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Suschana E, Correa MA, Meek J, Banach DB. An evaluation of outcomes and hospital readmissions among individuals with candidemia using statewide surveillance. Infect Control Hosp Epidemiol 2024:1-5. [PMID: 38561197 DOI: 10.1017/ice.2024.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Using statewide surveillance, we describe candidemia in Connecticut during 2019-2020. Mortality was high among individuals with candidemia, and the readmission rate was high among survivors. Mortality and readmission were associated with hospital-onset candidemia. Understanding risk factors for mortality and readmission can optimize prevention strategies to reduce mortality and readmissions.
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Affiliation(s)
| | - Maria A Correa
- CT Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - James Meek
- CT Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - David B Banach
- University of Connecticut School of Medicine, Farmington, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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2
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Turbett SE, Banach DB, Bard JD, Gandhi RG, Letourneau AR, Azar MM. Rapid antimicrobial resistance detection methods for bloodstream infection in solid organ transplantation: Proposed clinical guidance, unmet needs, and future directions. Transpl Infect Dis 2023; 25:e14113. [PMID: 37594214 DOI: 10.1111/tid.14113] [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: 06/06/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023]
Abstract
Recent advances in antimicrobial resistance detection have spurred the development of multiple assays that can accurately detect the presence of bacterial resistance from positive blood cultures, resulting in faster institution of effective antimicrobial therapy. Despite these advances, there are limited data regarding the use of these assays in solid organ transplant (SOT) recipients and there is little guidance on how to select, implement, and interpret them in clinical practice. We describe a practical approach to the implementation and interpretation of these assays in SOT recipients using the best available data and expert opinion. These findings were part of a consensus conference sponsored by the American Society of Transplantation held on December 7, 2021 and represent the collaboration between experts in transplant infectious diseases, pharmacy, antimicrobial and diagnostic stewardship, and clinical microbiology. Areas of unmet need and recommendations for future investigation are also presented.
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Affiliation(s)
- Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David B Banach
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ronak G Gandhi
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alyssa R Letourneau
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Marwan M Azar
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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3
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Carter EJ, Schramm C, Baron K, Zolla MM, Zavez K, Banach DB. Perceived usefulness of a mnemonic to improve nurses' evaluation of reported penicillin allergies. Antimicrob Steward Healthc Epidemiol 2023; 3:e124. [PMID: 37502243 PMCID: PMC10369439 DOI: 10.1017/ash.2023.177] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 07/29/2023]
Abstract
We surveyed clinicians to evaluate the perceived usefulness of a mnemonic, STORY, to improve penicillin allergy evaluation. Survey responses indicated that the perceived usefulness of STORY was high, and support for nurses' involvement in penicillin allergy assessment was high. Future research may evaluate the feasibility of STORY implementation in clinical care.
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Affiliation(s)
- Eileen J. Carter
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Carol Schramm
- UConn John Dempsey Hospital, Farmington, Connecticut
| | - Kate Baron
- University of Connecticut School of Nursing, Storrs, Connecticut
| | | | - Katherine Zavez
- Department of Statistics, University of Connecticut, Storrs, CT
| | - David B. Banach
- University of Connecticut School of Medicine, Farmington, Connecticut
- Yale School of Public Health, New Haven, Connecticut
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4
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Azar MM, Turbett S, Gaston D, Gitman M, Razonable R, Koo S, Hanson K, Kotton C, Silveira F, Banach DB, Basu SS, Bhaskaran A, Danziger-Isakov L, Bard JD, Gandhi R, Hanisch B, John TM, Odom John AR, Letourneau AR, Luong ML, Maron G, Miller S, Prinzi A, Schwartz I, Simner P, Kumar D. A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients. Am J Transplant 2022; 22:3150-3169. [PMID: 35822346 DOI: 10.1111/ajt.17147] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 04/26/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
The last decade has seen an explosion of advanced assays for the diagnosis of infectious diseases, yet evidence-based recommendations to inform their optimal use in the care of transplant recipients are lacking. A consensus conference sponsored by the American Society of Transplantation (AST) was convened on December 7, 2021, to define the utility of novel infectious disease diagnostics in organ transplant recipients. The conference represented a collaborative effort by experts in transplant infectious diseases, diagnostic stewardship, and clinical microbiology from centers across North America to evaluate current uses, unmet needs, and future directions for assays in 5 categories including (1) multiplex molecular assays, (2) rapid antimicrobial resistance detection methods, (3) pathogen-specific T-cell reactivity assays, (4) next-generation sequencing assays, and (5) mass spectrometry-based assays. Participants reviewed and appraised available literature, determined assay advantages and limitations, developed best practice guidance largely based on expert opinion for clinical use, and identified areas of future investigation in the setting of transplantation. In addition, attendees emphasized the need for well-designed studies to generate high-quality evidence needed to guide care, identified regulatory and financial barriers, and discussed the role of regulatory agencies in facilitating research and implementation of these assays. Findings and consensus statements are presented.
