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Shiferaw W, Martin BM, Dean JA, Mills D, Lau C, Paterson D, Koh K, Eriksson L, Furuya-Kanamori L. A systematic review and meta-analysis of sexually transmitted infections and blood-borne viruses in travellers. J Travel Med 2024:taae038. [PMID: 38438164 DOI: 10.1093/jtm/taae038] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/18/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) impose a global health and economic burden. International travellers facilitate the spread of infectious diseases, including STIs. Hence, this review assessed the prevalence/proportionate morbidity of travellers with STIs and sexually transmitted BBVs, and factors associated with the infection in this population. METHODS PubMed, Scopus, Web of Science, CINHAL, Embase, and Cochrane Library were searched from inception of the databases until November 2022. Published analytical observational studies reporting the prevalence/proportionate morbidity of travellers with STIs and factors associated with STIs by type of traveller (i.e. tourists, business travellers, students, visiting friends or relatives [VFRs], international truck drivers, backpackers, expatriates, and men who have sex with men [MSM]) were included. The selection of articles, data extraction, and risk of bias assessment were conducted by two independent reviewers. Meta-analyses were conducted for each STI by clinical presentation and type of traveller. RESULTS Thirty-two studies (n = 387 731 travellers) were included, 19 evaluated the proportionate morbidity of STIs among symptomatic travellers, while 13 examined the prevalence of STIs in asymptomatic travellers. The highest proportionate morbidity was found among VFRs (syphilis, 1.67%; 95%CI:1.03-2.81%), backpackers (chlamydia trachomatis, 6.58%; 95%CI: 5.96-7.25%), and MSM (HIV [2.50%;95%CI:0.44-12.88%], gonorrhoea [4.17%;95%CI:1.1.5-13.98%], lymphogranuloma venereum [4.17%;95%CI:1.1.5-13.98%], and HAV [20.0%; 95% CI: 14.99-26.17%]). The highest prevalence of STIs among asymptomatic were found in MSM (HIV [25.94%;95%CI:22.21-30.05%] and HBV [24.90%; 95%CI:21.23-28.96%]) and backpackers (chlamydia trachomatis, 3.92%;95% CI:2.72-5.32%). Short duration of the trip (<1 month), not having pre-travel consultation, travelling to Southeast Asia, and being unvaccinated for HBV were identified as risk factors for STIs. CONCLUSION Strategies to prevent STIs and sexually transmitted BBVs should be discussed at pretravel consultations and recommendations should be prioritized in high-risk groups of travellers, such as backpackers, VFRs, and MSMs. Additionally, healthcare providers should tailor recommendations for safe sex practices to individual travellers' unique needs.
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Affiliation(s)
- Wondimeneh Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Asrat Woldeyes Health Science Campus, Debre Berhan University, Ethiopia
| | - Beatris Mario Martin
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Judith A Dean
- UQ Poche Centre for Indigenous Health, Faculty of Health, and Behavioural Sciences, The University of Queensland, Toowong, Australia
| | - Deborah Mills
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Colleen Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - David Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Kenneth Koh
- Gladstone Road Medical Centre, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Herston, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
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Paoletti A, Ly B, Cailleau C, Gao F, de Ponfilly-Sotier MP, Pascaud J, Rivière E, Yang L, Nwosu L, Elmesmari A, Reynaud F, Hita M, Paterson D, Reboud J, Fay F, Nocturne G, Tsapis N, McInnes IB, Kurowska-Stolarska M, Fattal E, Mariette X. Liposomal AntagomiR-155-5p Restores Anti-Inflammatory Macrophages and Improves Arthritis in Preclinical Models of Rheumatoid Arthritis. Arthritis Rheumatol 2024; 76:18-31. [PMID: 37527031 DOI: 10.1002/art.42665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/16/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE We previously reported an increased expression of microRNA-155 (miR-155) in the blood monocytes of patients with rheumatoid arthritis (RA) that could be responsible for impaired monocyte polarization to anti-inflammatory M2-like macrophages. In this study, we employed two preclinical models of RA, collagen-induced arthritis and K/BxN serum transfer arthritis, to examine the therapeutic potential of antagomiR-155-5p entrapped within PEGylated (polyethylene glycol [PEG]) liposomes in resolution of arthritis and repolarization of monocytes towards the anti-inflammatory M2 phenotype. METHODS AntagomiR-155-5p or antagomiR-control were encapsulated in PEG liposomes of 100 nm in size and -10 mV in zeta potential with high antagomiR loading efficiency (above 80%). Mice were injected intravenously with 1.5 nmol/100 μL PEG liposomes containing antagomiR-155-5p or control after the induction of arthritis. RESULTS We demonstrated the biodistribution of fluorescently tagged PEG liposomes to inflamed joints one hour after the injection of fluorescently tagged PEG liposomes, as well as the liver's subsequent accumulation after 48 hours, indicative of hepatic clearance, in mice with arthritis. The injection of PEG liposomes containing antagomiR-155-5p decreased arthritis score and paw swelling compared with PEG liposomes containing antagomiR-control or the systemic delivery of free antagomiR-155-5p. Moreover, treatment with PEG liposomes containing antagomiR-155-5p led to the restoration of bone marrow monocyte defects in anti-inflammatory macrophage differentiation without any significant functional change in other immune cells, including splenic B and T cells. CONCLUSION The injection of antagomiR-155-5p encapsulated in PEG liposomes allows the delivery of small RNA to monocytes and macrophages and reduces joint inflammation in murine models of RA, providing a promising strategy in human disease.
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Affiliation(s)
- Audrey Paoletti
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Bineta Ly
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Catherine Cailleau
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay, France
| | - Fan Gao
- Division of Biomedical Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Marie Péan de Ponfilly-Sotier
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Juliette Pascaud
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Elodie Rivière
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Luxin Yang
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - Lilian Nwosu
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - Aziza Elmesmari
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - Franceline Reynaud
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay, France
| | - Magali Hita
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay, France
| | - David Paterson
- Division of Biomedical Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Julien Reboud
- Division of Biomedical Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Francois Fay
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay, France
| | - Gaetane Nocturne
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
- Rheumatology Department, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Nicolas Tsapis
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay, France
| | - Iain B McInnes
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | | | - Elias Fattal
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay, France
| | - Xavier Mariette
- Paris-Saclay University, INSERM UMR1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
- Rheumatology Department, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
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Wu S, Liu Y, Southam G, Nguyen TA, Konhauser KO, You F, Bougoure JJ, Paterson D, Chan TS, Lu YR, Haw SC, Yi Q, Li Z, Robertson LM, Hall M, Saha N, Ok YS, Huang L. Ecological engineering of iron ore tailings into useable soils for sustainable rehabilitation. iScience 2023; 26:107102. [PMID: 37485366 PMCID: PMC10359879 DOI: 10.1016/j.isci.2023.107102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Ecological engineering of soil formation in tailings is an emerging technology toward sustainable rehabilitation of iron (Fe) ore tailings landscapes worldwide, which requires the formation of well-organized and stable soil aggregates in finely textured tailings. Here, we demonstrate an approach using microbial and rhizosphere processes to progressively drive aggregate formation and development in Fe ore tailings. The aggregates were initially formed through the agglomeration of mineral particles by organic cements derived from microbial decomposition of exogenous organic matter. The aggregate stability was consolidated by colloidal nanosized Fe(III)-Si minerals formed during Fe-bearing primary mineral weathering driven by rhizosphere biogeochemical processes of pioneer plants. From these findings, we proposed a conceptual model for progressive aggregate structure development in the tailings with Fe(III)-Si rich cements as core nuclei. This renewable resource dependent eco-engineering approach opens a sustainable pathway to achieve resilient tailings rehabilitation without resorting to excavating natural soil resources.
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Affiliation(s)
- Songlin Wu
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Yunjia Liu
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Gordon Southam
- School of Earth & Environmental Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tuan A.H. Nguyen
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Kurt O. Konhauser
- Department of Earth & Atmospheric Sciences, University of Alberta, Edmonton, AB T6G 2E3, Canada
| | - Fang You
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jeremy J. Bougoure
- Centre for Microscopy, Characterisation and Analysis, University of Western Australia, 35 Stirling Hwy, Crawley, Perth, WA 6009, Australia
| | | | - Ting-Shan Chan
- National Synchrotron Radiation Research Centre, Hsinchu Science Park, Hsinchu 30092, Taiwan
| | - Ying-Rui Lu
- National Synchrotron Radiation Research Centre, Hsinchu Science Park, Hsinchu 30092, Taiwan
| | - Shu-Chih Haw
- National Synchrotron Radiation Research Centre, Hsinchu Science Park, Hsinchu 30092, Taiwan
| | - Qing Yi
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Zhen Li
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Lachlan M. Robertson
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Merinda Hall
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Narottam Saha
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Yong Sik Ok
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
- Korea Biochar Research Center, APRU Sustainable Waste Management Program & Division of Environmental Science and Ecological Engineering, Korea University, Seoul 02841, Korea
| | - Longbin Huang
- Centre for Mined Land Rehabilitation, Sustainable Minerals Institute, The University of Queensland, Brisbane, QLD 4072, Australia
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Soriano A, Puzniak LA, Paterson D, Thalhammer F, Kluge S, Viale P, Watanabe AH, Obi EN, Kaul S. 673. Study of Prescribing patterns and Effectiveness of Ceftolozane/Tazobactam Real-world Analysis (SPECTRA): Results from a multi-national, multicenter observational study. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Ceftolozane/tazobactam (C/T) has demonstrated efficacy to treat complicated intra-abdominal infections (cIAI), complicated urinary tract infections (cUTI) and hospital acquired bacterial and ventilator-associated bacterial pneumonia. However, physicians, providers, and other stakeholders including payers want broader real-world evidence to inform clinical decisions and optimize healthcare resource use.
Methods
SPECTRA is a multi-national, multicenter, retrospective, inpatient, observational study of patients treated with C/T in Australia, Austria, Germany, Italy, Mexico, Spain and The United Kingdom. Adult inpatients treated with ≥48 hours of C/T were included. Demographics, clinical characteristics, treatment management patterns, and outcomes were analyzed.
Results
There were 687 patients from 38 participating hospitals in 7 countries. The average age was 57.6 years (±17.3 [SD]) and most were male 456 (66.4%). The majority had at least one comorbidity 563 (82.0%), with the most common being heart disease 208 (30.3%), immunocompromised state 207 (30.1%) and chronic pulmonary disease 195 (28.4%). The most common indications were pneumonia 204 (29.7%), sepsis 147 (21.4%), and cIAI 106 (15.4%); 162 (23.6%) had multiple sites of infection and 245 (35.7%) were polymicrobial infections. Median C/T treatment was 12.0 days (11.0 [IQR]). Half of the patients were admitted to the ICU 343 (49.9%), 43.4% of which was related to the infection. Clinical success was 66.1%. All-cause in-hospital mortality was 22.0% with 8.7% being infection related. 30-day all-cause readmission was 9.8% and 4.7% were infection related.
Conclusion
C/T was used to treat infections among critically ill patients and for multi-source, polymicrobial infections. Despite the complexity of the patients in this real-world analysis, most C/T patients had beneficial outcomes that are similar to results of controlled clinical trials.
