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Lodise TP, Scheetz M, Carreno JJ, Chambers H, Fowler V, Holland TL. Associations Between Vancomycin Exposure and Acute Kidney Injury Within the Recommended Area Under the Curve Therapeutic Exposure Range Among Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infections. Open Forum Infect Dis 2022; 9:ofab651. [PMID: 35079599 PMCID: PMC8783632 DOI: 10.1093/ofid/ofab651] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Among patients with methicillin-resistant Staphylococcus aureus bacteremia, vancomycin-associated acute kidney injury increased as a function of the day 2 area under the curve (AUC), even for daily AUCs within the recommended therapeutic range (400–600). Further data are needed to determine if daily AUCs <400 can be maintained without compromising efficacy.
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Affiliation(s)
- Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Marc Scheetz
- Midwestern University Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Joseph J Carreno
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Henry Chambers
- San Francisco General Hospital, San Francisco, California, USA
| | - Vance Fowler
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
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2
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Fowler V. How I treat persistent S. aureus bacteremia. Int J Antimicrob Agents 2021. [DOI: 10.1016/j.ijantimicag.2021.106420.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Lantos PM, Tsao J, Janko M, Arab A, von Fricken ME, Auwaerter PG, Nigrovic LE, Fowler V, Ruffin F, Gaines D, Broyhill J, Swenson J. Environmental Correlates of Lyme Disease Emergence in Southwest Virginia, 2005-2014. J Med Entomol 2021; 58:1680-1685. [PMID: 33825903 PMCID: PMC8285012 DOI: 10.1093/jme/tjab038] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 06/12/2023]
Abstract
Lyme disease is the most common tick-borne disease in North America. Though human infection is mostly transmitted in a limited geography, the range has expanded in recent years. One notable area of recent expansion is in the mountainous region of southwestern Virginia. The ecological factors that facilitate or constrain the range of human Lyme disease in this region remain uncertain. To evaluate this further, we obtained ecological data, including remotely sensed data on forest structure and vegetation, weather data, and elevation. These data were aggregated within the census block groups of a 9,153 km2 area around the cities of Blacksburg and Roanoke, VA, an area with heterogeneous Lyme disease transmission. In this geographic area, 755 individuals were reported to have Lyme disease in the 10 yr from 2006 to 2015, and these cases were aggregated by block group. A zero-inflated negative binomial model was used to evaluate which environmental variables influenced the abundance of Lyme disease cases. Higher elevation and higher vegetation density had the greatest effect size on the abundance of Lyme disease. Measures of forest edge, forest integrity, temperature, and humidity were not associated with Lyme disease cases. Future southward expansion of Lyme disease into the southeastern states may be most likely in ecologically similar mountainous areas.
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Affiliation(s)
- Paul M Lantos
- Departments of Medicine, Pediatrics, Community and Family Medicine, and Global Health, Duke University, Durham, NC
| | - Jean Tsao
- Department of Fisheries and Wildlife, Michigan State University, Lansing, MI
| | - Mark Janko
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Ali Arab
- Department of Mathematics and Statistics, Georgetown University, Washington, DC
| | | | - Paul G Auwaerter
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lise E Nigrovic
- Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA
| | - Vance Fowler
- Department of Medicine, Duke University, Durham, NC
| | | | - David Gaines
- Office of Epidemiology, Virginia Department of Health, Richmond, VA
| | - James Broyhill
- Office of Epidemiology, Virginia Department of Health, Richmond, VA
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4
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Hasse B, Hannan MM, Keller PM, Maurer FP, Sommerstein R, Mertz D, Wagner D, Fernández-Hidalgo N, Nomura J, Manfrin V, Bettex D, Hernandez Conte A, Durante-Mangoni E, Tang THC, Stuart RL, Lundgren J, Gordon S, Jarashow MC, Schreiber PW, Niemann S, Kohl TA, Daley CL, Stewardson AJ, Whitener CJ, Perkins K, Plachouras D, Lamagni T, Chand M, Freiberger T, Zweifel S, Sander P, Schulthess B, Scriven JE, Sax H, van Ingen J, Mestres CA, Diekema D, Brown-Elliott BA, Wallace RJ, Baddour LM, Miro JM, Hoen B, Athan E, Bayer A, Barsic B, Corey GR, Chu VH, Durack DT, Fortes CQ, Fowler V, Hoen B, Krachmer AW, Durante-Magnoni E, Miro JM, Wilson WR. International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass. J Hosp Infect 2019; 104:214-235. [PMID: 31715282 DOI: 10.1016/j.jhin.2019.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 02/09/2023]
Abstract
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
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Affiliation(s)
- B Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland.
| | - M M Hannan
- Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - F P Maurer
- Diagnostic Mycobacteriology Group, National and WHO Supranational Reference Center for Mycobacteria, Research Center, Borstel, Germany
| | - R Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mertz
- Departments of Medicine, Health Research Methods, Evidence and Impact, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - D Wagner
- Department of Internal Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg i.Br, Germany
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Nomura
- Kaiser Permanente Infectious Diseases, Los Angeles Medical Center, CA, USA
| | - V Manfrin
- Infectious and Tropical Diseases Department, San Bortolo Hospital, Vincenca, Italy
| | - D Bettex
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - A Hernandez Conte
- Department of Anaesthesiology, Kaiser Permanente, Los Angeles Medical Center, CA, USA
| | - E Durante-Mangoni
- Infectious and Transplant Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - T H-C Tang
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R L Stuart
- Monash Infectious Diseases, Monash Health, Australia
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - S Gordon
- Department of Infectious Diseases, Cleveland Clinic, OH, USA
| | - M C Jarashow
- Acute Communicable Disease Control, Los Angeles Department of Public Health, LA, USA
| | - P W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - S Niemann
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - T A Kohl
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - C L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - C J Whitener
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - K Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - D Plachouras
- Healthcare-associated Infections, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - M Chand
- National Infection Service, Public Health England, London, UK; Guy's and St Thomas' NHS Foundation Trust, Imperial College London, UK
| | - T Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - S Zweifel
- Ophthalmology Unit, University of Zurich, Switzerland
| | - P Sander
- National Center for Mycobacteria, Zurich, Switzerland, Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - J E Scriven
- Department of Infection and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK
| | - H Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - J van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A Mestres
- Clinic for Cardiovascular Surgery, University Hospital and University of Zurich, Switzerland
| | - D Diekema
- Division of Infectious Diseases, University of Iowa, Carver College of Medicine, IA, USA
| | - B A Brown-Elliott
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - R J Wallace
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - L M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Diseases, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
| | - J M Miro
- Infectious Diseases Service at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France.