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Affiliation(s)
- Marwan M Azar
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah Turbett
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Gaston
- John's Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melissa Gitman
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sophia Koo
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Hanson
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Camille Kotton
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernanda Silveira
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David B Banach
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Sankha S Basu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Jennifer Dien Bard
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Ronak Gandhi
- Department of Pharmacy Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Hanisch
- Children's National Hospital, Washington, District of Columbia, USA
| | - Teny M John
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Audrey R Odom John
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alyssa R Letourneau
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Me-Linh Luong
- Department of Microbiology, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Gabriela Maron
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Steve Miller
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrea Prinzi
- Infectious Disease Medical Science Liaison, Denver, Colorado, USA
| | - Ilan Schwartz
- Faculty of Medicine and Dentistry, University of Alberta, University of Alberta, Alberta, Canada
| | - Patricia Simner
- John's Hopkins University School of Medicine, Baltimore, Maryland, USA
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5
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Banach DB, Lopez-Verdugo F, Sanchez-Garcia J, Tran A, Gomez-Llerena A, Munoz-Abraham AS, Bertacco A, Valentino PL, Yoo P, Dembry LM, Mulligan DC, Ekong UD, Emre SH, Rodriguez-Davalos MI. Epidemiology and outcomes of surgical site infections among pediatric liver transplant recipients. Transpl Infect Dis 2022; 24:e13941. [PMID: 35989545 DOI: 10.1111/tid.13941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/29/2021] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) are a significant cause of morbidity in liver transplant recipients, and the current data in the pediatric population are limited. The goal of this study was to identify the incidence, classification, risk factors, and outcomes of SSIs among children undergoing liver transplantation (LT). METHODS A single-center, retrospective descriptive analysis was performed of patients age ≤18 years undergoing LT between September 2007 and April 2017. SSI identified within the first 30 days were analyzed. Primary endpoints included incidence, classification, risk factors, and outcomes associated with SSIs. RESULTS We included 86 patients, eight patients (9.3%) developed SSIs. Among segmental grafts (SG) recipients, 7/61 (11.4%) developed SSI. Among whole grafts recipients, 1/25 (4%) developed SSI. SSIs were associated with the presence of biliary complications (35% vs. 3%, p < .01; odds ratios 24, 95% CI: 3.41-487.37, p<.01). There were no differences in long term graft or patient survival associated with SSI. Patients who developed SSI were more likely to undergo reoperation (50% vs. 16.7%, p = .045) and had an increased total number of hospital days in the first 60 days post-transplant (30.5 vs. 12.5 days, p = .001). CONCLUSIONS SSIs after pediatric LT was less frequent than what has been previously reported in literature. SSIs were associated with the presence of biliary complications without an increase in mortality. SG had an increased rate of biliary complications without an association to SSIs but, considering its positive impact on organ shortage barriers, should not be a deterrent to the utilization of SGs.