Disclosures
Alex Soriano, MD, MSD, Pfizer, Shionogi, Angelini, Menarini, Gilead: Honoraria Laura A. Puzniak, MPH, PhD, Merck & Co., Inc.: former employee and stockholder David Paterson, MBBS, Accelerate: Honoraria|bioMerieux: Honoraria|Entasis: Advisor/Consultant|Janssen-Cilag: Grant/Research Support|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria|PPD: Grant/Research Support|Shionogi: Grant/Research Support|VenatoRx: Advisor/Consultant Stefan Kluge, MD, Astrazeneca: Lecture fees|Biotest: Lecture fees|Cytosorbents: Grant/Research Support|Cytosorbents: Lecture fees|Daiichi Sankyo: Grant/Research Support|Daiichi Sankyo: Lecture fees|Fresenius Medical Care: Advisor/Consultant|Fresenius Medical Care: Lecture fees|Gilead: Advisor/Consultant|Gilead: Lecture fees|Mitsubishi Tanabe Pharma: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Advisor/Consultant|Pfizer: Lecture fees|Phillips: Lecture fees|Zoll: Lecture fees Alexandre H. Watanabe, PharmD, Merck & Co., Inc.: Employee Engels N. Obi, PhD, Merck & Co., Inc.: Employee|Merck & Co., Inc.: Stocks/Bonds Sunny Kaul, BSc, MBChB, PHD, FRCP, FFICM, Chiesi: Speaker fees|Gilead: Speaker fees|GlaxoSmithKline: Speaker fees|MSD: Grant/Research Support|MSD: Speaker fees|Shionogi: Speaker fees|Vifor Pharma: Grant/Research Support.
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Affiliation(s)
- Alex Soriano
- Hospital Clínic de Barcelona , Barcelona, Catalonia , Spain
| | | | - David Paterson
- The University of Queensland , Brisbane, Queensland , Australia
| | | | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf , Martinistrasse, Hamburg , Germany
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna , Bologna, Italy, Bologna, Emilia-Romagna , Italy
| | | | | | - Sunny Kaul
- Royal Brompton & Harefield NHS Foundation Trust , London, England , United Kingdom
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Boutzoukas AE, Boutzoukas AE, Komarow L, Chen L, Baum KR, Fowler VG, Hill C, Arias CA, Hanson BM, Paterson D, Ge L, Ordonez KM, Salcedo SSM, Kanj SS, Bonomo R, van Duin D. 229. Molecular and Clinical Epidemiology of Carbapenemase-Producing E. coli Isolates from Different Global Regions (CRACKLE-2). Open Forum Infect Dis 2022. [PMCID: PMC9752238 DOI: 10.1093/ofid/ofac492.307] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Carbapenemase-producing (CP) Escherichia coli (CPEc) are a global public health threat. We describe the epidemiology and outcomes of patients with CPEc isolates obtained in CRACKLE 2, a prospective cohort study of hospitalized patients with positive cultures for CP Enterobacteriaceae. Methods In CRACKLE-2, patients with CPEc were enrolled from 26 hospitals in 6 countries (ClinicalTrials.gov NCT03646227). Clinical data were collected, and bacterial isolates underwent whole genome sequencing (WGS). Here, we included unique patients with CPEc by WGS (n=114). The primary outcome was desirability of outcome ranking (DOOR) at 30 days after index culture. Chi squared tests with alpha = 0.05 were used to evaluate differences in culture source and outcomes between metallo-beta-lactamase (MBL) and non-MBL isolates. Results Of 114 CPEc isolates, 57 (50%) represented infection (Table 1). Isolates primarily arose from urine (34%) and blood (21%). Compared to non-MBL isolates, isolates containing MBL were more often from urine (41% vs 29%) and less frequently from blood (6% vs 32%); p=0.02. We observed strong regional variations in CP (Figure 1) and MBL (p < 0.0001). Sequence type (ST) 167 was more common among MBL than non-MBL isolates (31% vs 2%, p< 0.0001); non-MBL isolates were more often ST410 and ST131 (17% and 20%). Extended-spectrum beta-lactamases (ESBL) were present in 52% of isolates; most commonly, CTX-M-15 in both MBL (33%) and non-MBL isolates (34%). Phylogenetic analysis of the isolates and corresponding region, bacterial characteristics, and DOOR outcomes are in Figure 1. Death at 30 days occurred in 18 (16%) of patients, more commonly among non-MBL than MBL CPEc (23% vs 6%; p=0.01). The probability of a better DOOR outcome for a randomly selected MBL was 58% [95% CI: 48.2, 67.4], indicating no significant difference between the groups.
![]() Phylogenetic population structures of Carbapenemase-producing Escherichia coli (CPEc) isolates ![]() Legend: Infection = categorization as infection or colonization. ST = sequence type. BlaCarb = Carbapenemase gene. BlaESBL = acquired ESBL enzymes. DOOR = desirability of outcome ranking. DOOR rankings: 1 = Alive without events; DOOR 2 = Alive with 1 event; DOOR 3 = Alive with 2 or 3 events; DOOR 4 = dead. Conclusion Emergence of carbapenem resistance with important geographic variations was observed in E coli including among high-risk clones such as ST131. Mortality was higher among non-MBL isolates, which were more frequently from blood, but these findings may be confounded by region. Disclosures Vance G. Fowler, Jr, MD, MHS, Affinergy: Grant/Research Support|Affinergy: Honoraria|Affinium: Honoraria|Amphliphi Biosciences: Honoraria|ArcBio: Stocks/Bonds|Basilea: Grant/Research Support|Basilea: Honoraria|Bayer: Honoraria|C3J: Honoraria|Cerexa/Forest/Actavis/Allergan: Grant/Research Support|Contrafect: Grant/Research Support|Contrafect: Honoraria|Cubist/Merck: Grant/Research Support|Debiopharm: Grant/Research Support|Deep Blue: Grant/Research Support|Destiny: Honoraria|Genentech: Grant/Research Support|Genentech: Honoraria|Integrated Biotherapeutics: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|Karius: Grant/Research Support|Medicines Co.: Honoraria|MedImmune: Grant/Research Support|MedImmune: Honoraria|NIH: Grant/Research Support|Novartis: Grant/Research Support|Novartis: Honoraria|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Regeneron: Honoraria|Sepsis diagnostics: Sepsis diagnostics patent pending|UpToDate: Royalties|Valanbio: Stocks/Bonds Cesar A. Arias, MD, PhD, Entasis Phramceuticals: Grant/Research Support|MeMed Diagnostics: Grant/Research Support|Merck: Grant/Research Support David Paterson, MBBS, Accelerate: Honoraria|bioMerieux: Honoraria|Entasis: Advisor/Consultant|Janssen-Cilag: Grant/Research Support|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria|PPD: Grant/Research Support|Shionogi: Grant/Research Support|VenatoRx: Advisor/Consultant Karen M. Ordonez, MD, AstraZeneca: Expert Testimony|Biomerieux: Expert Testimony|Farma de Colombia: Expert Testimony|MSD: Expert Testimony|Pfizer: Expert Testimony Souha S. Kanj, Pr, MSD, Pfizer, Gilead, Menarini, Astellas: Advisor/Consultant|MSD, Pfizer, Gilead, Menarini, Astellas: Honoraria Robert Bonomo, MD, Cystic Fibrosis Foundation: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|VA: Grant/Research Support|VenatoRx: Grant/Research Support|Wockhardt: Grant/Research Support David van Duin, MD, PhD, Achaogen: Advisor/Consultant|Allergan: Advisor/Consultant|Astellas: Advisor/Consultant|MedImmune: Advisor/Consultant|Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|NeuMedicine: Advisor/Consultant|Pfizer: Advisor/Consultant|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|T2 Biosystems: Advisor/Consultant|Tetraphase: Advisor/Consultant.
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Affiliation(s)
| | | | | | | | - Keri R Baum
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Carol Hill
- Duke Clinical Research Institute, Durham, North Carolina
| | - Cesar A Arias
- Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX
| | - Blake M Hanson
- University of Texas Health Science Center, Houston, Texas
| | - David Paterson
- The University of Queensland, Brisbane, Queensland, Australia
| | - Lizhao Ge
- George Washington University, Rockville, Maryland
| | - Karen M Ordonez
- Hospital Universitario San Jorge de Pereira, Pereira, Risaralda, Colombia
| | | | - Souha S Kanj
- American University of Beirut Medical Center, Beirut, Beyrouth, Lebanon
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Denholm JT, Venkatesh B, Davis J, Bowen AC, Hammond NE, Jha V, McPhee G, McQuilten Z, O’Sullivan MVN, Paterson D, Price D, Rees M, Roberts J, Jones M, Totterdell J, Snelling T, Trask N, Morpeth S, Tong SYC. ASCOT ADAPT study of COVID-19 therapeutics in hospitalised patients: an international multicentre adaptive platform trial. Trials 2022; 23:1014. [PMID: 36514143 PMCID: PMC9747535 DOI: 10.1186/s13063-022-06929-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection is associated with a significant risk of hospitalisation, death, and prolonged impact on quality of life. Evaluation of new treatment options and optimising therapeutic management of people hospitalised with SARS-CoV-2 infection remains essential, but rapid changes in pandemic conditions and potential therapies have limited the utility of traditional approaches to randomised controlled trials. METHODS ASCOT ADAPT is an international, investigator-initiated, adaptive platform, randomised controlled trial of therapeutics for non-critically ill patients hospitalised with COVID-19. The study design is open label and pragmatic. Potential participants are hospitalised adults with PCR confirmed, symptomatic, SARS-CoV-2 infection, within 14 days of symptom onset. Domains include antiviral, antibody and anticoagulant interventions, with a composite primary outcome of 28-day mortality or progression to intensive-care level respiratory or haemodynamic support. Initial interventions include intravenous nafamostat and variable dose anticoagulation. A range of secondary endpoints, and substudies for specific domains and interventions are outlined. DISCUSSION This paper presents the trial protocol and management structure, including international governance, remote site monitoring and biobanking activities and provides commentary on ethical and pragmatic considerations in establishing the ASCOT ADAPT trial under pandemic conditions. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN12620000445976) and ClinicalTrials.gov (NCT04483960).