| | | | | | - E Athan
- Infectious Diseases Department at Barwon Health, University of Melbourne and Deakin University, Australia
| | - A Bayer
- Geffen School of Medicine at UCLA Senior Investigator - LA Biomedical Research Institute at Harbor-UCLA, USA
| | - B Barsic
- Department for Infectious Diseases, School of Medicine, University of Zagreb, Croatia
| | - G R Corey
- Duke University Medical Center, Hubert-Yeargan Center for Global Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - V H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - D T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - C Q Fortes
- Division of Infectious Diseases, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - V Fowler
- Departments of Medicine and Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France
| | - A W Krachmer
- Harvard Medical School, Division of Infectious Diseases at the Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Durante-Magnoni
- Infectious and Transplant Medicine of the 'V. Monaldi' Teaching Hospital in Naples, University of Campania 'L. Vanvitelli', Italy
| | - J M Miro
- Infectious Diseases at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
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Bowen AC, Carapetis JR, Currie BJ, Fowler V, Chambers HF, Tong SYC. Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess. Open Forum Infect Dis 2017; 4:ofx232. [PMID: 29255730 PMCID: PMC5730933 DOI: 10.1093/ofid/ofx232] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 07/02/2017] [Accepted: 10/23/2017] [Indexed: 01/28/2023] Open
Abstract
Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial. We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or Staphylococcus aureus, including methicillin-resistant (MRSA). We identified 196 studies, and 15 underwent full text review by 2 reviewers. Observational studies, which mainly focused on SSTI due to S aureus, supported the use of SXT when compared with clindamycin or β-lactams. Of 10 randomized controlled trials, 8 demonstrated the efficacy of SXT for SSTI treatment including conditions involving GAS. These findings support SXT use for treatment of impetigo and purulent cellulitis (without an additional β-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, β-lactams remain the treatment of choice.
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Affiliation(s)
- Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth.,Princess Margaret Hospital for Children, Perth, Western Australia.,Menzies School of Health Research, Charles Darwin University, North Territory, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth.,Princess Margaret Hospital for Children, Perth, Western Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, North Territory, Australia.,Royal Darwin Hospital, North Territory, Australia
| | - Vance Fowler
- Duke University Division of Infectious Diseases, Durham, North Carolina
| | - Henry F Chambers
- Division of Infectious Disease, Department of Medicine, San Francisco General Hospital, California
| | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, North Territory, Australia.,Victorian Infectious Disease Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
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6
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Fowler V, Ruffin F, Kuinkel BS, Cyr DD, Guo S, Dykxhoorn D, Skov R, Bruun N, Dahl A, Lærke C, Scott W, Andersen P. Complicated Staphylococcus aureus Bacteremia (SAB) Is Associated with Genetic Variation in GLS2. Open Forum Infect Dis 2017. [PMCID: PMC5632279 DOI: 10.1093/ofid/ofx162.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background SAB is a serious, common infection. We used whole exome sequencing (WES) to examine the cumulative effect of coding variants in each gene on risk of complicated SAB in a discovery set of patients, and then evaluated the nominally significant genes in a replication set of patients using custom-capture sequencing. Methods The discovery set comprised 84 complicated SAB cases (endocarditis or bone/joint infection) frequency-matched by age (in deciles), sex, and bacterial clonal complex (CC5/30, CC8) to 84 uncomplicated SAB controls. All were white inpatients at Duke University. WES utilized Agilent SureSelect 72Mb capture kits, followed by sequencing on an Illumina HiSeq2000, alignment and base calling with a standard pipeline. The SKAT-O and EPACTS packages were used for gene-based association tests and logistic regression models with Firth bias correction, respectively. Both controlled for age, sex, and clonal complex as covariates. The replication set of 122 complicated SAB cases and 118 uncomplicated SAB controls was frequency matched by age, sex, and clonal complex. All were white Europeans collected by the Statens Serum Institute. An Agilent SureSelect 2Mb capture array captured genic sequence for 342 genes nominally associated with complicated SAB in discovery (SKAT-O P < 0.035). Sequencing and data analysis proceeded as for WES. A Bonferroni-corrected gene-based test P-value of 1.5×10–4 determined significance in the replication set. Results One gene, GLS2, was significantly associated with complicated SAB in the replication set (P = 1.2 x 10–4). The strongest single-variant association in all 342 genes was rs2657878 in GLS2 (p = 5×10−4). This variant is strongly correlated with a missense variant (rs2657879, p = 4.4x10-3) in which the minor allele (associated here with complicated SAB) has previously been shown to reduce circulating glutamine levels. Conclusion Comprehensive examination of the coding sequence for association with complicated SAB in a two-stage discovery/replication design identified a novel candidate gene. GLS2 is an interesting candidate for complicated SAB due to its role in regulating glutamine production, a key factor in activation of T-cell production. Disclosures V. Fowler Jr., Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy, Janssen, xBiotech, Contrafect: Consultant, Consulting fee; NIH, Basilea, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Contrafect; Karius: Grant Investigator, Research grant; Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm: Consultant, Consulting fee; UpToDate: author on several chapters, Royalties
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Affiliation(s)
- Vance Fowler
- Medicine, Duke University, Durham, North Carolina
| | - Felicia Ruffin
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Derek D Cyr
- Center for Applied Genomics & Precision Medicine, Duke University, Durham, North Carolina
| | | | | | - Robert Skov
- National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Bruun
- Gentofte University Hospital, Copenhagen, Denmark
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7