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Affiliation(s)
- David B Banach
- Department of Medicine, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Fidel Lopez-Verdugo
- Liver Transplant Service, Intermountain Healthcare, Salt Lake City, Utah, USA
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | - Alexandria Tran
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Adriana Gomez-Llerena
- Facultad de Ciencias de la Salud, Universidad Anahuac Mexico, Estado de Mexico, Mexico
| | | | - Alessandra Bertacco
- Department of Surgery, Transplant Division, University of Padova, Padova, Italy
| | - Pamela L Valentino
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Peter Yoo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louise-Marie Dembry
- Department of Medicine West Haven VA Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - David C Mulligan
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Udeme D Ekong
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Sukru H Emre
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Manuel I Rodriguez-Davalos
- Liver Transplant Service, Intermountain Healthcare, Salt Lake City, Utah, USA
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah, USA
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6
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Hudon RE, Leung VH, Petit S, Banach DB. Hospital Readmissions Among Infants Diagnosed With Early-Onset Neonatal Sepsis in Connecticut. J Pediatric Infect Dis Soc 2022; 11:242-247. [PMID: 35275198 DOI: 10.1093/jpids/piac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Early-onset neonatal sepsis, defined as sepsis within 72 hours of birth, results in significant infant morbidity and mortality. Readmissions associated with neonatal sepsis have not previously been well described. Early-onset neonatal sepsis is a mandatory reportable condition in Connecticut, allowing for expanded data collection through public health surveillance to evaluate readmissions. METHODS Infants with early-onset neonatal sepsis born in Connecticut during 2007-2016 were identified from statewide surveillance data and matched with a statewide hospital discharge database. We describe readmission rates, causes and timing of readmissions, and demographic and clinical factors associated with readmission among this group. RESULTS Among 241 infants with early-onset neonatal sepsis matched to discharge data, 203 (84.2%) infants survived their initial hospitalization at birth. During the first year of life, 47 (23.2%) infants were readmitted, most often in the first 3 months after birth (n = 29, 42.6%). The most frequent reasons for readmissions were pulmonary complications (19%), infections (17%), and gastrointestinal illness (13%). Infants with initial hospitalizations lasting longer than 30 days after birth were associated with higher rates of readmission compared with those discharged within 30 days after birth (35% vs 19%, P = .02). CONCLUSIONS A substantial proportion of infants diagnosed with early-onset neonatal sepsis are readmitted within the first year of life. Those with prolonged hospitalizations after birth are at the highest risk. Further efforts and intensified strategies are needed to prevent readmissions among this vulnerable patient population.
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Affiliation(s)
- Rebecca E Hudon
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Vivian H Leung
- Infectious Diseases Section, Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - Susan Petit
- Infectious Diseases Section, Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - David B Banach
- Department of Medicine, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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7
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Abstract
Pandemic preparedness is a key function of any health care facility. Activities pertaining to pandemic preparedness should be developed and maintained within a broader emergency management plan. The use of a Hospital Incident Command System can centralize coordination of the response and facilitate internal and external communication. This review addresses several components of pandemic preparedness, including incident management, health care personnel safety, strategies to support ongoing clinical activities, and organizational communication during a pandemic. Preparations addressing potential ethical challenges and the psychological impact associated with pandemic response are also reviewed.
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Affiliation(s)
- Casey E Godshall
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - David B Banach
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
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McKenna AM, Ioannidou E, Banach DB. Antibiotic prescribing at a periodontal residency practice in Connecticut. J Periodontol 2021; 92:e76-e83. [PMID: 33533490 DOI: 10.1002/jper.20-0657] [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: 09/01/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Antibiotics are important in the treatment of odontogenic infections and the prevention of infection following dental procedures in high-risk situations. Little is known about antibiotic prescribing in periodontal practice. This study describes prescribing practices by periodontal faculty and residents in an academic setting in order to identify opportunities to optimize prescribing behaviors. METHODS This cross-sectional study analyzed all antibiotic prescriptions from residents or faculty in an academic periodontal clinic from 2014-2017. Information was manually extracted from the electronic health record. Antibiotic prescriptions were stratified into three indication categories: pre-procedural prophylaxis, post-procedural prophylaxis, and treatment. RESULTS Out of 275 prescriptions analyzed, 266 met inclusion criteria. The most frequent antibiotic indication was post-procedural prophylaxis (n = 130, 48.87%). Amoxicillin was the most frequently prescribed antibiotic across all groups (n = 236, 88.72%), followed by clindamycin (n = 22, 8.27%). Most patients presented in a non-emergent setting (n = 200, 75.19%), without pain (n = 210, 78.95%), and had restorative/endodontic-related clinical findings (n = 55, 20.68%). Among the 35 patients receiving antibiotics for infection treatment, 8 (22.86%) underwent a surgical intervention on the date of antibiotic prescription. Of the 130 patients receiving post-procedural prophylaxis, 121 (93.08%) received surgical interventions on the day of antibiotic prescription. CONCLUSIONS Antibiotics are prescribed in various situations in periodontal practice, most frequently as post-procedural prophylaxis, an indication for which data is limited. There is an urgent need to study the role of post-procedural prophylactic antibiotics and understand antibiotic prescribing in the management of periodontal disease in order to optimize prescribing practices.