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Affiliation(s)
- Justin T. Denholm
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
| | - Balasubramanian Venkatesh
- grid.415508.d0000 0001 1964 6010The George Institute for Global Health, Sydney, Australia ,grid.464831.c0000 0004 8496 8261The George Institute for Global Health, New Delhi, India ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Joshua Davis
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Australia ,grid.414724.00000 0004 0577 6676Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW Australia
| | - Asha C. Bowen
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Australia ,grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia ,grid.1012.20000 0004 1936 7910Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Naomi E. Hammond
- grid.415508.d0000 0001 1964 6010The George Institute for Global Health, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Vivekanand Jha
- grid.464831.c0000 0004 8496 8261The George Institute for Global Health, New Delhi, India ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Grace McPhee
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
| | - Zoe McQuilten
- grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Transfusion Research Unit, Monash University, Melbourne, Australia
| | - Matthew V. N. O’Sullivan
- grid.413252.30000 0001 0180 6477Department of Infectious Diseases Westmead Hospital, Westmead, Australia ,grid.416088.30000 0001 0753 1056NSW Health Pathology, Institute for Clinical Pathology and Medical Research, Westmead, Australia ,grid.1013.30000 0004 1936 834XSydney Institute for Infectious Diseases, University of Sydney, Sydney, Australia
| | - David Paterson
- grid.1003.20000 0000 9320 7537University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia ,grid.416100.20000 0001 0688 4634Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia
| | - David Price
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
| | - Megan Rees
- grid.1008.90000 0001 2179 088XDepartment of Respiratory Medicine, The Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Victoria Australia
| | - Jason Roberts
- grid.1003.20000 0000 9320 7537University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia ,grid.416100.20000 0001 0688 4634Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia ,grid.416100.20000 0001 0688 4634Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia ,grid.411165.60000 0004 0593 8241Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mark Jones
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Camperdown, Australia
| | - James Totterdell
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Camperdown, Australia
| | - Thomas Snelling
- grid.414724.00000 0004 0577 6676Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW Australia ,grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Camperdown, Australia
| | | | - Susan Morpeth
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Steven YC Tong
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
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7
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Avent M, Mccarthy K, Sime F, Naickera S, Heffernan A, Wallis S, Paterson D, Roberts JA. 35: EVALUATING MONO- AND COMBINATION THERAPY OF MEROPENEM AND AMIKACIN AGAINST PSEUDOMONAS AERUGINOSA BACTEREMIA IN THE HOLLOW-FIBER INFECTION MODEL. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00314-9] [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: 12/23/2022] Open
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8
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Rickard C, Larsen E, Marsh N, McGrail M, Ullman A, Kleidon T, Chan R, Byrnes J, Mollee P, Paterson D, Chopra V, Stone L, Tapsall D, Keogh S, Gavin N, McCarthy S, Alexandrou E, Choudhury M, Corley A, Schults J, Ray-Barruel G, Geoffrey Playford E. 76. “Gadgets and gizmos aplenty!” Dressing and securing peripherally inserted central catheters to prevent infection and failure. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.034] [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: 12/15/2022]
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9
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Paterson D, Badeghiesh A, Baghlaf H, Debay A, Turki F, Baghlaf O, Dahan H. National Trends, Risk Factors, and Obstetrical Outcomes of Uterine Prolapse: A Population-Based Study. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.094] [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: 11/29/2022]
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10
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Debay A, Badeghiesh A, Baghlaf O, Paterson D, Dahan M, Alturki F, Baghlaf H. Pregnancy, Delivery, and Neonatal Outcomes Among Women with Incarcerated Uterus: A Population-Based Study. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.037] [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: 11/27/2022]
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11
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Nguyen DD, Niburski K, Cheng B, Demir K, Dixon A, Luo OD, de Meulemeester J, Nguyen AXL, Paterson D, Thomson M, de Waal A, Singh L, Hendricks K, Razack S. The Community Health and Social Medicine Incubator: a service-learning framework for medical student-led projects. Can Med Educ J 2021; 12:64-67. [PMID: 34804292 PMCID: PMC8603893 DOI: 10.36834/cmej.70653] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Community Health and Social Medicine (CHASM) Incubator is a social impact venture that gives medical and other health care students the opportunity to develop initiatives that sustainably promote health equity for, and in partnership with, community partners and historically marginalized communities. Students learn how to develop projects with project management curricula, are paired with community health mentors, and are given seed micro-financing. As the first community health incubator driven by medical students, CHASM provides a framework for students interested in implementing sustainable solutions to local health disparities which extends the service-learning opportunities offered in existing curricula.
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Affiliation(s)
| | | | - Brianna Cheng
- Faculty of Medicine, McGill University, Quebec, Canada
| | - Koray Demir
- Faculty of Medicine, McGill University, Quebec, Canada
| | - Andrew Dixon
- Faculty of Medicine, McGill University, Quebec, Canada
| | - Owen D Luo
- Faculty of Medicine, McGill University, Quebec, Canada
| | | | | | | | | | - Anna de Waal
- Faculty of Medicine, McGill University, Quebec, Canada
| | | | - Kristin Hendricks
- Global Health Programs, Faculty of Medicine, McGill University, Quebec, Canada
| | - Saleem Razack
- Department of Pediatrics, Institute of Health Sciences Education, Office of Social Accountability and Community Engagement, McGill University, Quebec, Canada
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12
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Johansson U, Carbone D, Kalbfleisch S, Björling A, Kahnt M, Sala S, Stankevic T, Liebi M, Rodriguez Fernandez A, Bring B, Paterson D, Thånell K, Bell P, Erb D, Weninger C, Matej Z, Roslund L, Åhnberg K, Norsk Jensen B, Tarawneh H, Mikkelsen A, Vogt U. NanoMAX: the hard X-ray nanoprobe beamline at the MAX IV Laboratory. J Synchrotron Radiat 2021; 28:1935-1947. [PMID: 34738949 PMCID: PMC8570223 DOI: 10.1107/s1600577521008213] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/10/2021] [Indexed: 06/01/2023]
Abstract
NanoMAX is the first hard X-ray nanoprobe beamline at the MAX IV laboratory. It utilizes the unique properties of the world's first operational multi-bend achromat storage ring to provide an intense and coherent focused beam for experiments with several methods. In this paper we present the beamline optics design in detail, show the performance figures, and give an overview of the surrounding infrastructure and the operational diffraction endstation.
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Affiliation(s)
- Ulf Johansson
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Dina Carbone
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | | | | | - Maik Kahnt
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Simone Sala
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Tomas Stankevic
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Marianne Liebi
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | | | - Björn Bring
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - David Paterson
- Australian Synchrotron, ANSTO, 800 Blackburn Road, Clayton, Victoria 3168, Australia
| | - Karina Thånell
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Paul Bell
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - David Erb
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Clemens Weninger
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Zdenek Matej
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Linus Roslund
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Karl Åhnberg
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | | | - Hamed Tarawneh
- MAX IV Laboratory, Lund University, PO Box 118, S-221 00 Lund, Sweden
| | - Anders Mikkelsen
- Lund University, Synchrotron Radiation Research, 22100 Lund, Sweden
| | - Ulrich Vogt
- KTH Royal Institute of Technology, Department of Applied Physics, Biomedical and X-ray Physics, Albanova University Center, 106 91 Stockholm, Sweden
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13
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Henderson B, Hurst T, Harris P, Forde B, Paterson D. The next generation – the use of whole genome sequencing in outbreak management and HAI. Infect Dis Health 2021. [DOI: 10.1016/j.idh.2021.09.020] [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: 11/24/2022]
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14
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Wang G, Lu CJ, Trafford AW, Tian X, Flores HM, Maj P, Zhang K, Niu Y, Wang L, Du Y, Ji X, Xu Y, Wu L, Li D, Herring N, Paterson D, Huang CLH, Zhang H, Lei M, Hao G. Electrophysiological and Proarrhythmic Effects of Hydroxychloroquine Challenge in Guinea-Pig Hearts. ACS Pharmacol Transl Sci 2021; 4:1639-1653. [PMID: 34661080 PMCID: PMC8506600 DOI: 10.1021/acsptsci.1c00166] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Indexed: 12/27/2022]
Abstract
Hydroxychloroquine (HCQ), clinically established in antimalarial and autoimmune therapy, recently raised cardiac arrhythmogenic concerns when used alone or with azithromycin (HCQ+AZM) in Covid-19. We report complementary, experimental, studies of its electrophysiological effects. In patch clamped HEK293 cells expressing human cardiac ion channels, HCQ inhibited IKr and IK1 at a therapeutic concentrations (IC50s: 10 ± 0.6 and 34 ± 5.0 μM). INa and ICaL showed higher IC50s; Ito and IKs were unaffected. AZM slightly inhibited INa, ICaL, IKs, and IKr, sparing IK1 and Ito. (HCQ+AZM) inhibited IKr and IK1 (IC50s: 7.7 ± 0.8 and 30.4 ± 3.0 μM), sparing INa, ICaL, and Ito. Molecular induced-fit docking modeling confirmed potential HCQ-hERG but weak AZM-hERG binding. Effects of μM-HCQ were studied in isolated perfused guinea-pig hearts by multielectrode, optical RH237 voltage, and Rhod-2 mapping. These revealed reversibly reduced left atrial and ventricular action potential (AP) conduction velocities increasing their heterogeneities, increased AP durations (APDs), and increased durations and dispersions of intracellular [Ca2+] transients, respectively. Hearts also became bradycardic with increased electrocardiographic PR and QRS durations. The (HCQ+AZM) combination accentuated these effects. Contrastingly, (HCQ+AZM) and not HCQ alone disrupted AP propagation, inducing alternans and torsadogenic-like episodes on voltage mapping during forced pacing. O'Hara-Rudy modeling showed that the observed IKr and IK1 effects explained the APD alterations and the consequently prolonged Ca2+ transients. The latter might then downregulate INa, reducing AP conduction velocity through recently reported INa downregulation by cytosolic [Ca2+] in a novel scheme for drug action. The findings may thus prompt future investigations of HCQ's cardiac safety under particular, chronic and acute, clinical situations.
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Affiliation(s)
- Gongxin Wang
- Henan
SCOPE Research Institute of Electrophysiology Co. Ltd., Kaifeng 475000, China
| | - Chieh-Ju Lu
- Henan
SCOPE Research Institute of Electrophysiology Co. Ltd., Kaifeng 475000, China
| | - Andrew W. Trafford
- Unit
of Cardiac Physiology, Institute of Cardiovascular Sciences, Manchester
Academic Health Sciences Centre, The University
of Manchester, Manchester M13 9PL, U.K.
| | - Xiaohui Tian
- Department
of Pharmacy, Huaihe Hospital and College of Medicine, Henan University, Kaifeng 475000, China
| | - Hannali M Flores
- Biological
Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, U.K.
| | - Piotr Maj
- Department
of Pharmacology, University of Oxford, Oxford OX1 2JD, U.K.
| | - Kevin Zhang
- School of
Medicine, Imperial College of London, London SW7 2AZ, U.K.
| | - Yanhong Niu
- Fuwai
Central China Cardiovascular Hospital, Zhengzhou 450003, China
| | - Luxi Wang
- Henan
SCOPE Research Institute of Electrophysiology Co. Ltd., Kaifeng 475000, China
| | - Yimei Du
- Department
of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xinying Ji
- Department
of Pharmacy, Huaihe Hospital and College of Medicine, Henan University, Kaifeng 475000, China
| | - Yanfang Xu
- Department
of Pharmacology, Hebei Medical University, Shijiazhuang City 050017, China
| | - Lin Wu
- Department
of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Dan Li
- Department
of Physiology, Anatomy and Genetics, University
of Oxford, Oxford OX1 2JD, U.K.
| | - Neil Herring
- Department
of Physiology, Anatomy and Genetics, University
of Oxford, Oxford OX1 2JD, U.K.
| | - David Paterson
- Department
of Physiology, Anatomy and Genetics, University
of Oxford, Oxford OX1 2JD, U.K.
| | - Christopher L.-H. Huang
- Physiological
Laboratory and Department of Biochemistry, University of Cambridge, Cambridge CB2 3EG, U.K.
- Key
Laboratory of Medical Electrophysiology of the Ministry of Education
and Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
| | - Henggui Zhang
- Biological
Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, U.K.
- Peng
Cheng Laboratory, Shenzhen 518066, China
- Key
Laboratory of Medical Electrophysiology of the Ministry of Education
and Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
| | - Ming Lei
- Department
of Pharmacology, University of Oxford, Oxford OX1 2JD, U.K.
- Key
Laboratory of Medical Electrophysiology of the Ministry of Education
and Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
| | - Guoliang Hao
- Henan
SCOPE Research Institute of Electrophysiology Co. Ltd., Kaifeng 475000, China
- Department
of Physiology, Anatomy and Genetics, University
of Oxford, Oxford OX1 2JD, U.K.