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Lodise TP, Rosenkranz SL, Finnemeyer M, Huvane J, Pereira A, Sims M, Zervos MJ, Creech CB, Patel PC, Keefer M, Riska P, Silveira FP, Scheetz M, Wunderink RG, Rodriguez M, Schrank J, Bleasdale SC, Schultz S, Barron M, Stapleton A, Chambers H, Fowler V, Holland TL. The Emperor’s New Clothes: Prospective Observational Evaluation of the Association between the Day 2 Vancomycin Exposure and Failure Rates among Adult Hospitalized Patients with MRSA Bloodstream Infections (PROVIDE). Open Forum Infect Dis 2017. [PMCID: PMC5632097 DOI: 10.1093/ofid/ofx162.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Current guidelines recommend vancomycin (VAN) dosing to achieve AUC/MIC ratio ≥400 for patients (pts) with serious MRSA bloodstream infections (BSI), but supporting data were largely derived in single center retrospective studies. A recent study using a Bayesian approach to estimate the VAN AUC found that patients with MRSA BSI who had an AUCDAY2/MICBMD ≥ 650 or an AUCDAY2/MICETEST ≥ 320 had lower incidences of failure (Clin Infect Dis 59:666, 2014). This study prospectively evaluated if these VAN AUCDAY2/MIC targets were associated with lower incidences of failure (PROVIDE, Award number UM1AI104681, Antibacterial Resistance Leadership Group). Methods Prospective, multi-center (n = 14), observational study (2014–2106) of hospitalized adults with confirmed MRSA BSI treated with VAN ≥ 72h. Exclusion: (1) neutropenia; (2) cystic fibrosis; (3) renal replacement therapy; (4) APACHE-II score > 25; (5) previous MRSA BSI within 60 days. VAN exposures were estimated using maximum a posteriori probability procedure in ADAPT 5. MICBMD and MICETEST were performed at a central laboratory. Outcomes: failure (30-day mortality or MRSA BSI ≥ 7 days); acute kidney injury (AKI), ≥1.5 × increase in serum creatinine (Scr) among patients with a baseline SCR < 2.0mg/dl. The study was powered at 80% to detect a 17.5% difference in failure between AUCDAY2/MIC groups. Results Among the 265 evaluable patients, mean (SD) age was 61 (17) and APACHE-II was 12 (6). Endocarditis was definite/possible in 29%. The MIC50/90 by BMD and ETEST were 1/1 and 1.5/1.5mg/l, respectively. Failure occurred in 18%; 26% had AKI. Mean (SD) VAN duration was 18 (14) days. Mean (SD) AUCDAY2 was 586.9 (235.5) and 44% and 73% of patients achieved an AUCDAY2/MICBMD ≥ 650 and AUCDAY2/MICETEST ≥ 320. In the multivariate analyses (Figure 1), failure was not significantly different between AUCDAY2/MIC groups. In contrast, AKI was significantly more common in patients with an AUCDAY2/ MICETEST > = 320. Conclusion Achievement of higher VAN AUCDAY2/MIC exposures for patients with MRSA BSIs were not associated with better outcomes and were found to result in increased AKI. Clinicians should assess the benefits vs. risks of using VAN regimens that confer high AUCDAY2/MIC exposures for patients with MRSA BSIs. Disclosures T. P. Lodise Jr., allergan: Consultant, Grant Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee and Speaker honorarium; medicines company: Consultant, Grant Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium; melinta: Consultant, Consulting fee; motif: Consultant and Scientific Advisor, Consulting fee; paratek: Consultant and Scientific Advisor, Consulting fee; nabriva: Consultant, Consulting fee; M. J. Zervos, Merck, Inc.: Investigator, Research grant; M. Scheetz, Bayer: Scientific Advisor, Consulting fee; V. Fowler Jr., Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy, Janssen, xBiotech, Contrafect: Consultant, Consulting fee; NIH, Basilea, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Contrafect; Karius: Grant Investigator, Research grant; Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm: Consultant, Consulting fee; UpToDate: author on several chapters, Royalties
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Affiliation(s)
- Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York
| | | | - Matthew Finnemeyer
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
| | | | - Alenda Pereira
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - C Buddy Creech
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | | | - Marc Scheetz
- Department of Pharmacy, Northwestern Medicine, Chicago, Illinois
| | - Richard G Wunderink
- Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Martin Rodriguez
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - John Schrank
- Infectious Disease, Greenville Health System, Greenville, South Carolina
| | - Susan C Bleasdale
- Division of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois
| | - Sara Schultz
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Michelle Barron
- Internal Medicine/Infectious Diseases, University of Colorado Denver, Aurora, Colorado
| | - Ann Stapleton
- Medicine, University of Washington, Seattle, Washington
| | - H Chambers
- SF General Hosp, San Francisco, California
| | - Vance Fowler
- Medicine, Duke University, Durham, North Carolina
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8
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Holland TL, Boucher HW, Raad I, Anderson DJ, Cosgrove SE, Aycock S, Baddley JW, Chow SC, Chu VH, Cook PP, Corey GR, Daly JS, Hachem RY, Chaftari AM, Horton JM, Jenkins TC, Gu J, Levine DP, Miro JM, Riska P, Rubin ZA, Rupp ME, Schrank J, Sims M, Wray D, Zervos MJ, Fowler V. Doing the Same with Less: A Randomized, Multinational, Open-Label, Adjudicator-Blinded Trial of an Algorithm vs. Standard of Care to Determine Treatment Duration for Staphylococcal Bacteremia. Open Forum Infect Dis 2017. [PMCID: PMC5632232 DOI: 10.1093/ofid/ofx162.072] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The appropriate duration of antibiotics for staphylococcal bloodstream infection (BSI) is unknown. An algorithm to identify patients with staphylococcal BSI who can be safely treated with shorter courses of therapy would improve care and reduce total antibiotic use.
Methods
Adult patients with staphylococcal BSI were randomized to treatment based on algorithm-based therapy (ABT) or to standard of care (SOC). Co-primary outcomes were clinical success, as determined by a blinded Adjudication Committee, and serious adverse event (SAE) rates. The prespecified secondary outcome measure was antibiotic days by treatment group, among patients without complicated BSI. Prespecified durations of therapy in ABT were: S. aureus BSI (SAB): uncomplicated: 14 days; complicated: 4–6 weeks. Coagulase-negative staphylococci BSI (CoNSB): simple (1 positive blood culture) (0–3 days), uncomplicated (>1 positive blood culture) (5 days), complicated (7–28 days). Outcomes were compared using intention-to-treat principles. The target sample size was 500 patients, to ensure 90% power for establishing noninferiority within a margin of 15%.
Results
Between April 2011 and March 2017, 509 adults with suspected staphylococcal BSI at 16 sites in the US and Spain were randomized to ABT (N = 255) or SOC (N = 254). There were 116 patients with SAB (23%) and 385 (76%) with CoNSB (Figure 1). Overall success rate in the ABT group was 82.0% vs. 81.5% in the SOC group, difference 0.5%, 95% CI −5.2% to 6.1%. SAEs were reported in 32.9% of ABT vs. 28.3% of SOC patients (OR 1.2, 95% CI 0.9 to 1.8). Among evaluable patients without complicated BSI, mean duration of therapy was 4.4 days in the ABT group vs. 6.4 days in the SOC group (difference −2.0 days, 95% CI −3.3 to −-0.7, P = 0.003). Among patients with uncomplicated SAB, treatment durations were similar (15.3 days in ABT vs. 16.3 days in SOC, difference −1 day, 95% CI −3.89 to 1.91, P = 0.497), whereas for uncomplicated CoNSB, duration was shorter in the ABT group (5.3 days in ABT vs. 8.4 days in SOC, difference −3 days, 95% CI −4.87 to −1.34, P < 0.001).
Conclusion
The use of a treatment algorithm for staphylococcal BSI was associated with significant reductions in duration of antibiotic therapy in patients without complicated BSI, without significant differences in overall success or SAEs.