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Affiliation(s)
- Alexandra M McKenna
- University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Effie Ioannidou
- Department of Periodontics, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - David B Banach
- Department of Medicine, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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9
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McCarthy M, Andrews R, Banach DB. Prophylactic antibiotics prior to dental procedures: A cross-disciplinary survey of dentists and medical providers. Am J Infect Control 2020; 48:116-118. [PMID: 31358418 DOI: 10.1016/j.ajic.2019.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/08/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 11/18/2022]
Abstract
The prescription of prophylactic antibiotics prior to dental procedures is common, although factors influencing prescribing are poorly understood. We surveyed general and specialist medical providers and dentists on beliefs and attitudes regarding prophylactic antibiotic prescribing prior to dental procedures. There were significant differences in factors influencing decisions and perceived responsibility regarding prophylactic antibiotic prescribing between groups, although interest in additional education on the subject was high across both groups.
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Affiliation(s)
- Morgan McCarthy
- University of Connecticut School of Medicine, Farmington, CT
| | - Rebecca Andrews
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - David B Banach
- Department of Medicine, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT.
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10
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Gupta S, Banach DB, Chirch LM. Pulmonary artery intravascular abscess: A rare complication of incomplete infective endocarditis treatment in the setting of injection drug use. IDCases 2018; 12:88-91. [PMID: 29942758 PMCID: PMC6010969 DOI: 10.1016/j.idcr.2018.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 11/25/2022] Open
Abstract
Infective endocarditis (IE) is a serious complication of injection drug use. Right-sided IE encompasses 5–10% of all IE cases, with the majority involving the tricuspid valve (TV). The predominant causal organism is Staphylococcus aureus. Most cases of right-sided IE can be successfully treated with antimicrobials, but approximately 5–16% require eventual surgical intervention. We report the case of a 36-year-old female with active injection drug use who developed methicillin-sensitive Staphylococcus aureus IE of the tricuspid valve. Associated with poor adherence to medical therapy as a consequence of opioid addiction, she developed septic emboli to the lungs and an intravascular abscess in the left main pulmonary artery. These long-term potentially fatal, sequelae of incompletely treated IE require surgical intervention, as medical therapy is unlikely to be sufficient. Surgical management may involve TV replacement, pulmonary artery resection, and pneumonectomy. Prevention of these complications may have been achieved by concurrent opioid addiction therapy. An intravascular pulmonary artery abscess is a novel complication of advanced IE that has not been previously reported. This complication likely arose due to incomplete IE treatment as a consequence of opioid addiction, highlighting the need for concurrent addiction management. Intravenous antimicrobial therapy is likely not adequate, and surgical intervention, including pulmonary artery resection and pneumonectomy may be necessary.