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15
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Paterson D. Designing and conducting clinical trials that change the practice. Int J Antimicrob Agents 2021. [DOI: 10.1016/j.ijantimicag.2021.106420.40] [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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16
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Paterson D. Shorter the better: Current evidence for the shorter duration of antibiotic therapy. Int J Antimicrob Agents 2021. [DOI: 10.1016/j.ijantimicag.2021.106420.21] [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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17
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Tran CQ, Chantler CT, Kirk T, Dao MH, Di Pasquale P, Ceddia J, Barnea Z, de Jonge M, Kewish C, Paterson D. Complex atomic fine structure in the phase domain: exciting opportunities and challenges. Acta Crystallogr A Found Adv 2021. [DOI: 10.1107/s0108767321084476] [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: 11/11/2022] Open
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18
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Dharmaprani D, Bradley C, Hayward M, Paterson D, Taggart P, Jenkins E, Xian Quah J, Lahiri A, Tiver K, Mitchell L, Clayton RH, Nash MP, Ganesan AN. B-YIA2-03 A GOVERNING EQUATION TO EXPLAIN THE NUMBER OF WAVELETS AND ROTORS OBSERVED IN HUMAN VENTRICULAR FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.145] [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: 11/24/2022]
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19
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Irwin AD, Coin LJM, Harris PNA, Cotta MO, Bauer MJ, Buckley C, Balch R, Kruger P, Meyer J, Shekar K, Brady K, Fourie C, Sharp N, Vlad L, Whiley D, Beatson SA, Forde BM, Paterson D, Clark J, Hajkowicz K, Raman S, Bialasiewicz S, Lipman J, Schlapbach LJ, Roberts JA. Optimising Treatment Outcomes for Children and Adults Through Rapid Genome Sequencing of Sepsis Pathogens. A Study Protocol for a Prospective, Multi-Centre Trial (DIRECT). Front Cell Infect Microbiol 2021; 11:667680. [PMID: 34249774 PMCID: PMC8261237 DOI: 10.3389/fcimb.2021.667680] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sepsis contributes significantly to morbidity and mortality globally. In Australia, 20,000 develop sepsis every year, resulting in 5,000 deaths, and more than AUD$846 million in expenditure. Prompt, appropriate antibiotic therapy is effective in improving outcomes in sepsis. Conventional culture-based methods to identify appropriate therapy have limited yield and take days to complete. Recently, nanopore technology has enabled rapid sequencing with real-time analysis of pathogen DNA. We set out to demonstrate the feasibility and diagnostic accuracy of pathogen sequencing direct from clinical samples, and estimate the impact of this approach on time to effective therapy when integrated with personalised software-guided antimicrobial dosing in children and adults on ICU with sepsis. Methods The DIRECT study is a pilot prospective, non-randomized multicentre trial of an integrated diagnostic and therapeutic algorithm combining rapid direct pathogen sequencing and software-guided, personalised antibiotic dosing in children and adults with sepsis on ICU. Participants and interventions DIRECT will collect microbiological and pharmacokinetic samples from approximately 200 children and adults with sepsis admitted to one of four ICUs in Brisbane. In Phase 1, we will evaluate Oxford Nanopore Technologies MinION sequencing direct from blood in 50 blood culture-proven sepsis patients recruited from consecutive patients with suspected sepsis. In Phase 2, a further 50 consecutive patients with suspected sepsis will be recruited in whom MinION sequencing will be combined with Bayesian software-guided (ID-ODS) personalised antimicrobial dosing. Outcome measures The primary outcome is time to effective antimicrobial therapy, defined as trough drug concentrations above the MIC of the pathogen. Secondary outcomes are diagnostic accuracy of MinION sequencing from whole blood, time to pathogen identification and susceptibility testing using sequencing direct from whole blood and from positive blood culture broth. Discussion Rapid pathogen sequencing coupled with antimicrobial dosing software has great potential to overcome the limitations of conventional diagnostics which often result in prolonged inappropriate antimicrobial therapy. Reduced time to optimal antimicrobial therapy may reduce sepsis mortality and ICU length of stay. This pilot study will yield key feasibility data to inform further, urgently needed sepsis studies. Phase 2 of the trial protocol is registered with the ANZCTR (ACTRN12620001122943). Trial registration Registered with the Australia New Zealand Clinical Trials Registry Number ACTRN12620001122943
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Affiliation(s)
- Adam D Irwin
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Lachlan J M Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Menino Osbert Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Cameron Buckley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiran Shekar
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kara Brady
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Cheryl Fourie
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Brisbane, QLD, Australia
| | - Natalie Sharp
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Luminita Vlad
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brian M Forde
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Julia Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Brisbane, QLD, Australia
| | - Sainath Raman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Seweryn Bialasiewicz
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.,Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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20
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Hackett MJ, Hollings AL, Lam V, Takechi R, Mamo JCL, de Jonge MD, Paterson D, Okuyama S. [Mapping the Metallo-maze to Memory Loss: Does Neuronal Metal Ion Deficiency Contribute to Dementia?]. YAKUGAKU ZASSHI 2021; 141:835-842. [PMID: 34078791 DOI: 10.1248/yakushi.20-00251-4] [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] [Indexed: 11/22/2022]
Abstract
Dementia has no cure and is an international health crisis. In addition to the immeasurable loss of QOL caused by dementia, the global economic cost is predicted to reach $2 trillion (USD) by 2030. Although much remains unknown about the biochemical pathways driving cognitive decline and memory loss during dementia, metals have been implicated in neurodegenerative disease. For example, total levels of Fe and Cu increase, which has been proposed to drive oxidative stress; and Fe, Cu, and Zn can bind amyloid-β, catalysing aggregation and formation of amyloid plaques. Unfortunately, despite these known facets through which metal ions may induce pathology, studies in greater detail have been hampered by a lack of microscopy methods to directly visualise metal ions, and their chemical form, within brain cells. Herein we report the use of synchrotron X-ray fluorescence microscopy to simultaneously image Fe, Cu, and Zn within neurons in ex vivo brain tissue sections. Using animal models of dementia, we now demonstrate for the first time that despite global increases in brain metal content and metal ion accumulation within amyloid plaques, key brain regions may also become metal ion deficient. Such deficiency could contribute to cognitive decline because of the essential roles metal ions play in neurotransmitter synthesis and energy metabolism. These recent findings are discussed in the context of memory loss, and the impact that metal ion dis-homeostasis may have on diagnostic and therapeutic development.
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Affiliation(s)
- Mark J Hackett
- School of Molecular and Life Sciences, Curtin University.,Curtin Health Innovation Research Institute, Curtin University.,Curtin Institute of Functional Molecules and Interfaces, Curtin University
| | - Ashley L Hollings
- School of Molecular and Life Sciences, Curtin University.,Curtin Health Innovation Research Institute, Curtin University.,Curtin Institute of Functional Molecules and Interfaces, Curtin University
| | - Virginie Lam
- Curtin Health Innovation Research Institute, Curtin University
| | - Ryusuke Takechi
- Curtin Health Innovation Research Institute, Curtin University
| | - John C L Mamo
- Curtin Health Innovation Research Institute, Curtin University
| | | | | | - Satoshi Okuyama
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University
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21
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Henderson A, Bursle E, Stewart A, Harris PNA, Paterson D, Chatfield MD, Paul M, Dickstein Y, Rodriguez-Baño J, Turnidge JD, Kahlmeter G. A systematic review of antimicrobial susceptibility testing as a tool in clinical trials assessing antimicrobials against infections due to gram-negative pathogens. Clin Microbiol Infect 2021; 27:1746-1753. [PMID: 33813125 DOI: 10.1016/j.cmi.2021.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antimicrobial susceptibility testing (AST) is the standard of care for treating bacterial infections. In randomized clinical trials of new antimicrobials, AST might not be performed or reported in real time. OBJECTIVES To determine local, real-time laboratory AST performance, its usage in the trial flow, quality control (QC) of the local testing, central AST performance and the effect of using AST categorization on the trials' primary outcomes. DATA SOURCES We systematically searched PubMed, Embase, PsychINFO and Web of Science. ELIGIBILITY CRITERIA We included registered randomized controlled trials published in journals between January 2015 and December 2019. PARTICIPANTS AND INTERVENTIONS We included trials comparing different antibiotics for the treatment of infections caused predominantly by Gram-negative bacteria. METHODS Primary outcomes for different trial populations were extracted and differences between trial arms were compared for patients with infections caused by susceptible versus non-susceptible bacteria. Results are described narratively. RESULTS Of 32 randomized trials, 25 trials reported that local AST was performed, 1312 reported the local laboratory AST methods, no trial reported QC, but post-hoc referral for AST at a reference laboratory was common. Patients' outcomes were superior when patients with infections due to susceptible and non-susceptible pathogens were compared post hoc (median difference 14%, interquartile range 8%-24%) in trials allowing this comparison (seven antimicrobials), except for colistin, where 14-day mortality was 9% higher when patients were treated with colistin for colistin-susceptible versus colistin-resistant carbapenem-resistant Acinetobacter baumannii. When excluding patients with pathogens that were non-susceptible to either antimicrobial in the trials, the difference in the primary outcome between the trial arms was reduced in five out of six trials. CONCLUSIONS Trials should perform AST to guide patient inclusion or exclusion from the study and consider the impact of the central laboratory susceptibility results on the study outcomes when using post-hoc reference testing.
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Affiliation(s)
- Andrew Henderson
- Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, QLD, Australia.
| | - Evan Bursle
- Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, QLD, Australia; Sullivan and Nicolaides Pathology, Brisbane, QLD, Australia
| | - Adam Stewart
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Patrick N A Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, QLD, Australia; Pathology Queensland, Brisbane, QLD, Australia
| | - David Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, QLD, Australia
| | - Mark D Chatfield
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, QLD, Australia
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Jesus Rodriguez-Baño
- Hospital Universitario Virgen Macarena, Sevilla, Spain; Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla and Instituto de Biomedicina de Seville, Sevilla, Spain
| | - John D Turnidge
- University of Adelaide, Adelaide, SA, Australia; European Committee on Antimicrobial Susceptibility Testing (EUCAST), Adelaide, Australia
| | - Gunnar Kahlmeter
- European Committee on Antimicrobial Susceptibility Testing (EUCAST), Adelaide, Australia; European Committee on Antimicrobial Susceptibility Testing (EUCAST), Vaxjo, Sweden
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22
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Roberts LW, Forde BM, Hurst T, Ling W, Nimmo GR, Bergh H, George N, Hajkowicz K, McNamara JF, Lipman J, Permana B, Schembri MA, Paterson D, Beatson SA, Harris PNA. Genomic surveillance, characterization and intervention of a polymicrobial multidrug-resistant outbreak in critical care. Microb Genom 2021; 7:mgen000530. [PMID: 33599607 PMCID: PMC8190620 DOI: 10.1099/mgen.0.000530] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/24/2021] [Indexed: 02/01/2023] Open
Abstract
Background. Infections caused by carbapenem-resistant Acinetobacter baumannii (CR-Ab) have become increasingly prevalent in clinical settings and often result in significant morbidity and mortality due to their multidrug resistance (MDR). Here we present an integrated whole-genome sequencing (WGS) response to a persistent CR-Ab outbreak in a Brisbane hospital between 2016-2018.Methods. A. baumannii, Klebsiella pneumoniae, Serratia marcescens and Pseudomonas aeruginosa isolates were sequenced using the Illumina platform primarily to establish isolate relationships based on core-genome SNPs, MLST and antimicrobial resistance gene profiles. Representative isolates were selected for PacBio sequencing. Environmental metagenomic sequencing with Illumina was used to detect persistence of the outbreak strain in the hospital.Results. In response to a suspected polymicrobial outbreak between May to August of 2016, 28 CR-Ab (and 21 other MDR Gram-negative bacilli) were collected from Intensive Care Unit and Burns Unit patients and sent for WGS with a 7 day turn-around time in clinical reporting. All CR-Ab were sequence type (ST)1050 (Pasteur ST2) and within 10 SNPs apart, indicative of an ongoing outbreak, and distinct from historical CR-Ab isolates from the same hospital. Possible transmission routes between patients were identified on the basis of CR-Ab and K. pneumoniae SNP profiles. Continued WGS surveillance between 2016 to 2018 enabled suspected outbreak cases to be refuted, but a resurgence of the outbreak CR-Ab mid-2018 in the Burns Unit prompted additional screening. Environmental metagenomic sequencing identified the hospital plumbing as a potential source. Replacement of the plumbing and routine drain maintenance resulted in rapid resolution of the secondary outbreak and significant risk reduction with no discernable transmission in the Burns Unit since.Conclusion. We implemented a comprehensive WGS and metagenomics investigation that resolved a persistent CR-Ab outbreak in a critical care setting.