Disclosures
V. Fowler Jr., NIH: Investigator, Contract HHSN272200900023C
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Affiliation(s)
| | | | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Suzanne Aycock
- Duke Clinical Research Institute, Durham, North Carolina
| | - John W Baddley
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina
| | - Paul P Cook
- Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - G Ralph Corey
- Duke University Medical Center, Durham, North Carolina
| | - Jennifer S Daly
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ray Y Hachem
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Jose M Miro
- Hospital Clinic-IDIBAPS, Barcelona, Spain
- Hospital Clínic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | - Zachary A Rubin
- David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - John Schrank
- Greenville Health System, Greenville, South Carolina
| | | | - Dannah Wray
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Vance Fowler
- Duke University Medical Center, Durham, North Carolina
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9
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Lauridsen TK, Park L, Selton-Suty C, Peterson G, Dickerman S, Cecchi E, Habib G, Johansson M, Lerakis S, Tamin S, Thuny F, Bermejo J, Pare C, Bruun NE, Chu V, Fowler V, Wang A, Crowley AL. ECHOCARDIOGRAPHIC PREDICTORS FOR IN-HOSPITAL AND 1-YEAR OUTCOMES IN LEFT-SIDED INFECTIVE ENDOCARDITIS: AN ANALYSIS FROM THE INTERNATIONAL COLLABORATION ON ENDOCARDITIS-PROSPECTIVE ECHO COHORT STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Turner N, Moehring RW, Fowler V, Schmader K, Weber DJ, Sexton DJ, Anderson DJ. Multi-drug-resistant Organisms (MDROs) Have Escaped the Hospital: Evidence of Community Acquisition at a Regional Hospital. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Souli M, Ruffin F, Park L, Sharma-Kuinkel BK, Thaden JT, Maskarinec S, Gao S, Lent NC, Wanda L, Hill-Rorie J, Warren B, Hansen B, Fowler V. Twenty-One Years of Staphylococcus aureus Bacteremia (SAB): Variations in Bacterial Genotype and Clinical Phenotype in the S. aureus Bacteremia Group Prospective Cohort Study (SABG-PCS) from 1995 to 2015. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Thaden JT, Sutton G, Ruffin F, Fouts D, Fowler V. Sequence Type 393 Associated with Increased Mortality in Escherichia coli Bloodstream Infections. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Holland TL, Davis JS, Doernberg SB, Tran TTT, Evans SR, Cosgrove SE, Boucher HW, Corey GR, Fowler V, Chambers HF, Tong SYC. Analysis of CAMERA-1 S. aureus Bacteremia Trial Results Using the DOOR. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Brumwell A, Thaden JT, Lantos P, Hoffman K, Ruffin F, Fowler V. Escherichia coli ST131 is Associated With Increased Mortality In Bloodstream Infections From Urinary Tract Source. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Evans S, Tran TTT, Hujer A, Hill C, Hujer KM, Mediavilla JR, Manca C, Domitrovic TN, Kreiswirth BN, Patel R, Jacobs MR, Perez F, Chen L, Sampath R, Hall T, Marzan C, Fowler V, Chambers H, Bonomo RA. Choosing Ceftazidime/Avibactam and Ceftolozane/Tazobactam as Empiric Therapies against Pseudomonas aeruginosa (Pa) using Rapid Molecular Diagnostics (RMDs): PRIMERS IV. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Scott Evans
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Thuy Tien T. Tran
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Andrea Hujer
- Case Western Reserve University, Cleveland, Ohio
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Carol Hill
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Kristine M. Hujer
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Jose R. Mediavilla
- Public Health Research Institute, Rutgers University, Newark, New Jersey
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Claudia Manca
- Public Health Research Institute - Rutgers University, Newark, New Jersey
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - T. Nicholas Domitrovic
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Barry N. Kreiswirth
- Public Health Research Institute Tuberculosis Center, Rutgers University, Newark, New Jersey
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Robin Patel
- Divisions of Clinical Microbiology and Infectious Diseases, Mayo Clinic, Rochester, Minnesota
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Michael R. Jacobs
- Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Federico Perez
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Liang Chen
- Public Health Research Institute, Rutgers University, Newark, New Jersey
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Rangarajan Sampath
- Ibis Biosciences, Inc., Carlsbad, California
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Thomas Hall
- Ibis Biosciences, Carlsbad, California
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Christine Marzan
- Ibis Biosciences, Carlsbad, California
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Vance Fowler
- Duke University, Durham, North Carolina
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Henry Chambers
- University of California, San Francisco, San Francisco, California
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Robert A. Bonomo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, Ohio
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
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16
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Rojas LJ, Marshall S, Cober E, Richter SS, Perez F, Salata R, Kalayjian R, Watkins RR, Doi Y, Kaye KS, Evans S, Fowler V, Van Duin D, Bonomo RA. Molecular Analysis of Colistin Resistance Among Klebsiella pneumoniae Producing K pneumoniae Carbapenemase: Heterogeneity of Genetic Mechanisms. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura J. Rojas
- Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, Ohio
| | - Steven Marshall
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Eric Cober
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Sandra S. Richter
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Federico Perez
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Robert Salata
- University Hospitals Case Medical Center, Cleveland, Ohio
| | - Robert Kalayjian
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | | | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Scott Evans
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | - David Van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Robert A. Bonomo
- Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, Ohio
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Doernberg S, Gouskova N, Evans S, Boucher H, Corey G, Cosgrove S, Chambers H, Fowler V, Holland T. BAC DOOR: A Clinician Ranking Exercise for Better Staphylococcus aureus Bacteremia Trial Design. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Doernberg
- University of California, San Francisco, San Francisco, California
| | | | - Scott Evans
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | - G. Corey
- Duke University Medical Center, Durham, North Carolina
| | - Sara Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry Chambers
- University of California, San Francisco, San Francisco, California
| | | | - Thomas Holland
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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18
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Evans S, Kreiswirth B, Fowler V, Chambers H, Patel R, Hujer AM, Perez F, Bonomo RA. Reply to Lesho and Clifford. Clin Infect Dis 2016; 63:571-2. [PMID: 27225238 DOI: 10.1093/cid/ciw336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/08/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Scott Evans
- Center for Biostatistics in AIDS Research and the Department of Biostatistics, Harvard University, Boston, Massachusetts
| | - Barry Kreiswirth