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Affiliation(s)
- Simran Gupta
- University of Connecticut School of Medicine, UCONN Health, 263 Farmington Ave, Farmington, CT, 06030, United States
| | - David B Banach
- University of Connecticut School of Medicine, UCONN Health, 263 Farmington Ave, Farmington, CT, 06030, United States.,Department of Infectious Diseases, UCONN Health, 263 Farmington Ave, Farmington, CT, 06030, United States
| | - Lisa M Chirch
- University of Connecticut School of Medicine, UCONN Health, 263 Farmington Ave, Farmington, CT, 06030, United States.,Department of Infectious Diseases, UCONN Health, 263 Farmington Ave, Farmington, CT, 06030, United States
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11
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Abrantes-Figueiredo JI, Ross JW, Banach DB. Device Utilization Ratios in Infection Prevention: Process or Outcome Measure? Curr Infect Dis Rep 2018; 20:8. [DOI: 10.1007/s11908-018-0616-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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12
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Singh N, Sifri CD, Silveira FP, Miller R, Gregg KS, Huprikar S, Lease ED, Zimmer A, Dummer JS, Spak CW, Koval C, Banach DB, Shroff M, Le J, Ostrander D, Avery R, Eid A, Razonable RR, Montero J, Blumberg E, Alynbiawi A, Morris MI, Randall HB, Alangaden G, Tessier J, Cacciarelli TV, Wagener MM, Sun HY. Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis: comparison with concurrent cohort diagnosed antemortem. Med Mycol 2017; 55:278-284. [PMID: 27601609 DOI: 10.1093/mmy/myw079] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/21/2016] [Indexed: 11/13/2022] Open
Abstract
Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers.
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Affiliation(s)
- Nina Singh
- University of Pittsburgh, Pittsburgh, PA
| | | | | | - Rachel Miller
- University of Iowa, Iowa City, IA; Duke University Medical Center, Durham, NC
| | | | | | | | | | | | | | | | - David B Banach
- Yale School of Medicine, New Haven, CT; University of Connecticut School of Medicine, Farmington, CT
| | - Miloni Shroff
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jade Le
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hsin Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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13
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Azar MM, Assi R, Valika AK, Banach DB, Hall IE, Landry ML, Malinis MF. Graft loss among renal-transplant recipients with early reduction of immunosuppression for BK viremia. World J Transplant 2017; 7:269-275. [PMID: 29104861 PMCID: PMC5661124 DOI: 10.5500/wjt.v7.i5.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.
METHODS We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyoma-virus associated nephropathy (PyVAN). Recipient plasma was screened for BKV DNA via quantitative polymerase chain reaction (PCR) at months 1, 3, 6, 9 and 12 post-transplant and on worsening graft function. Immunosuppression was reduced at ≥ 3-log copies/mL. Those with viremia of ≥ 4-log copies/mL (presumptive PyVAN) underwent renal transplant biopsy. Presumptive PyVAN (PP) and definitive PyVAN (DP; biopsy-proven) were treated by immunosuppression reduction (IR) only.
RESULTS Among 319 kidney transplant recipients, the median age was 53 years (range 19-83), 65.8% were male, and 58.9% were white. Biopsy-proven acute rejection was found in 18.5% within 0-168 wk. Death-censored graft loss occurred in 5.3% (n = 17) and graft loss attributable to PyVAN was 0.6% (n = 2). Forty-seven patients were diagnosed with PP (14.7%) and 18 (5.6%) with DP. Graft loss among participants with PyVAN (8.5%) and those without (4.8%) was not significantly different. Deceased donor kidney transplantation (OR = 2.3, 95%CI = 1.1-4.6) and AR (OR = 2.3, 95%CI = 1.2-4.7) were associated with PyVAN in the multivariate analysis. BK viremia between 3 and 4-log copies/mL occurred in 27 patients, all of whom underwent IR. Of these, 16 (59%) never developed PyVAN while 11 (41%) developed PyVAN (4 DP, 7 PP) within a range of 11-39 wk.
CONCLUSION Instituting an early reduction of immunosuppression, in the absence of adjunctive antivirals, is effective at preventing PyVAN and may be associated with a lower incidence of graft-loss without a reciprocal increase in the incidence of acute rejection.
