Freier-Dror Y, Yinnon AM, Lachish T. The clinical significance of isolation of two different organisms from the urine of patients with an indwelling catheter. Diagn Microbiol Infect Dis 2013; 76:1-4. [PMID: 23420010 DOI: 10.1016/j.diagmicrobio.2013.01.015] [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] [Received: 10/16/2012] [Revised: 12/30/2012] [Accepted: 01/15/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND We evaluated the clinical significance of urine cultures from patients with an indwelling urinary catheter (UC) from which 2 different pathogens were isolated. METHODS Urine cultures from patients with a UC from which 2 different organisms were isolated were randomly divided into a control group (culture results were reported as usual) and a study group (culture results were reported as "mixed growth"). Endpoints included change in antibiotic treatment, use of broad spectrum agents, time for clinical improvement, and duration of admission. RESULTS A total of 81 cultures met the inclusion criteria. Antibiotic treatment was changed after 72-96 h in 19 (48%) study patients and in 25 (61%) controls (NS). There was no difference regarding narrowing or broadening of antibiotic spectrum, and duration of hospitalization was similar. In each group, 15 (36%) patients died. CONCLUSION Our findings imply that laboratory work-up of 2 pathogens from patients with an indwelling catheter may be discarded.
Collapse
Affiliation(s)
- Yonit Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | | | | | | | | | | |
Collapse
|
29
|
Ben-Chetrit E, Lachish T, Nesher G. Fatal haemorrhagic varicella in a patient with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Clin Exp Rheumatol 2013; 31:S95. [PMID: 23433083] [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] [Received: 12/06/2012] [Accepted: 01/28/2013] [Indexed: 06/01/2023]
|
30
|
Schechner V, Gottesman T, Schwartz O, Korem M, Maor Y, Rahav G, Karplus R, Lazarovitch T, Braun E, Finkelstein R, Lachish T, Wiener-Well Y, Alon D, Chowers M, Bardenstein R, Zimhony O, Paz A, Potasman I, Giladi M, Schwaber MJ, Klarfeld-Lidji S, Hochman M, Marchaim D, Carmeli Y. Pseudomonas aeruginosa bacteremia upon hospital admission: risk factors for mortality and influence of inadequate empirical antimicrobial therapy. Diagn Microbiol Infect Dis 2011; 71:38-45. [PMID: 21763093 DOI: 10.1016/j.diagmicrobio.2011.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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: 02/23/2011] [Revised: 05/05/2011] [Accepted: 05/17/2011] [Indexed: 11/18/2022]
Abstract
Pseudomonas aeruginosa is an uncommon cause of bacteremia upon hospital admission (UHA) and the chosen empirical antimicrobial therapy may not cover it appropriately. In a multicenter prospective study conducted in Israel, we evaluated risk factors for in-hospital mortality in patients with P. aeruginosa bacteremia UHA and determined the influence of delay in adequate empirical antimicrobial therapy on patients' outcome. Seventy-six adult patients with P. aeruginosa bacteremia within 72 h of hospital admission were included. Demographic, clinical, and treatment data were collected. Microbiological adequacy of empirical therapy was determined. Severe sepsis or septic shock at admission (OR, 21.9; P < 0.001), respiratory or unknown sources of bacteremia (OR, 11.5; P = 0.003), recent hospitalization (OR, 6.2; P = 0.032), and poor functional status (OR, 5.8; P = 0.029) were identified as independent predictors of mortality. Inadequate empirical antimicrobial therapy was marginally associated with increased mortality only among patients who presented with severe sepsis or septic shock (P = 0.051).
Collapse
Affiliation(s)
- Vered Schechner
- Division of Epidemiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
We describe a 31-year-old immunocompromised patient who developed sepsis and osteomyelitis due to Salmonella enterica subsp. arizonae secondary to exposure to iguana and snakes kept as pets at her home, and review all 23 previously published cases of bone and joint infections due to this organism, for a total of nine children and 15 adults. Eleven of the adults were female (73%), compared with three (33%) of the children (p <0.01). Significant underlying illnesses were present in all 15 adults and in five children (55%, p <0.05); 10 (77%) of the adults were immunosuppressed, compared with one child only (17%) (p <0.05). In ten of the adults the knee was infected (67%), compared with one child only (11%, p <0.01). Antibiotic therapy was prolonged in both adults and children, and in most cases consisted of 4-6 weeks of parenteral treatment. Complete cure and survival was attained in 11 of 15 adults (73%) and all nine children (NS). Optimal antibiotic treatment probably consists of ceftriaxone or a fluoroquinolone, if the organism is susceptible.