- Public Health Research Institute Center, New Jersey Medical School-Rutgers University, Newark
| | - Vance Fowler
- Duke Clinical Research Institute, Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Henry Chambers
- University of California, San Francisco General Hospital
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrea M Hujer
- Department of Medicine, Case Western Reserve University School of Medicine Louis Stokes Cleveland Department of Veterans Affairs Medical Center
| | - Federico Perez
- Department of Medicine, Case Western Reserve University School of Medicine Louis Stokes Cleveland Department of Veterans Affairs Medical Center
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine Louis Stokes Cleveland Department of Veterans Affairs Medical Center Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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19
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Thaden JT, Li Y, Ruffin F, Reed S, Fowler V. Risk Factors for and Clinical Outcomes of Multidrug-Resistant Gram-Negative Bacterial Bloodstream Infections: Initial Results From a 12-Year Prospective Cohort Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Lantos PM, Branda JA, Boggan JC, Chudgar SM, Wilson EA, Ruffin F, Fowler V, Auwaerter PG, Nigrovic LE. Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence. Clin Infect Dis 2015. [PMID: 26195017 DOI: 10.1093/cid/civ584] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Lyme disease is diagnosed by 2-tiered serologic testing in patients with a compatible clinical illness, but the significance of positive test results in low-prevalence regions has not been investigated. METHODS We reviewed the medical records of patients who tested positive for Lyme disease with standardized 2-tiered serologic testing between 2005 and 2010 at a single hospital system in a region with little endemic Lyme disease. Based on clinical findings, we calculated the positive predictive value of Lyme disease serology. Next, we reviewed the outcome of serologic testing in patients with select clinical syndromes compatible with disseminated Lyme disease (arthritis, cranial neuropathy, or meningitis). RESULTS During the 6-year study period 4723 patients were tested for Lyme disease, but only 76 (1.6%) had positive results by established laboratory criteria. Among 70 seropositive patients whose medical records were available for review, 12 (17%; 95% confidence interval, 9%-28%) were found to have Lyme disease (6 with documented travel to endemic regions). During the same time period, 297 patients with a clinical illness compatible with disseminated Lyme disease underwent 2-tiered serologic testing. Six of them (2%; 95% confidence interval, 0.7%-4.3%) were seropositive, 3 with documented travel and 1 who had an alternative diagnosis that explained the clinical findings. CONCLUSIONS In this low-prevalence cohort, fewer than 20% of positive Lyme disease tests are obtained from patients with clinically likely Lyme disease. Positive Lyme disease test results may have little diagnostic value in this setting.
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Affiliation(s)
- Paul M Lantos
- Divisions of Pediatric Infectious Diseases General Internal Medicine
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital
| | | | | | - Elizabeth A Wilson
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | | | | | - Paul G Auwaerter
- Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Massachusetts
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21
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Hujer AM, Evans S, Jiang H, Hujer KM, Hall T, Marzan C, Jacobs M, Sampath R, Ecker DJ, Domitrovic TN, Manca C, Chavda K, Zhang P, Chen L, Hill C, Perez F, Kreiswirth B, Fowler V, Chambers HF, Bonomo RA. 608Can Rapid Molecular Diagnostics Assist in the Choice of b-Lactam Antibiotics? An Analysis of Data from PRIMERS-II of the Antibiotic Resistance Leadership Group (ARLG). Open Forum Infect Dis 2014. [PMCID: PMC5782209 DOI: 10.1093/ofid/ofu051.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Scott Evans
- Center for Biostatistics in AIDS Research, Harvard University, Boston, MA
| | - Hongyu Jiang
- Biostatistics, Harvard School of Public Health, Boston, MA
| | - Kristine M. Hujer
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | | | | | - Michael Jacobs
- Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH
| | - Ranga Sampath
- Ibis Biosciences, Inc., A Division of Abbott, Carlsbad, CA
| | | | | | | | | | - Pan Zhang
- Weill Cornell Medical College, New York, NY
| | | | - Carol Hill
- Duke University Medical Center, Durham, NC
| | - Federico Perez
- Cleveland VAMC Case Western Reserve University, Cleveland Heights, OH
| | - Barry Kreiswirth
- University of Medicine and Dentistry of NJ, PHRI TB Center, Newark, NJ
| | | | - Henry F. Chambers
- University of California, San Francisco General Hospital, San Francisco, CA
| | - Robert A. Bonomo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
- Medicine, Pharmacology and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH
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Messina J, Cober E, Richter SS, Kaye K, Salata R, Evans S, Bonomo RA, Fowler V, Van Duin D. 1804Use of Tigecycline in Patients with Carbapenem-resistant Klebsiella pneumoniae (CRKP) is Associated with Increased Risk for Readmissions with CRKP. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu051.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Eric Cober
- Infectious Disease, Cleveland Clinic, Cleveland, OH
| | | | | | - Robert Salata
- University Hospitals Case Medical Center, Cleveland, OH
| | - Scott Evans
- Center for Biostatistics in AIDS Research, Harvard University, Boston, MA
| | - Robert A. Bonomo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
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Zaas AK, Burke T, Chen M, McClain M, Nicholson B, Veldman T, Tsalik EL, Fowler V, Rivers EP, Otero R, Kingsmore SF, Voora D, Lucas J, Hero AO, Carin L, Woods CW, Ginsburg GS. A host-based RT-PCR gene expression signature to identify acute respiratory viral infection. Sci Transl Med 2014; 5:203ra126. [PMID: 24048524 DOI: 10.1126/scitranslmed.3006280] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Improved ways to diagnose acute respiratory viral infections could decrease inappropriate antibacterial use and serve as a vital triage mechanism in the event of a potential viral pandemic. Measurement of the host response to infection is an alternative to pathogen-based diagnostic testing and may improve diagnostic accuracy. We have developed a host-based assay with a reverse transcription polymerase chain reaction (RT-PCR) TaqMan low-density array (TLDA) platform for classifying respiratory viral infection. We developed the assay using two cohorts experimentally infected with influenza A H3N2/Wisconsin or influenza A H1N1/Brisbane, and validated the assay in a sample of adults presenting to the emergency department with fever (n = 102) and in healthy volunteers (n = 41). Peripheral blood RNA samples were obtained from individuals who underwent experimental viral challenge or who presented to the emergency department and had microbiologically proven viral respiratory infection or systemic bacterial infection. The selected gene set on the RT-PCR TLDA assay classified participants with experimentally induced influenza H3N2 and H1N1 infection with 100 and 87% accuracy, respectively. We validated this host gene expression signature in a cohort of 102 individuals arriving at the emergency department. The sensitivity of the RT-PCR test was 89% [95% confidence interval (CI), 72 to 98%], and the specificity was 94% (95% CI, 86 to 99%). These results show that RT-PCR-based detection of a host gene expression signature can classify individuals with respiratory viral infection and sets the stage for prospective evaluation of this diagnostic approach in a clinical setting.