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Affiliation(s)
- Marwan M Azar
- Department of Pathology, Section of Microbiology, Massachusetts General Hospital, Boston, MA 02145, United States
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
| | - Roland Assi
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Aziz K Valika
- Adventist Health Partners, Chicago, IL 60521, United States
| | - David B Banach
- Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT 06032, United States
| | - Isaac E Hall
- Division of Hypertension and Nephrology, University of Utah School of Medicine, Dalt Lake City, UT 84132, United States
| | - Marie-Louise Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Maricar F Malinis
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
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Banach DB, Peaper DR, Fortune BE, Emre S, Dembry LM. The clinical and molecular epidemiology of pre-transplant vancomycin-resistant enterococci colonization among liver transplant recipients. Clin Transplant 2016; 30:306-11. [DOI: 10.1111/ctr.12690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 02/01/2023]
Affiliation(s)
- David B. Banach
- Section of Infectious Diseases; Yale School of Medicine; New Haven CT USA
| | - David R. Peaper
- Department of Laboratory Medicine; Yale School of Medicine; New Haven CT USA
| | | | - Sukru Emre
- Yale-New Haven Transplantation Center; New Haven CT USA
| | - Louise M. Dembry
- Section of Infectious Diseases; Yale School of Medicine; New Haven CT USA
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15
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Tsai KC, Danziger-Isakov LA, Banach DB. Cytomegalovirus Infection in Pediatric Solid Organ Transplant Recipients: a Focus on Prevention. Curr Infect Dis Rep 2016; 18:5. [DOI: 10.1007/s11908-015-0511-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Azar MM, Folk D, Henderson T, Mehra S, Vining E, Banach DB. Cervicofacial necrotizing fasciitis caused by Haemophilus influenzae serotype e in a patient with Sjogren's syndrome, systemic lupus erythematosus and hypocomplementaemia. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000040] [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: 11/18/2022] Open
Affiliation(s)
- Marwan M. Azar
- Section of Infectious Diseases, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - David Folk
- Section of Otolaryngology Head and Neck Surgery, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - Triona Henderson
- Department of Pathology, Yale School of Medicine, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - Saral Mehra
- Section of Otolaryngology Head and Neck Surgery, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - Eugenia Vining
- Section of Otolaryngology Head and Neck Surgery, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - David B. Banach
- Section of Infectious Diseases, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
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17
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Banach DB, Bearman GM, Morgan DJ, Munoz-Price LS. Infection control precautions for visitors to healthcare facilities. Expert Rev Anti Infect Ther 2015; 13:1047-50. [DOI: 10.1586/14787210.2015.1068119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Navaratnam AMD, Grant M, Banach DB. Endotipsitis: A case report with a literature review on an emerging prosthetic related infection. World J Hepatol 2015; 7:710-716. [PMID: 25866608 PMCID: PMC4388999 DOI: 10.4254/wjh.v7.i4.710] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/15/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the etiology and management of a poorly understood complication of transjugular intrahepatic portosystemic shunt; “endotipsitis”.
METHODS: A MEDLINE database search was carried out, reviewing all papers with specific words in the title or abstract, and excluding appropriately. Of 283 papers that were reviewed, 22 papers reporting 53 cases in total were included in the analyses.
RESULTS: No predominant etiology for endotipsitis was identified, but gram-positive organisms were more common among early-onset infections (P < 0.01). A higher mortality rate was associated with Staphylococcus aureus and Candida spp infections (P < 0.01). There was no trend in choice of antibiotic based on the microorganisms isolated and treatment varied from the guidelines of other vegetative prosthetic infections. In endotipsitis “high risk” organisms have been identified, emphasizing the importance of ensuring optimal antimicrobial therapy and adjunctive management strategies.
CONCLUSION: Higher mortality rate was associated with Staphylococcus aureus and Candida spp infections. A prospective multicenter trial is needed before specific treatment can be recommended.
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Banach DB, Francois J, Blash S, Patel G, Jenkins SG, LaBombardi V, Kreiswirth BN, Srinivasan A, Calfee DP. Active surveillance for carbapenem-resistant Enterobacteriaceae using stool specimens submitted for testing for Clostridium difficile. Infect Control Hosp Epidemiol 2013; 35:82-4. [PMID: 24334803 DOI: 10.1086/674391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Active surveillance to identify asymptomatic carriers of carbapenem-resistant Enterobacteriaceae (CRE) is a recommended strategy for CRE control in healthcare facilities. Active surveillance using stool specimens tested for Clostridium difficile is a relatively low-cost strategy to detect CRE carriers. Further evaluation of this and other risk factor-based active surveillance strategies is warranted.