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Affiliation(s)
- Leah W. Roberts
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
- EMBL-EBI, Wellcome Genome Campus, Hinxton, Cambridgeshire, UK
| | - Brian M. Forde
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Trish Hurst
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, QLD, Australia
- Infection Monitoring and Prevention Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- Unit of Infectious Diseases, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Weiping Ling
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, QLD, Australia
| | - Graeme R. Nimmo
- Pathology Queensland, Central Laboratory, Brisbane, QLD, Australia
| | - Haakon Bergh
- Pathology Queensland, Central Laboratory, Brisbane, QLD, Australia
| | - Narelle George
- Pathology Queensland, Central Laboratory, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Unit of Infectious Diseases, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - John F. McNamara
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, QLD, Australia
| | - Jeffrey Lipman
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Budi Permana
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Mark A. Schembri
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - David Paterson
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, QLD, Australia
- Unit of Infectious Diseases, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Scott A. Beatson
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Patrick N. A. Harris
- Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, QLD, Australia
- Pathology Queensland, Central Laboratory, Brisbane, QLD, Australia
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23
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Dharmaprani D, Jenkins E, Quah J, Lahiri A, Tiver K, Mitchell L, Bradley C, Hayward M, Paterson D, Taggart P, Clayton R, Nash M, Ganesan A. A Governing Equation for Human Ventricular Fibrillation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.121] [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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24
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Soriano A, Puzniak LA, Bassetti M, Kaul S, Moise P, Paterson D, Paterson D. 1612. Evaluation of the Use of Ceftolozane/Tazobactam for the Treatment of ESBL-producing Enterobacterales Infections Using International Data from SPECTRA (Study of Prescribing Patterns and Effectiveness of Ceftolozane/Tazobactam Real World Analysis). Open Forum Infect Dis 2020. [PMCID: PMC7778033 DOI: 10.1093/ofid/ofaa439.1792] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There is a paucity of data on outcomes of patients with severe ESBL-producing Enterobacterales infections treated with empiric or directed ceftolozane/tazobactam (C/T). This study looked at the treatment patterns and outcomes associated with C/T use in the treatment of ESBL-producing Enterobacterales. Methods Data were collected from an international cohort of 32 hospitals in 6 countries as part of SPECTRA, a retrospective multicenter database of C/T use globally, from 2016 – 2019. All adult patients with an ESBL positive Enterobacterales sterile site culture and treated with ≥ 48 hours of C/T were eligible. Outcomes assessed were clinical success, 30-day mortality from index event and readmission. Results There were 59 patients with 121 ESBL positive isolates. Blood and urine were the most common sites of infection at 19.8% each, followed by respiratory (18.2%). E. coli (50%) and K. pneumoniae (30%) were the most common pathogens. On average patients had 2 positive ESBL isolates; median 1; range 1-15. Most patients had the same infection site and ESBL pathogen, however 13 had multi-site ESBL pathogens identified and only 2 had polymicrobial ESBL pathogens. Septic shock was observed in 14 (24%) patients; 29 (49%) were in the ICU at the onset of infection. The most common comorbid conditions were immunocompromised hosts (37%) and cardiac disease (32%). 29% of patients were transplant recipients, and 28% had a CrCl < 50 ml/min. In most patients (71%), C/T was given as directed therapy (i.e., once culture results were available). C/T was given prior to culture results (i.e., as empiric therapy) in 17 (29%) patients, of which 77% had clinical success. C/T dose was 1.5 g in 49%. Only 2 of 10 patients with a respiratory source received the currently licensed 3 g dose. Overall, clinical success was observed in 36 (61%) patients. 30-day mortality was 12%. Readmissions occurred in 5%, of which 2 were infection related. Conclusion The role of newer non-carbapenem antibiotics in the treatment of severe ESBL infections is currently undefined. In a multinational patient database, C/T was found to be effective in severe infections caused by ESBL-producing Enterobacterales. Prospective studies are needed to further define the role of C/T in the setting of frequent drug-resistant Gram-negative pathogens. Disclosures Laura A. Puzniak, PhD, Merck (Employee) Matteo Bassetti, MD, Shionogi Inc. (Advisor or Review Panel member) Pamela Moise, PharmD, Merck & Co., Inc. (Employee, Shareholder) David Paterson, Accelerate (Speaker’s Bureau)BioMerieux (Speaker’s Bureau)BioMerieux (Advisor or Review Panel member)Entasis (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Merck (Grant/Research Support)Merck (Speaker’s Bureau)Pfizer (Speaker’s Bureau)Shionogi & Co., Ltd. (Grant/Research Support)VenatoRx (Advisor or Review Panel member)
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Affiliation(s)
- Alex Soriano
- Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | | | - Matteo Bassetti
- University of Genoa and Ospedale Policlinico San Martino, Udine, Friuli-Venezia Giulia, Italy
| | - Sundeep Kaul
- Harefield hospital, london, England, United Kingdom
| | - Pamela Moise
- Merck Research Labs, Merck & Co., Inc., Kenilworth, New Jersey
| | - David Paterson
- Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | - David Paterson
- Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
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25
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Katsube T, Kawaguchi N, Matsunaga Y, Ariyasu M, Den Nagata T, Portsmouth S, Paterson D, Paterson D, Satlin MJ, Zeitlinger M, Echols R, Wajima T. 1316. Pharmacokinetic/Pharmacodynamic Analyses of Cefiderocol in Critically Ill Patients. Open Forum Infect Dis 2020. [PMCID: PMC7777002 DOI: 10.1093/ofid/ofaa439.1498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/12/2022] Open
Abstract
Abstract
Background
Cefiderocol (CFDC), a novel siderophore cephalosporin, has demonstrated potent antibacterial activity against a wide range of Gram-negative bacteria including carbapenem-resistant strains. We aimed to evaluate relationships between drug exposure and outcomes in critically ill patients.
Methods
Sparse pharmacokinetic (PK) samples at steady state from critically ill patients with pneumonia, bloodstream infection/sepsis, or complicated urinary tract infection receiving CFDC in two Phase 3 studies were analyzed. Percent time of dosing interval of free drug concentration exceeding the minimum inhibitory concentration (MIC) in plasma and epithelial lining fluid (ELF) (%fT>MIC and %fT>MIC,ELF, respectively) were determined for 60 (CREDIBLE-CR; NCT02714595) and 97 patients (APEKS-NP; NCT03032380), using a 3-compartment population PK model. The %fT>MIC,ELF was calculated for 125 pneumonia patients based on an intrapulmonary PK model. Relationships between %fT>MIC, %fT>MIC,ELF and clinical and microbiological outcomes at test of cure (TOC), or mortality at Day 28 were assessed.
Results
The median (90th percentile) MICs of Gram-negative pathogens in the PK/pharmacodynamic (PD) analyses were 0.25 (4) µg/mL (CREDIBLE-CR) and 0.25 (2) µg/mL (APEKS-NP), respectively. Individual plasma %fT>MIC was 100% in ≥95% of patients in each study, and estimated %fT>MIC,ELF was 100% in 89.3% (25/28 pneumonia patients; CREDIBLE-CR) and 97.9% (95/97 pneumonia patients; APEKS-NP). Clinical cure rates and survival rates in patients with 100% fT>MIC or %fT>MIC,ELF were similar between the two studies (Table). No PK/PD relationships between %fT>MIC, %fT>MIC,ELF and clinical cure, microbiological eradication, or survival were identified in either study because high %fT>MIC or %fT>MIC,ELF was achieved in all patients.
Table. Clinical cure and survival rates in patients with 100% fT>MIC or %fT>MIC,ELF in CREDIBLE-CR and APEKS-NP studies
Conclusion
PK/PD relationship was not identified between CFDC plasma or ELF exposure and clinical or microbiological outcomes, or mortality as high %fT>MIC and %fT>MIC,ELF were achieved, suggesting the recommended dosing regimen of 2 g q8h or renally adjusted dosage (including augmented renal clearance), infused over 3 hours, provides sufficient exposure to CFDC in critically ill patients.