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Affiliation(s)
- Aimee K Zaas
- Institute for Genome Sciences and Policy, Duke University School of Medicine, Durham, NC 27710, USA
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Fowler V, Robinson L, Bankowski B, Cox S, Parida S, Lawlor C, Gibson D, O'Brien F, Ellefsen B, Hannaman D, Takamatsu HH, Barnett PV. A DNA vaccination regime including protein boost and electroporation protects cattle against foot-and-mouth disease. Antiviral Res 2012; 94:25-34. [PMID: 22330893 DOI: 10.1016/j.antiviral.2012.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 11/21/2022]
Abstract
Protection against foot-and-mouth disease (FMD) using DNA technology has been documented for sheep and pigs but not for the highly susceptible species of cattle. Twenty-five Holstein Friesian cross-bred cattle were vaccinated twice, 21 days apart, with a DNA vaccine containing the capsid coding region (P1) along with the non-structural proteins 2A, 3C and 3D (pcDNA3.1/P1-2A3C3D) of O(1) Kaufbeuren alone or coated onto PLG (d,l-lactide-co-glycolide) microparticles. In some pcDNA3.1/P1-2A3C3D was also combined with an adjuvant plasmid expressing bovine granulocyte macrophage colony stimulating factor (GM-CSF). DNA vaccinations were administered intramuscularly with, or without, the use of electroporation and at 42 days post primary vaccination cattle received a protein boost of 146S FMD virus (FMDV) antigen and non-structural protein 3D. For comparison, four cattle were vaccinated with a conventional FMD vaccine and two more included as unvaccinated controls. Apart from those immunised with PLG microparticles all cattle were challenged with 10(5) TCID(50) cattle adapted O(1) Lausanne FMDV virus at day 93 post primary vaccination. All DNA vaccinated cattle regardless of regime developed good humoral and cell mediated responses prior to challenge. The best overall virus neutralising antibody, IFN-γ and clinical protection (75%) were seen in the cattle whereby the DNA was delivered by electroporation. In contrast, only 25% of cattle vaccinated with the DNA vaccine without electroporation were clinically protected. The addition of GM-CSF in combination with electroporation further improved the efficacy of the vaccine, as demonstrated from the reduction of clinical disease and virus excretions in nasal swabs. We thus demonstrate for the first time that cattle can be clinically protected against FMDV challenge following a DNA prime-protein boost strategy, and particularly when DNA vaccine is combined with GM-CSF and delivered by electroporation.
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Affiliation(s)
- V Fowler
- Institute for Animal Health, Pirbright Laboratory, Surrey, UK.
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Fowler V, Holland T. Reply to Gould. J Infect Dis 2012. [DOI: 10.1093/infdis/jir847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kanafani Z, Boucher H, Fowler V, Cabell C, Hoen B, Miró JM, Lalani T, Vigliani G, Campion M, Corey R, Levine D. Daptomycin compared to standard therapy for the treatment of native valve endocarditis. Enferm Infecc Microbiol Clin 2010; 28:498-503. [PMID: 20188444 DOI: 10.1016/j.eimc.2009.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/15/2009] [Accepted: 07/17/2009] [Indexed: 01/23/2023]
Abstract
INTRODUCTION In a recent randomized trial of Staphylococcus aureus bacteremia and native valve endocarditis, daptomycin was found not inferior to standard therapy. We summarized findings in the subgroup of patients with endocarditis according to the Duke criteria. METHODS Patients were randomly assigned to receive daptomycin 6 mg/kg/day or standard therapy (vancomycin 1g every 12h or antistaphylococcal penicillin 2g every 4h, both with gentamicin 1mg/kg every 8h for the first 4 days). The primary end point was success in the modified intent-to-treat population 6 weeks after the end of therapy. RESULTS Fifty-three patients were included: 35 with right-sided endocarditis (RIE) and 18 with left-sided endocarditis (LIE). The success rates in patients with RIE were similar between daptomycin and the comparator (42% vs 44%). Patients with RIE with septic pulmonary infarcts responded similarly to treatment with daptomycin and standard therapy (60% vs 67%). In the LIE population, treatment success rates were poor in both arms (11% vs 22%). CONCLUSION Daptomycin is an efficacious and well-tolerated alternative to standard therapy in the treatment of RIE. Patients with LIE had a poor outcome regardless of the treatment received. Daptomycin is also effective in treating endocarditis with septic pulmonary infarcts.
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Affiliation(s)
- Zeina Kanafani
- American University of Beirut Medical Center, Beirut, Líbano
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Roncato-Saberan M, Alla F, Leroy J, Doco-Lecompte T, Fowler V, Miró J, Mudrick D, Chirouze C, Corey R, Hoen B. 103 LOW RATE OF EARLY VALVE SURGERY (EVS) IN STAPHYLOCOCCUS AUREUS (SA) NATIVE VALVE (NV) INFECTIVE ENDOCARDITIS (IE): CAN WE SOLVE THE CONUNDRUM? Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
With infective endocarditis afflicting 15,000 patients each year and with a mortality rate that still hovers at almost 40%, the disease remains a very serious health problem. Surprisingly, the incidence has not declined over the last 30 years, and now with more health care interventions, such as pacer/defibrillators, and an increasingly elderly population with degenerative valvular heart disease, the number susceptible to endocarditis is actually increasing. Given the weak evidence for endocarditis prophylaxis, there remains a large population at risk. Much has been learned recently about the pathogenesis of endocarditis, including the role of endothelial damage, platelet adhesion, and microbial adherence to the vegetation or intact valvular tissue. Three-fourths of patients have preexisting structural heart disease. Once infection is manifest, major cardiac complications include congestive heart failure, embolization, mycotic aneurysms, renal dysfunction, and abscess formation. The diagnosis of endocarditis has been enhanced recently by modifications in the Duke criteria to include the use of transesophageal echocardiography and microbial antibody titers. Surgery continues to play an important role, with criteria for emergency, urgent, and early surgery now defined. The major organisms involved in infective endocarditis include streptococci and staphylococcus (representing 75% or so of all cases). Enterococcal infections account for many of the remaining cases, although small series and case reports suggest almost all organisms that infect humans can be implicated at times. A sizeable number of "culture-negative" cases still occur despite all the improvements in diagnostic methodology. Recent guidelines for the diagnosis, treatment, and management of infective endocarditis from the American Heart Association are reviewed and the issues surrounding prophylaxis are summarized. International cooperative databases are now being developed that hold promise for a continual reexamination of the epidemiology of this highly aggressive disease and may help provide sorely needed prospective trial data that will enhance our understanding and treatment.