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Abstract
Gemella haemolysans is an uncommon but described cause of invasive disease in humans. We report a case of meningitis due to G. haemolysans that did not grow in cerebrospinal fluid culture, demonstrating a potential role for direct 16S rRNA gene PCR and sequencing in culture-negative cerebrospinal fluid when bacterial meningitis is suspected.
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Affiliation(s)
- Benjamin T Galen
- Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David B Banach
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Melissa R Gitman
- Pathology and Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Terence K Trow
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
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21
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Swaminathan M, Sharma S, Poliansky Blash S, Patel G, Banach DB, Phillips M, LaBombardi V, Anderson KF, Kitchel B, Srinivasan A, Calfee DP. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013; 34:809-17. [PMID: 23838221 DOI: 10.1086/671270] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) carriage and acquisition among hospitalized patients in an area of CRE endemicity. DESIGN Cohort study with a nested case-control study. SETTING Two acute care, academic hospitals in New York City. PARTICIPANTS All patients admitted to 7 study units, including intensive care, medical-surgical, and acute rehabilitation units. METHOD Perianal samples were collected from patients at admission and weekly thereafter to detect asymptomatic gastrointestinal carriage of CRE. A nested case-control study was performed to identify factors associated with CRE acquisition. Case patients were those who acquired CRE during a single hospitalization. Control subjects had no microbiologic evidence of CRE and at least 1 negative surveillance sample. Clinical data were abstracted from the medical record. RESULTS The prevalence of CRE in the study population was 5.4% (306 of 5,676 patients), and 104 patients met the case definition of acquisition during a single hospital stay. Mechanical ventilation (odds ratio [OR], 11.5), pulmonary disease (OR, 5.2), days of antibiotic therapy (OR, 1.04), and CRE colonization pressure (OR, 1.15) were independently associated with CRE acquisition. Pulsed-field gel electrophoresis analysis identified 87% of tested Klebsiella pneumoniae isolates as sharing related patterns (greater than 78% similarity), which suggests clonal transmission within and between the study hospitals. CONCLUSIONS Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition. Adherence to infection control practices and antimicrobial stewardship appear to be critical components of a CRE control program.
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Affiliation(s)
- Mahesh Swaminathan
- Department of Medicine, Mount Sinai School of Medicine, New York, New York
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Banach DB, Zhang C, Factor SH, Calfee DP. Support for mandatory health care worker influenza vaccination among allied health professionals, technical staff, and medical students. Am J Infect Control 2013; 41:354-6. [PMID: 23102982 DOI: 10.1016/j.ajic.2012.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/21/2012] [Accepted: 05/21/2012] [Indexed: 10/27/2022]
Abstract
Although policies mandating annual influenza vaccination among health care workers (HCWs) are recommended, little is known about which HCWs support mandatory vaccination. We surveyed non-physician, non-nursing HCWs to identify beliefs associated with supporting mandatory HCW vaccination. Although similarities were identified, some beliefs and concerns associated with supporting mandatory vaccination differed among HCW groups. Policy makers should understand these differences and address beliefs and concerns of all HCW groups when attempting to implement a mandatory influenza vaccination policy.
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23
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Banach DB, Bielang R, Calfee DP. Factors associated with unprotected exposure to 2009 H1N1 influenza A among healthcare workers during the first wave of the pandemic. Infect Control Hosp Epidemiol 2011; 32:293-5. [PMID: 21460517 DOI: 10.1086/658911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Protecting healthcare workers (HCWs) from occupational exposure to 2009 H1N1 influenza was a challenge. During the first wave of the pandemic, many HCWs reported that they had been exposed to 2009 H1N1 when they were not using respiratory personal protective equipment. Unprotected exposures tended to be more frequent among HCWs caring for patients with atypical clinical presentations.
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Affiliation(s)
- David B Banach
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
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Banach DB, Ornstein K, Factor SH, Soriano TA. Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City. J Community Health 2011; 37:10-4. [DOI: 10.1007/s10900-011-9409-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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