Disclosures
Takayuki Katsube, PhD, Shionogi & Co., Ltd. (Employee) Nao Kawaguchi, BPharm, Shionogi & Co., Ltd. (Employee) Yuko Matsunaga, MD, Shionogi Inc. (Employee) Mari Ariyasu, BPharm, Shionogi & Co., Ltd. (Employee) Tsutae Den Nagata, MD, Shionogi & Co., Ltd. (Employee) Simon Portsmouth, MD, Shionogi Inc. (Employee) David Paterson, Accelerate (Speaker’s Bureau)BioMerieux (Speaker’s Bureau)BioMerieux (Advisor or Review Panel member)Entasis (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Merck (Grant/Research Support)Merck (Speaker’s Bureau)Pfizer (Speaker’s Bureau)Shionogi & Co., Ltd. (Grant/Research Support)VenatoRx (Advisor or Review Panel member) Michael J. Satlin, MD, MS, Achaogen (Consultant)Allergan (Grant/Research Support)Merck (Grant/Research Support)Shionogi Inc. (Consultant) Roger Echols, MD, Shionogi Inc. (Consultant) Toshihiro Wajima, PhD, Shionogi & Co., Ltd. (Employee)
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Roger Echols
- Infectious Disease Drug Development Consulting LLC, Easton, Connecticut
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26
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Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, van Bentum-Puijk W, Berry L, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Buzgau A, Cheng AC, de Jong M, Detry M, Estcourt L, Fitzgerald M, Goossens H, Green C, Haniffa R, Higgins AM, Horvat C, Hullegie SJ, Kruger P, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, Marshall J, McAuley D, McGlothin A, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Parker J, Rowan K, Sanil A, Santos M, Saunders C, Seymour C, Turner A, van de Veerdonk F, Venkatesh B, Zarychanski R, Berry S, Lewis RJ, McArthur C, Webb SA, Gordon AC, Al-Beidh F, Angus D, Annane D, Arabi Y, van Bentum-Puijk W, Berry S, Beane A, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Cheng A, De Jong M, Derde L, Estcourt L, Goossens H, Gordon A, Green C, Haniffa R, Lamontagne F, Lawler P, Litton E, Marshall J, McArthur C, McAuley D, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Rowan K, Seymour C, Turner A, van de Veerdonk F, Webb S, Zarychanski R, Campbell L, Forbes A, Gattas D, Heritier S, Higgins L, Kruger P, Peake S, Presneill J, Seppelt I, Trapani T, Young P, Bagshaw S, Daneman N, Ferguson N, Misak C, Santos M, Hullegie S, Pletz M, Rohde G, Rowan K, Alexander B, Basile K, Girard T, Horvat C, Huang D, Linstrum K, Vates J, Beasley R, Fowler R, McGloughlin S, Morpeth S, Paterson D, Venkatesh B, Uyeki T, Baillie K, Duffy E, Fowler R, Hills T, Orr K, Patanwala A, Tong S, Netea M, Bihari S, Carrier M, Fergusson D, Goligher E, Haidar G, Hunt B, Kumar A, Laffan M, Lawless P, Lother S, McCallum P, Middeldopr S, McQuilten Z, Neal M, Pasi J, Schutgens R, Stanworth S, Turgeon A, Weissman A, Adhikari N, Anstey M, Brant E, de Man A, Lamonagne F, Masse MH, Udy A, Arnold D, Begin P, Charlewood R, Chasse M, Coyne M, Cooper J, Daly J, Gosbell I, Harvala-Simmonds H, Hills T, MacLennan S, Menon D, McDyer J, Pridee N, Roberts D, Shankar-Hari M, Thomas H, Tinmouth A, Triulzi D, Walsh T, Wood E, Calfee C, O’Kane C, Shyamsundar M, Sinha P, Thompson T, Young I, Bihari S, Hodgson C, Laffey J, McAuley D, Orford N, Neto A, Detry M, Fitzgerald M, Lewis R, McGlothlin A, Sanil A, Saunders C, Berry L, Lorenzi E, Miller E, Singh V, Zammit C, van Bentum Puijk W, Bouwman W, Mangindaan Y, Parker L, Peters S, Rietveld I, Raymakers K, Ganpat R, Brillinger N, Markgraf R, Ainscough K, Brickell K, Anjum A, Lane JB, Richards-Belle A, Saull M, Wiley D, Bion J, Connor J, Gates S, Manax V, van der Poll T, Reynolds J, van Beurden M, Effelaar E, Schotsman J, Boyd C, Harland C, Shearer A, Wren J, Clermont G, Garrard W, Kalchthaler K, King A, Ricketts D, Malakoutis S, Marroquin O, Music E, Quinn K, Cate H, Pearson K, Collins J, Hanson J, Williams P, Jackson S, Asghar A, Dyas S, Sutu M, Murphy S, Williamson D, Mguni N, Potter A, Porter D, Goodwin J, Rook C, Harrison S, Williams H, Campbell H, Lomme K, Williamson J, Sheffield J, van’t Hoff W, McCracken P, Young M, Board J, Mart E, Knott C, Smith J, Boschert C, Affleck J, Ramanan M, D’Souza R, Pateman K, Shakih A, Cheung W, Kol M, Wong H, Shah A, Wagh A, Simpson J, Duke G, Chan P, Cartner B, Hunter S, Laver R, Shrestha T, Regli A, Pellicano A, McCullough J, Tallott M, Kumar N, Panwar R, Brinkerhoff G, Koppen C, Cazzola F, Brain M, Mineall S, Fischer R, Biradar V, Soar N, White H, Estensen K, Morrison L, Smith J, Cooper M, Health M, Shehabi Y, Al-Bassam W, Hulley A, Whitehead C, Lowrey J, Gresha R, Walsham J, Meyer J, Harward M, Venz E, Williams P, Kurenda C, Smith K, Smith M, Garcia R, Barge D, Byrne D, Byrne K, Driscoll A, Fortune L, Janin P, Yarad E, Hammond N, Bass F, Ashelford A, Waterson S, Wedd S, McNamara R, Buhr H, Coles J, Schweikert S, Wibrow B, Rauniyar R, Myers E, Fysh E, Dawda A, Mevavala B, Litton E, Ferrier J, Nair P, Buscher H, Reynolds C, Santamaria J, Barbazza L, Homes J, Smith R, Murray L, Brailsford J, Forbes L, Maguire T, Mariappa V, Smith J, Simpson S, Maiden M, Bone A, Horton M, Salerno T, Sterba M, Geng W, Depuydt P, De Waele J, De Bus L, Fierens J, Bracke S, Reeve B, Dechert W, Chassé M, Carrier FM, Boumahni D, Benettaib F, Ghamraoui A, Bellemare D, Cloutier È, Francoeur C, Lamontagne F, D’Aragon F, Carbonneau E, Leblond J, Vazquez-Grande G, Marten N, Wilson M, Albert M, Serri K, Cavayas A, Duplaix M, Williams V, Rochwerg B, Karachi T, Oczkowski S, Centofanti J, Millen T, Duan E, Tsang J, Patterson L, English S, Watpool I, Porteous R, Miezitis S, McIntyre L, Brochard L, Burns K, Sandhu G, Khalid I, Binnie A, Powell E, McMillan A, Luk T, Aref N, Andric Z, Cviljevic S, Đimoti R, Zapalac M, Mirković G, Baršić B, Kutleša M, Kotarski V, Vujaklija Brajković A, Babel J, Sever H, Dragija L, Kušan I, Vaara S, Pettilä L, Heinonen J, Kuitunen A, Karlsson S, Vahtera A, Kiiski H, Ristimäki S, Azaiz A, Charron C, Godement M, Geri G, Vieillard-Baron A, Pourcine F, Monchi M, Luis D, Mercier R, Sagnier A, Verrier N, Caplin C, Siami S, Aparicio C, Vautier S, Jeblaoui A, Fartoukh M, Courtin L, Labbe V, Leparco C, Muller G, Nay MA, Kamel T, Benzekri D, Jacquier S, Mercier E, Chartier D, Salmon C, Dequin P, Schneider F, Morel G, L’Hotellier S, Badie J, Berdaguer FD, Malfroy S, Mezher C, Bourgoin C, Megarbane B, Voicu S, Deye N, Malissin I, Sutterlin L, Guitton C, Darreau C, Landais M, Chudeau N, Robert A, Moine P, Heming N, Maxime V, Bossard I, Nicholier TB, Colin G, Zinzoni V, Maquigneau N, Finn A, Kreß G, Hoff U, Friedrich Hinrichs C, Nee J, Pletz M, Hagel S, Ankert J, Kolanos S, Bloos F, Petros S, Pasieka B, Kunz K, Appelt P, Schütze B, Kluge S, Nierhaus A, Jarczak D, Roedl K, Weismann D, Frey A, Klinikum Neukölln V, Reill L, Distler M, Maselli A, Bélteczki J, Magyar I, Fazekas Á, Kovács S, Szőke V, Szigligeti G, Leszkoven J, Collins D, Breen P, Frohlich S, Whelan R, McNicholas B, Scully M, Casey S, Kernan M, Doran P, O’Dywer M, Smyth M, Hayes L, Hoiting O, Peters M, Rengers E, Evers M, Prinssen A, Bosch Ziekenhuis J, Simons K, Rozendaal W, Polderman F, de Jager P, Moviat M, Paling A, Salet A, Rademaker E, Peters AL, de Jonge E, Wigbers J, Guilder E, Butler M, Cowdrey KA, Newby L, Chen Y, Simmonds C, McConnochie R, Ritzema Carter J, Henderson S, Van Der Heyden K, Mehrtens J, Williams T, Kazemi A, Song R, Lai V, Girijadevi D, Everitt R, Russell R, Hacking D, Buehner U, Williams E, Browne T, Grimwade K, Goodson J, Keet O, Callender O, Martynoga R, Trask K, Butler A, Schischka L, Young C, Lesona E, Olatunji S, Robertson Y, José N, Amaro dos Santos Catorze T, de Lima Pereira TNA, Neves Pessoa LM, Castro Ferreira RM, Pereira Sousa Bastos JM, Aysel Florescu S, Stanciu D, Zaharia MF, Kosa AG, Codreanu D, Marabi Y, Al Qasim E, Moneer Hagazy M, Al Swaidan L, Arishi H, Muñoz-Bermúdez R, Marin-Corral J, Salazar Degracia A, Parrilla Gómez F, Mateo López MI, Rodriguez Fernandez J, Cárcel Fernández S, Carmona Flores R, León López R, de la Fuente Martos C, Allan A, Polgarova P, Farahi N, McWilliam S, Hawcutt D, Rad L, O’Malley L, Whitbread J, Kelsall O, Wild 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Fernández de Pinedo Artaraz Z, Cabreros L, White I, Croft M, Holland N, Pereira R, Zaki A, Johnson D, Jackson M, Garrard H, Juhaz V, Roy A, Rostron A, Woods L, Cornell S, Pillai S, Harford R, Rees T, Ivatt H, Sundara Raman A, Davey M, Lee K, Barber R, Chablani M, Brohi F, Jagannathan V, Clark M, Purvis S, Wetherill B, Dushianthan A, Cusack R, de Courcy-Golder K, Smith S, Jackson S, Attwood B, Parsons P, Page V, Zhao XB, Oza D, Rhodes J, Anderson T, Morris S, Xia Le Tai C, Thomas A, Keen A, Digby S, Cowley N, Wild L, Southern D, Reddy H, Campbell A, Watkins C, Smuts S, Touma O, Barnes N, Alexander P, Felton T, Ferguson S, Sellers K, Bradley-Potts J, Yates D, Birkinshaw I, Kell K, Marshall N, Carr-Knott L, Summers C. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020. [PMID: 32876697 DOI: 10.1001/jama.2020.1702221] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. OBJECTIVE To determine whether hydrocortisone improves outcome for patients with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. INTERVENTIONS The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). MAIN OUTCOMES AND MEASURES The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). RESULTS After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Derek C Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Farah Al-Beidh
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charlotte Bradbury
- Bristol Royal Informatory, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - Frank Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Adrian Buzgau
- Helix, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Menno de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | | | - Lise Estcourt
- NHS Blood and Transplant, Bristol, United Kingdom
- Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Horvat
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Sebastiaan J Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | | | - John Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Bryan McVerry
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Montgomery
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Marlene Santos
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher Seymour
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Balasubramanian Venkatesh
- Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, van Bentum-Puijk W, Berry L, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Buzgau A, Cheng AC, de Jong M, Detry M, Estcourt L, Fitzgerald M, Goossens H, Green C, Haniffa R, Higgins AM, Horvat C, Hullegie SJ, Kruger P, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, Marshall J, McAuley D, McGlothin A, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Parker J, Rowan K, Sanil A, Santos M, Saunders C, Seymour C, Turner A, van de Veerdonk F, Venkatesh B, Zarychanski R, Berry S, Lewis RJ, McArthur C, Webb SA, Gordon AC, Al-Beidh F, Angus D, Annane D, Arabi Y, van Bentum-Puijk W, Berry S, Beane A, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Cheng A, De Jong M, Derde L, Estcourt L, Goossens H, Gordon A, Green C, Haniffa R, Lamontagne F, Lawler P, Litton E, Marshall J, McArthur C, McAuley D, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Rowan K, Seymour C, Turner A, van de Veerdonk F, Webb S, Zarychanski R, Campbell L, Forbes A, Gattas D, Heritier S, Higgins L, Kruger P, Peake S, Presneill J, Seppelt I, Trapani T, Young P, Bagshaw S, Daneman N, Ferguson N, Misak C, Santos M, Hullegie S, Pletz M, Rohde G, Rowan K, Alexander B, Basile K, Girard T, Horvat C, Huang D, Linstrum K, Vates J, Beasley R, Fowler R, McGloughlin S, Morpeth S, Paterson D, Venkatesh B, Uyeki T, Baillie K, Duffy E, Fowler R, Hills T, Orr K, Patanwala A, Tong S, Netea M, Bihari S, Carrier M, Fergusson D, Goligher E, Haidar G, Hunt B, Kumar A, Laffan M, Lawless P, Lother S, McCallum P, Middeldopr S, McQuilten Z, Neal M, Pasi J, Schutgens R, Stanworth S, Turgeon A, Weissman A, Adhikari N, Anstey M, Brant E, de Man A, Lamonagne F, Masse MH, Udy A, Arnold D, Begin P, Charlewood R, Chasse M, Coyne M, Cooper J, Daly J, Gosbell I, Harvala-Simmonds H, Hills T, MacLennan S, Menon D, McDyer J, Pridee N, Roberts D, Shankar-Hari M, Thomas H, Tinmouth A, Triulzi D, Walsh T, Wood E, Calfee C, O’Kane C, Shyamsundar M, Sinha P, Thompson T, Young I, Bihari S, Hodgson C, Laffey J, McAuley D, Orford N, Neto A, Detry M, Fitzgerald M, Lewis R, McGlothlin A, Sanil A, Saunders C, Berry L, Lorenzi E, Miller E, Singh V, Zammit C, van Bentum Puijk W, Bouwman W, Mangindaan Y, Parker L, Peters S, Rietveld I, Raymakers K, Ganpat R, Brillinger N, Markgraf R, Ainscough K, Brickell K, Anjum A, Lane JB, Richards-Belle A, Saull M, Wiley D, Bion J, Connor J, Gates S, Manax V, van der Poll T, Reynolds J, van Beurden M, Effelaar E, Schotsman J, Boyd C, Harland C, Shearer A, Wren J, Clermont G, Garrard W, Kalchthaler K, King A, Ricketts D, Malakoutis S, Marroquin O, Music E, Quinn K, Cate H, Pearson K, Collins J, Hanson J, Williams P, Jackson S, Asghar A, Dyas S, Sutu M, Murphy S, Williamson D, Mguni N, Potter A, Porter D, Goodwin J, Rook C, Harrison S, Williams H, Campbell H, Lomme K, Williamson J, Sheffield J, van’t Hoff W, McCracken P, Young M, Board J, Mart E, Knott C, Smith J, Boschert C, Affleck J, Ramanan M, D’Souza R, Pateman K, Shakih A, Cheung W, Kol M, Wong H, Shah A, Wagh A, Simpson J, Duke G, Chan P, Cartner B, Hunter S, Laver R, Shrestha T, Regli A, Pellicano A, McCullough J, Tallott M, Kumar N, Panwar R, Brinkerhoff G, Koppen C, Cazzola F, Brain M, Mineall S, Fischer R, Biradar V, Soar N, White H, Estensen K, Morrison L, Smith J, Cooper M, Health M, Shehabi Y, Al-Bassam W, Hulley A, Whitehead C, Lowrey J, Gresha R, Walsham J, Meyer J, Harward M, Venz E, Williams P, Kurenda C, Smith K, Smith M, Garcia R, Barge D, Byrne D, Byrne K, Driscoll A, Fortune L, Janin P, Yarad E, Hammond N, Bass F, Ashelford A, Waterson S, Wedd S, McNamara R, Buhr H, Coles J, Schweikert S, Wibrow B, Rauniyar R, Myers E, Fysh E, Dawda A, Mevavala B, Litton E, Ferrier J, Nair P, Buscher H, Reynolds C, Santamaria J, Barbazza L, Homes J, Smith R, Murray L, Brailsford J, Forbes L, Maguire T, Mariappa V, Smith J, Simpson S, Maiden M, Bone A, Horton M, Salerno T, Sterba M, Geng W, Depuydt P, De Waele J, De Bus L, Fierens J, Bracke S, Reeve B, Dechert W, Chassé M, Carrier FM, Boumahni D, Benettaib F, Ghamraoui A, Bellemare D, Cloutier È, Francoeur C, Lamontagne F, D’Aragon F, Carbonneau E, Leblond J, Vazquez-Grande G, Marten N, Wilson M, Albert M, Serri K, Cavayas A, Duplaix M, Williams V, Rochwerg B, Karachi T, Oczkowski S, Centofanti J, Millen T, Duan E, Tsang J, Patterson L, English S, Watpool I, Porteous R, Miezitis S, McIntyre L, Brochard L, Burns K, Sandhu G, Khalid I, Binnie A, Powell E, McMillan A, Luk T, Aref N, Andric Z, Cviljevic S, Đimoti R, Zapalac M, Mirković G, Baršić B, Kutleša M, Kotarski V, Vujaklija Brajković A, Babel J, Sever H, Dragija L, Kušan I, Vaara S, Pettilä L, Heinonen J, Kuitunen A, Karlsson S, Vahtera A, Kiiski H, Ristimäki S, Azaiz A, Charron C, Godement M, Geri G, Vieillard-Baron A, Pourcine F, Monchi M, Luis D, Mercier R, Sagnier A, Verrier N, Caplin C, Siami S, Aparicio C, Vautier S, Jeblaoui A, Fartoukh M, Courtin L, Labbe V, Leparco C, Muller G, Nay MA, Kamel T, Benzekri D, Jacquier S, Mercier E, Chartier D, Salmon C, Dequin P, Schneider F, Morel G, L’Hotellier S, Badie J, Berdaguer FD, Malfroy S, Mezher C, Bourgoin C, Megarbane B, Voicu S, Deye N, Malissin I, Sutterlin L, Guitton C, Darreau C, Landais M, Chudeau N, Robert A, Moine P, Heming N, Maxime V, Bossard I, Nicholier TB, Colin G, Zinzoni V, Maquigneau N, Finn A, Kreß G, Hoff U, Friedrich Hinrichs C, Nee J, Pletz M, Hagel S, Ankert J, Kolanos S, Bloos F, Petros S, Pasieka B, Kunz K, Appelt P, Schütze B, Kluge S, Nierhaus A, Jarczak D, Roedl K, Weismann D, Frey A, Klinikum Neukölln V, Reill L, Distler M, Maselli A, Bélteczki J, Magyar I, Fazekas Á, Kovács S, Szőke V, Szigligeti G, Leszkoven J, Collins D, Breen P, Frohlich S, Whelan R, McNicholas B, Scully M, Casey S, Kernan M, Doran P, O’Dywer M, Smyth M, Hayes L, Hoiting O, Peters M, Rengers E, Evers M, Prinssen A, Bosch Ziekenhuis J, Simons K, Rozendaal W, Polderman F, de Jager P, Moviat M, Paling A, Salet A, Rademaker E, Peters AL, de Jonge E, Wigbers J, Guilder E, Butler M, Cowdrey KA, Newby L, Chen Y, Simmonds C, McConnochie R, Ritzema Carter J, Henderson S, Van Der Heyden K, Mehrtens J, Williams T, Kazemi A, Song R, Lai V, Girijadevi D, Everitt R, Russell R, Hacking D, Buehner U, Williams E, Browne T, Grimwade K, Goodson J, Keet O, Callender O, Martynoga R, Trask K, Butler A, Schischka L, Young C, Lesona E, Olatunji S, Robertson Y, José N, Amaro dos Santos Catorze T, de Lima Pereira TNA, Neves Pessoa LM, Castro Ferreira RM, Pereira Sousa Bastos JM, Aysel Florescu S, Stanciu D, Zaharia MF, Kosa AG, Codreanu D, Marabi Y, Al Qasim E, Moneer Hagazy M, Al Swaidan L, Arishi H, Muñoz-Bermúdez R, Marin-Corral J, Salazar Degracia A, Parrilla Gómez F, Mateo López MI, Rodriguez Fernandez J, Cárcel Fernández S, Carmona Flores R, León López R, de la Fuente Martos C, Allan A, Polgarova P, Farahi N, McWilliam S, Hawcutt D, Rad L, O’Malley L, Whitbread J, Kelsall O, Wild L, Thrush J, Wood H, Austin K, Donnelly A, Kelly M, O’Kane S, McClintock D, Warnock M, Johnston P, Gallagher LJ, Mc Goldrick C, Mc Master M, Strzelecka A, Jha R, Kalogirou M, Ellis C, Krishnamurthy V, Deelchand V, Silversides J, McGuigan P, Ward K, O’Neill A, Finn S, Phillips B, Mullan D, Oritz-Ruiz de Gordoa L, Thomas M, Sweet K, Grimmer L, Johnson R, Pinnell J, Robinson M, Gledhill L, Wood T, Morgan M, Cole J, Hill H, Davies M, Antcliffe D, Templeton M, Rojo R, Coghlan P, Smee J, Mackay E, Cort J, Whileman A, Spencer T, Spittle N, Kasipandian V, Patel A, Allibone S, Genetu RM, Ramali M, Ghosh A, Bamford P, London E, Cawley K, Faulkner M, Jeffrey H, Smith T, Brewer C, Gregory J, Limb J, Cowton A, O’Brien J, Nikitas N, Wells C, Lankester L, Pulletz M, Williams P, Birch J, Wiseman S, Horton S, Alegria A, Turki S, Elsefi T, Crisp N, Allen L, McCullagh I, Robinson P, Hays C, Babio-Galan M, Stevenson H, Khare D, Pinder M, Selvamoni S, Gopinath A, Pugh R, Menzies D, Mackay C, Allan E, Davies G, Puxty K, McCue C, Cathcart S, Hickey N, Ireland J, Yusuff H, Isgro G, Brightling C, Bourne M, Craner M, Watters M, Prout R, Davies L, Pegler S, Kyeremeh L, Arbane G, Wilson K, Gomm L, Francia F, Brett S, Sousa Arias S, Elin Hall R, Budd J, Small C, Birch J, Collins E, Henning J, Bonner S, Hugill K, Cirstea E, Wilkinson D, Karlikowski M, Sutherland H, Wilhelmsen E, Woods J, North J, Sundaran D, Hollos L, Coburn S, Walsh J, Turns M, Hopkins P, Smith J, Noble H, Depante MT, Clarey E, Laha S, Verlander M, Williams A, Huckle A, Hall A, Cooke J, Gardiner-Hill C, Maloney C, Qureshi H, Flint N, Nicholson S, Southin S, Nicholson A, Borgatta B, Turner-Bone I, Reddy A, Wilding L, Chamara Warnapura L, Agno Sathianathan R, Golden D, Hart C, Jones J, Bannard-Smith J, Henry J, Birchall K, Pomeroy F, Quayle R, Makowski A, Misztal B, Ahmed I, KyereDiabour T, Naiker K, Stewart R, Mwaura E, Mew L, Wren L, Willams F, Innes R, Doble P, Hutter J, Shovelton C, Plumb B, Szakmany T, Hamlyn V, Hawkins N, Lewis S, Dell A, Gopal S, Ganguly S, Smallwood A, Harris N, Metherell S, Lazaro JM, Newman T, Fletcher S, Nortje J, Fottrell-Gould D, Randell G, Zaman M, Elmahi E, Jones A, Hall K, Mills G, Ryalls K, Bowler H, Sall J, Bourne R, Borrill Z, Duncan T, Lamb T, Shaw J, Fox C, Moreno Cuesta J, Xavier K, Purohit D, Elhassan M, Bakthavatsalam D, Rowland M, Hutton P, Bashyal A, Davidson N, Hird C, Chhablani M, Phalod G, Kirkby A, Archer S, Netherton K, Reschreiter H, Camsooksai J, Patch S, Jenkins S, Pogson D, Rose S, Daly Z, Brimfield L, Claridge H, Parekh D, Bergin C, Bates M, Dasgin J, McGhee C, Sim M, Hay SK, Henderson S, Phull MK, Zaidi A, Pogreban T, Rosaroso LP, Harvey D, Lowe B, Meredith M, Ryan L, Hormis A, Walker R, Collier D, Kimpton S, Oakley S, Rooney K, Rodden N, Hughes E, Thomson N, McGlynn D, Walden A, Jacques N, Coles H, Tilney E, Vowell E, Schuster-Bruce M, Pitts S, Miln R, Purandare L, Vamplew L, Spivey M, Bean S, Burt K, Moore L, Day C, Gibson C, Gordon E, Zitter L, Keenan S, Baker E, Cherian S, Cutler S, Roynon-Reed A, Harrington K, Raithatha A, Bauchmuller K, Ahmad N, Grecu I, Trodd D, Martin J, Wrey Brown C, Arias AM, Craven T, Hope D, Singleton J, Clark S, Rae N, Welters I, Hamilton DO, Williams K, Waugh V, Shaw D, Puthucheary Z, Martin T, Santos F, Uddin R, Somerville A, Tatham KC, Jhanji S, Black E, Dela Rosa A, Howle R, Tully R, Drummond A, Dearden J, Philbin J, Munt S, Vuylsteke A, Chan C, Victor S, Matsa R, Gellamucho M, Creagh-Brown B, Tooley J, Montague L, De Beaux F, Bullman L, Kersiake I, Demetriou C, Mitchard S, Ramos L, White K, Donnison P, Johns M, Casey R, Mattocks L, Salisbury S, Dark P, Claxton A, McLachlan D, Slevin K, Lee S, Hulme J, Joseph S, Kinney F, Senya HJ, Oborska A, Kayani A, Hadebe B, Orath Prabakaran R, Nichols L, Thomas M, Worner R, Faulkner B, Gendall E, Hayes K, Hamilton-Davies C, Chan C, Mfuko C, Abbass H, Mandadapu V, Leaver S, Forton D, Patel K, Paramasivam E, Powell M, Gould R, Wilby E, Howcroft C, Banach D, Fernández de Pinedo Artaraz Z, Cabreros L, White I, Croft M, Holland N, Pereira R, Zaki A, Johnson D, Jackson M, Garrard H, Juhaz V, Roy A, Rostron A, Woods L, Cornell S, Pillai S, Harford R, Rees T, Ivatt H, Sundara Raman A, Davey M, Lee K, Barber R, Chablani M, Brohi F, Jagannathan V, Clark M, Purvis S, Wetherill B, Dushianthan A, Cusack R, de Courcy-Golder K, Smith S, Jackson S, Attwood B, Parsons P, Page V, Zhao XB, Oza D, Rhodes J, Anderson T, Morris S, Xia Le Tai C, Thomas A, Keen A, Digby S, Cowley N, Wild L, Southern D, Reddy H, Campbell A, Watkins C, Smuts S, Touma O, Barnes N, Alexander P, Felton T, Ferguson S, Sellers K, Bradley-Potts J, Yates D, Birkinshaw I, Kell K, Marshall N, Carr-Knott L, Summers C. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020; 324:1317-1329. [PMID: 32876697 PMCID: PMC7489418 DOI: 10.1001/jama.2020.17022] [Citation(s) in RCA: 542] [Impact Index Per Article: 135.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. OBJECTIVE To determine whether hydrocortisone improves outcome for patients with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. INTERVENTIONS The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). MAIN OUTCOMES AND MEASURES The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). RESULTS After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Derek C Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Farah Al-Beidh
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charlotte Bradbury
- Bristol Royal Informatory, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - Frank Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Adrian Buzgau