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Abstract
The explosive growth in the use of cardiac devices and the continued large number of thoracic operations produce a significant number of costly infectious complications. These infections represent a leading cause of death and disability after device implantation or surgery. Unfortunately, few objective data are available to validate the clinical epidemiology of surgical and device-related infections, and although the number of randomized trials is increasing, too few have tested strategies for prophylaxis or treatment, particularly in the cardiac arena. Because of the expected increase in invasive vascular procedures and device implantations, it is timely to consider innovative approaches to clinical research that will hasten the translation of effective therapeutic strategies and technologies into clinical practice. Because of the multidisciplinary nature of the care of patients undergoing thoracic surgery or device implantation, bringing together existing networks and several arms of the Federal government could rapidly advance this field to provide a definitive base of evidence to guide clinical practice and improve clinical outcomes. The remainder of the articles in this supplement discuss specific issues on the diagnosis and treatment of device-related or surgical infection. The purpose of this manuscript is to discuss issues about the design of studies and their organization.
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Affiliation(s)
- Robert M Califf
- Division of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC 27715, USA.
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Valente AM, Jain R, Scheurer M, Fowler V, Ralph Corey G, Resal Bengur A, Sanders S, Li J. 1171-206 Frequency of infective endocarditis among infants and children with staphylococcus aureus bacteremia. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El-Ahdab FM, Wang A, Cabell C, Reller B, Corey R, Sexton D, Fowler V. 1143-135 The risk of prosthetic valve endocarditis in patients with staphylococcus aureus bacteremia. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Webb Y, Clifford P, Fowler V, Morgan C, Hanson M. Comparing patients' experience of mental health services in England: a five-Trust survey. Int J Health Care Qual Assur Inc Leadersh Health Serv 2001; 13:273-81. [PMID: 11484645 DOI: 10.1108/09526860010373253] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The implementation of the Care Programme Approach (CPA) in English mental health services has been slow to proceed despite general support, both in England and in other countries, of its principles of good practice. This study set out to evaluate the implementation of the CPA directly from patients' experience using the "Your Treatment and Care" assessment tool. The results of a survey of 503 patients across five NHS Trusts in England showed that many patients did not have a copy of their care plan and had not been involved in the care planning procedure. Many reported shortcomings in their experience of their key worker and their psychiatrist. However, there was substantial variation in experience across services. "Your Treatment and Care" showed good internal reliability, was acceptable to users, and appeared to be able to access actual experiences better than a traditional "satisfaction" item. It appears to be very useful as a benchmarking tool and is now being used in services across the UK, the USA and Australia.
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Affiliation(s)
- Y Webb
- Centre for Outcomes, Research and Effectiveness (CORE), University College, London, UK
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Fowler V. Models for actin filament organization in the erythrocyte membrane skeleton. Blood 2000; 96:780-2. [PMID: 10950518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Rowe PJ, Crosbie J, Fowler V, Durward B, Baer G. A new system for the measurement of displacements of the human body with widespread applications in human movement studies. Med Eng Phys 1999; 21:265-75. [PMID: 10514045 DOI: 10.1016/s1350-4533(99)00057-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/19/2022]
Abstract
This paper reports the development, construction and use of a new system for the measurement of linear kinematics in one, two or three dimensions. The system uses a series of rotary shaft encoders and inelastic tensioned strings to measure the linear displacement of key anatomical points in space. The system is simple, inexpensive, portable, accurate and flexible. It is therefore suitable for inclusion in a variety of motion analysis studies. Details of the construction, calibration and interfacing of the device to an IBM PC computer are given as is a full mathematical description of the appropriate measurement theory for one, two and three dimensions. Examples of the results obtained from the device during gait, running, rising to stand, sitting down and pointing with the upper limb are given. Finally it is proposed that, provided the constraints of the system are considered, this method has the potential to measure a variety of functional human movements simply and inexpensively and may therefore be a valuable addition to the methods available to the motion scientist.
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Affiliation(s)
- P J Rowe
- Department of Physiotherapy, Queen Margaret University College, Leith Campus, Edinburgh, UK.
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Abstract
OBJECTIVE An investigation of the effect of the length of knee extensor muscles on the pendulum test. DESIGN Descriptive. Statistical analysis utilized analysis of variance with planned comparisons. SETTING Community clubs and a stroke rehabilitation unit. PARTICIPANTS Twenty subjects aged 54 to 83 yrs, more than 6 weeks after stroke, and 31 healthy subjects aged 60 to 79 yrs. OUTCOME MEASURES Two tests: pendulum test and knee extensor muscle length test. RESULTS For both affected and intact legs, stroke subjects had significantly smaller angle of reversal (p < .001), peak angular velocity (p < .001), and maximum passive knee flexion (p < .001) than healthy subjects. When angle of reversal was normalized for passive knee flexion, there were no significant differences between healthy and stroke subjects. There were no significant differences in any variable between the intact and affected legs of the stroke subjects. CONCLUSION Soft tissue changes, rather than hyperreflexia, may explain the decreased angle of reversal and peak angular velocity in the stroke subjects studied.
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Affiliation(s)
- V Fowler
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
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Wade LD, Canning CG, Fowler V, Felmingham KL, Baguley IJ. Changes in postural sway and performance of functional tasks during rehabilitation after traumatic brain injury. Arch Phys Med Rehabil 1997; 78:1107-11. [PMID: 9339161 DOI: 10.1016/s0003-9993(97)90136-2] [Citation(s) in RCA: 45] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate changes in postural sway while standing, walking parameters, and performance of functional tasks during rehabilitation in a group of traumatic brain injury (TBI) patients. DESIGN Descriptive. SETTING Inpatient brain injury rehabilitation unit. PARTICIPANTS Thirteen subjects undergoing rehabilitation after severe TBI. OUTCOME MEASURES Two assessments were performed, 2 to 6 weeks apart that included the following: postural sway in three stance conditions; temporal and spatial parameters of walking; functional assessments of walking, standing up, reaching while standing, and stair climbing. RESULTS There were significant reductions in postural sway in all stance conditions (p < .05) and significant increases in velocity of walking (p < .05), stride length (p < .01), and left and right step lengths (p < .01). Performance on all functional tasks improved (p < .05) except for functional reach. There were no significant correlations between changes in postural sway and changes in walking parameters or functional assessments. CONCLUSION This study demonstrated significant improvements in postural sway, walking parameters, and functional tasks during a relatively short period of rehabilitation after severe TBI. Improvements in standing balance appear to be independent of improvements in walking performance, suggesting that different mechanisms underlie improved control of these tasks.