Collapse
Affiliation(s)
- S Kolker
- Division of Internal Medicine, Shaare Zedek Medical Centre, Affiliated with Hebrew University Hadassah Medical School, Jerusalem, Israel
| | | | | | | |
Collapse
|
32
|
Wiener-Well Y, Rudensky B, Yinnon A, Kopuit P, Schlesinger Y, Broide E, Lachish T, Raveh D. Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak. J Hosp Infect 2010; 74:344-9. [DOI: 10.1016/j.jhin.2009.07.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 07/21/2009] [Indexed: 12/01/2022]
|
33
|
Lachish T, Rudensky B, Slotki I, Zevin S. Enoxaparin Dosage Adjustment in Patients with Severe Renal Failure: Antifactor Xa Concentrations and Safety. Pharmacotherapy 2007; 27:1347-52. [PMID: 17896889 DOI: 10.1592/phco.27.10.1347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To evaluate the safety and efficacy, by measuring antifactor Xa levels, of enoxaparin 1 mg/kg subcutaneously once every 24 hours in patients with severe renal failure. DESIGN Prospective study. SETTING Emergency, internal medicine, geriatrics, and cardiology departments of a medical center in Israel. PATIENTS Nineteen patients with stage 4 or 5 chronic kidney disease who required full anticoagulation. INTERVENTION Patients received enoxaparin 1 mg/kg subcutaneously every 24 hours for 2 or more days, as determined by a treating physician. MEASUREMENTS AND MAIN RESULTS Data on patients' demographic and clinical characteristics were collected. Blood samples for peak and trough antifactor Xa levels were obtained during the enoxaparin treatment period. Of the 19 study patients, 14 (74%) had peak antifactor Xa levels within the recommended range for full anticoagulation of 0.5-1.0 U/ml after their first enoxaparin dose; no concentration exceeded 1.0 U/ml. The mean peak antifactor Xa level was not significantly different after the first enoxaparin dose compared with the second and third doses. The mean +/- SD trough antifactor Xa level, thought to be an indicator of drug accumulation, was 0.12 +/- 0.12 U/ml; its clinical significance and target range are still unknown. No major bleeding events were noted. CONCLUSION Enoxaparin 1 mg/kg once every 24 hours in patients with stage 4 or 5 chronic kidney disease who required full anticoagulation was safe, and this dose did not exceed recommended concentrations. The significance of enoxaparin trough levels remains unclear and should be investigated in future studies. Other dosing regimens of enoxaparin for specific patient populations should also be assessed for safety and efficacy.
Collapse
Affiliation(s)
- Tamar Lachish
- Department of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | |
Collapse
|
34
|
Shavit L, Lifschitz M, Lachish T, Rosenmann D, Balkin J, Slotki I. [Use of N-acetylcysteine prior to cardiac catheterization to prevent acute renal injury in patients with stage III chronic kidney disease]. Harefuah 2007; 146:655-736. [PMID: 17969299] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The role of N-acetylcysteine (NAC) to protect against contrast-induced nephropathy (CN) in patients with pre-existing renal insufficiency remains controversial despite several randomized controlled trials and meta-analyses. The potential reasons of inconsistency may be due to differences in definition, type and dose of contrast medium, imaging procedures, and the frequency of other potential causes of acute renal injury. Renal function before contrast administration is a major determinant of deterioration in function after administration. METHODS We conducted a retrospective review of patients with Stage III Chronic Kidney Disease (CKD) who underwent cardiac catheterization from January 2000 through January 2004 in our hospital. The incidence of CN was examined in patients pretreated and not pretreated with NAC. RESULTS From January 2000 to January 2004, 189 patients with Stage III CKD underwent cardiac catheterization. All patients received 0.45% or 0.9% saline hydration prior to catheterization. NAC was given prior to 83 catheterizations and not given prior to 57. Eleven of 57 patients (19.3%) not pretreated with NAC developed acute renal injury (ARI) while 6 of 83 who received NAC (7.2%) developed ARI (p<0.05). Nineteen patients underwent more than one cardiac catheterization, but there was no pattern to their potential for multiple episodes of ARI irrespective of prophylactic NAC administration. CONCLUSION In our study NAC offered significant protection against ARI in patients with Stage III CKD. No overt risk factor for multiple episodes of ARI was observed, nor was the occurrence of ARI after first cardiac catheterization predictive of ARI after a subsequent catheterization.
Collapse
Affiliation(s)
- Linda Shavit
- The Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
| | | | | | | | | | | |
Collapse
|