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Affiliation(s)
- L D Wade
- Brain Injury Rehabilitation Programme, Westmead Hospital, Sydney, Australia
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Abstract
BACKGROUND Acute renal failure has long been associated with severe Rocky Mountain spotted fever (RMSF). Despite many descriptions of the protean manifestations of this disease, relatively little is known concerning the risk factors for acute renal failure. Only a few studies have examined the outcome of patients infected with Rickettsia rickettsii who develop renal insufficiency, and these studies had methodological problems. OBJECTIVE To study the incidence, risk factors, and outcomes of acute renal failure in a large group of hospitalized patients with definite or probable RMSF. METHODS The clinical records of 114 patients with definite or probable RMSF were retrospectively reviewed to identify clinical and biochemical abnormalities at the time of admission that were associated with the development of acute renal failure and subsequent mortality. Renal failure was defined as a serum creatinine (Cr) above 2 mg/dL. Logistic regression was used to study the association between these variables and the outcomes during hospitalization: death and the development of acute renal failure. RESULTS The mortality rate in this series was 14%; 19% of the patients developed acute renal failure. The development of acute renal failure increased the odds ratio (OR) of dying by a factor of 17 (P = 0.001). Factors at the time of hospitalization that were associated at a univariate level with subsequent mortality included elevated serum Cr, increased age, increased level of AST, increased level of bilirubin, decreased serum sodium and platelet count, the presence of neurological involvement, and being male. Both the presence of neurological involvement and an elevated serum Cr at presentation were independently associated with increased mortality by multivariate analysis. Three patients developed acute renal failure that required hemodialysis, and only 1 of these 3 patients survived; he was ultimately discharged with a normal serum Cr. Factors at presentation that were associated with the development of acute renal failure included increased bilirubin, increasing age, thrombocytopenia, and the presence of neurological involvement. Both age and decreased platelet count at presentation were independently associated with the development of acute renal failure by multivariate analysis. CONCLUSION Acute renal failure was a frequent complication of RMSF in this series of patients from a tertiary referral medical center. The presence of acute renal failure was strongly associated with death. Clinical and biochemical variables are useful in predicting which patients will develop acute renal failure.
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Affiliation(s)
- P J Conlon
- Division of Nephrology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Fowler V, Carr J. Auditory feedback: effects on vertical force production during standing up following stroke. Int J Rehabil Res 1996; 19:265-9. [PMID: 8910129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- V Fowler
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
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Burke L, Richardson R, Fowler V, Jackson L. Therapeutic methods for cerebral palsy. J Paediatr Child Health 1995; 31:567. [PMID: 8924320 DOI: 10.1111/j.1440-1754.1995.tb00894.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Tumor-associated antigens (TAA) can be detected in the urine of sarcoma patients by a variety of assays. This study was designed to correlate antigen activity in three assays: complement fixation assay (CFA), enzyme-linked immunosorbent assay (ELISA), and Western blot (WB). This study identifies the antibody class responsible for TAA identification in these assays and characterizes the nature of the antigen. One hundred eighty-nine urine samples from eight sarcoma patients with known levels of TAA in CFA were tested in ELISA and WB. Allogeneic anti-TAA containing sera (1 degree antibody) from a sarcoma patient was reacted with urine samples followed by detection with alkaline phosphatase-linked goat anti-human IgG and IgM (2 degree antibody in both assays). Reactivity in CFA correlated to IgM reactivity in ELISA and WB (chi 2 test, P less than 0.001). No correlation was found to IgG reactivity in either assay. Reactivity in WB vs ELISA was also highly correlated for IgM (P less than 0.001). TAA was visualized in WB as a distinct pattern of repeating bands, with most bands being detected in the range 30,000-60,000 Da. The separation between bands approximated 2500-3000 Da, suggesting a molecule composed of repeating subunits. This study suggests that the antigen is glycoprotein in nature, and that the detecting antibody is of the IgM class.
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Affiliation(s)
- J F Huth
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill 27599
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Pollard HB, Creutz CE, Fowler V, Scott J, Pazoles CJ. Calcium-dependent regulation of chromaffin granule movement, membrane contact, and fusion during exocytosis. Cold Spring Harb Symp Quant Biol 1982; 46 Pt 2:819-34. [PMID: 6213354 DOI: 10.1101/sqb.1982.046.01.077] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
A low-salt extract prepared from human erythrocyte membranes forms a solid gel when purified rabbit muscle G- or F-actin is added to it to give a concentration of approximately 1 mg/ml. This extract contains spectrin, actin, band 4.1, band 4.9, hemoglobin, and several minor components. Pellets obtained by centrifugation of the gelled material at 43,000 g for 10 min contain spectrin, actin, band 4.1, and band 4.9. Although extracts that are diluted severalfold do not gel when actin is added to them, the viscosity of the mixtures increases dramatically over that of G-actin alone, extract alone, or F-actin alone at equivalent concentrations. Heat-denatured extract is completely inactive. Under conditions of physiological ionic strength and pH, information of this supramolecular structure is inhibited by raising the free calcium ion concentration to micromolar levels. Low-salt extracts prepared by initial extraction at 37 degrees C (and stored at 0 degree C) gel after actin is added to them only when warmed, whereas extracts prepared by extraction at 0 degree C are active on ice as well as after warming. Preincubation of the 37 degrees C low-salt extract under conditions that favor conversion of spectrin dimer to tetramer greatly enhances gelation activity at 0 degree C. Conversely, preincubation of the 0 degree C low-salt extract under conditions that favor conversion of spectrin tetramer to dimer greatly diminishes gelation activity at 0 degree C. Spectrin dimers or tetramers are purified from the 37 dgrees or 0 degree C low-salt extract by gel filtration at 4 degrees C over Sepharose 4B. The addition of actin to either purified spectrin dimer (at 32 degrees C) or tetramer (at 0 degree C or 32 degrees C) results in relatively small increases in viscosity, whereas the addition of actin to a high-molecular-weight complex (HMW complex) containing spectrin, actin, band 4.1, and band 4.9 results in dramatic, calcium-sensitive increases in viscosity. These viscosities are comparable to those obtained with the 37 degrees or 0 degree C low-salt extracts. The addition of purified band 4.1 to either purified spectrin dimer (at 32 degrees C) or purified spectrin tetramer (at 0 degree C) plus actin results in large increases in viscosity similar to those observed for the HMW complex and the crude extract, which is in agreement with a recent report by E. Ungewickell, P. M. Bennett, R. Calvert, V. Ohanian, and W. B. Gratzer. 1979 Nature (Lond.) 280:811-814. We suggest that this spectrin-actin-band 4.1 gel represents a major structural component of the erythrocyte cytoskeleton.
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Abstract
Fluorescein isothiocyanate-labelled integral membrane proteins are mobile in the membranes of human erythrocytes that have fused (and haemolysed) by Sendai virus or polyethylene glycol. Minimum diffusion coefficients are of the order of 10(-11) cm2 s-1 at 37 degrees C. This mobility is reduced several-fold at room temperature, not detected at 0 degrees C, and is significantly greater in fresh than in aged blood. Mobility was assessed by observing the spread of fluorescence on labelled cells which had been fused with unlabelled cells; neither intramembrane particle aggregation nor spectrin release occurred during this process.
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