- Helix, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Menno de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | | | - Lise Estcourt
- NHS Blood and Transplant, Bristol, United Kingdom
- Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Horvat
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Sebastiaan J Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | | | - John Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Bryan McVerry
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Montgomery
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Marlene Santos
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher Seymour
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Balasubramanian Venkatesh
- Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Denholm JT, Davis J, Paterson D, Roberts J, Morpeth S, Snelling T, Zentner D, Rees M, O’Sullivan M, Price D, Bowen A, Tong SYC. The Australasian COVID-19 Trial (ASCOT) to assess clinical outcomes in hospitalised patients with SARS-CoV-2 infection (COVID-19) treated with lopinavir/ritonavir and/or hydroxychloroquine compared to standard of care: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:646. [PMID: 32665040 PMCID: PMC7359440 DOI: 10.1186/s13063-020-04576-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To determine if lopinavir/ritonavir +/- hydroxychloroquine will reduce the proportion of participants who survive without requiring ventilatory support, 15 days after enrolment, in adult participants with non-critically ill SARS-CoV-2 infection. TRIAL DESIGN ASCOT is an investigator-initiated, multi-centre, open-label, randomised controlled trial. Participants will have been hospitalised with confirmed COVID-19, and will be randomised 1:1:1:1 to receive lopinavir /ritonavir, hydroxychloroquine, both or neither drug in addition to standard of care management. PARTICIPANTS Participants will be recruited from >80 hospitals across Australia and New Zealand, representing metropolitan and regional centres in both public and private sectors. Admitted patients will be eligible if aged ≥ 18 years, have confirmed SARS-CoV-2 by nucleic acid testing in the past 12 days and are expected to remain an inpatient for at least 48 hours from the time of randomisation. Potentially eligible participants will be excluded if admitted to intensive care or requiring high level respiratory support, are currently receiving study drugs or their use is contraindicated due to allergy, drug interaction or comorbidities (including baseline QTc prolongation of 470ms for women or 480ms for men), or death is anticipated imminently. INTERVENTION AND COMPARATOR Participants will be randomised 1:1:1:1 to: Group 1: standard of care; Group 2: lopinavir (400mg) / ritonavir (100mg) twice daily for 10 days in tablet form; Group 3: hydroxychloroquine (800mg) 4x200mg administered 12 hours apart on Day 1, followed by 400mg twice a day for 6 days; Group 4: lopinavir /ritonavir plus hydroxychloroquine. MAIN OUTCOMES Proportion of participants alive and not having required intensive respiratory support (invasive or non-invasive ventilation) at 15 days after enrolment. A range of clinical and virological secondary outcomes will also be evaluated. RANDOMISATION The randomisation schedule will be generated by an independent statistician. Randomisation will be stratified by site and will be in permuted blocks of variable block size. The randomised sequence allocation will only be accessible to the data management group, and site investigators will have individual participant allocation provided through a web-based trial enrolment platform. BLINDING (MASKING) This is an open-label study, with researchers assessing the laboratory outcomes blinded to treatment allocation. No unblinding procedures relating to potential adverse effects are therefore required. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) We assumed that 5% of participants receiving standard of care would meet the primary outcome, aimed to evaluate whether interventions could lead to a relative risk of 0.5, assuming no interaction between intervention arms. This corresponds to a required sample size of 610 per arm, with a 5% two-sided significance level (alpha) and 80% power. The total sample size therefore is planned to be 2440. TRIAL STATUS ASCOT protocol version 3, May 5, 2020. Recruitment opened April 4, 2020 and is ongoing, with planned completion of enrolment July 31, 2021. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12620000445976 ). Prospectively registered April 6, 2020. FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Justin T. Denholm
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria Australia
| | - Joshua Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW Australia
| | - David Paterson
- University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia
| | - Jason Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Susan Morpeth
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Thomas Snelling
- School of Public Health, University of Sydney, Sydney, New South Wales Australia
| | - Dominica Zentner
- Department of Cardiology, The Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Victoria Australia
| | - Megan Rees
- Department of Respiratory Medicine, The Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Victoria Australia
| | - Matthew O’Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales Australia
- University of Sydney, Sydney, New South Wales Australia
| | - David Price
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Victoria Australia
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit at the Peter Doherty Institute for Infection & Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria Australia
| | - Asha Bowen
- Telehealth Kids Institute, Perth, West Australia Australia
| | - Steven Y. C. Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Holmes AM, Kempson I, Turnbull T, Paterson D, Roberts MS. Penetration of Zinc into Human Skin after Topical Application of Nano Zinc Oxide Used in Commercial Sunscreen Formulations. ACS Appl Bio Mater 2020; 3:3640-3647. [DOI: 10.1021/acsabm.0c00280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Amy M. Holmes
- School of Pharmacy and Medical Sciences, The University of South Australia, Adelaide 5001, Australia
| | - Ivan Kempson
- Future Industries Institute, The University of South Australia, Mawson Lakes 5095, Australia
| | - Tyron Turnbull
- Future Industries Institute, The University of South Australia, Mawson Lakes 5095, Australia
| | | | - Michael S. Roberts
- School of Pharmacy and Medical Sciences, The University of South Australia, Adelaide 5001, Australia
- Therapeutics Research Centre, The University of Queensland, Brisbane 4102, Australia
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Manning L, Metcalf S, Clark B, Robinson JO, Huggan P, Luey C, McBride S, Aboltins C, Nelson R, Campbell D, Solomon LB, Schneider K, Loewenthal M, Yates P, Athan E, Cooper D, Rad B, Allworth T, Reid A, Read K, Leung P, Sud A, Nagendra V, Chean R, Lemoh C, Mutalima N, Grimwade K, Sehu M, Torda A, Aung T, Graves S, Paterson D, Davis J. Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint Infection: A Multicenter, Prospective Observational Cohort Study of 783 Patients. Open Forum Infect Dis 2020; 7:ofaa068. [PMID: 32432148 PMCID: PMC7224250 DOI: 10.1093/ofid/ofaa068] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 11/27/2019] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
Background Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. Methods The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. Results We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and <7 days of symptoms; 351, 45%), followed by early (≤30 days postimplantation; 196, 25%) and chronic (>30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). Conclusions In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials.
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Affiliation(s)
- Laurens Manning
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia
| | - Sarah Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Benjamin Clark
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - James Owen Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
| | - Paul Huggan
- Department of Infectious Diseases, Waikato Hospital, Hamilton, New Zealand
| | - Chris Luey
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Stephen McBride
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Craig Aboltins
- Department of Infectious Diseases, Northern Health, Epping, Melbourne, VIC, Australia.,Northern Clinical School, University of Melbourne, Melbourne, VIC, Australia
| | - Renjy Nelson
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - David Campbell
- Department of Orthopadic Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lucian Bogdan Solomon
- Department of Orthopadic Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,The University of Adelaide, Adelaide, SA, Australia
| | - Kellie Schneider
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - Mark Loewenthal
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - Piers Yates
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Orthopaedic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Eugene Athan
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Darcie Cooper
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Babak Rad
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Tony Allworth
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Alistair Reid
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, NSW, Australia
| | - Kerry Read
- Department of Infectious Diseases, North Shore Hospital, Auckland, New Zealand
| | - Peter Leung
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Archana Sud
- Department of Infectious Diseases, Nepean Hospital, Kingswood, NSW, Australia
| | - Vana Nagendra
- Department of Infectious Diseases, Liverpool Hospital, Liverpool, NSW, Australia
| | - Roy Chean
- Department of Infectious Diseases, Latrobe Regional Hospital, Traralgon, West, VIC, Australia
| | - Chris Lemoh
- Department of Infectious Diseases, Dandenong Hospital, Dandenong, VIC, Australia
| | - Nora Mutalima
- Department of Infectious Diseases, Dandenong Hospital, Dandenong, VIC, Australia
| | - Kate Grimwade
- Department of Infectious Diseases, Tauranga Hospital, Tauranga, New Zealand
| | - Marjorie Sehu
- Department of Infectious Diseases, Logan Hospital, Meadowbrook, QLD, Australia
| | - Adrienne Torda
- Faculty of Medicine, UNSW Sydney, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Thi Aung
- Department of Infectious Diseases, Redcliffe, Hospital, Redcliffe, QLD, Australia
| | - Steven Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.,School of Surgery, University of South Australia, Adelaide, SA, Australia
| | - David Paterson
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Josh Davis
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Davis H, Musa A, Li D, Herring N, Paterson D. When the Efferent Becomes Afferent ‐ the Cellular Response of Sympathetic Neurons to Sensory Stimuli. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.09256] [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: 11/11/2022]
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Ayfan A, Ertl N, Whiley D, Paterson D, Heney C, Harris P, Macdonald J, Irwin A, Zowawi H. Rapid and sensitive molecular detection of antimicrobial resistance (AMR); towards point-of-care testing in low resource settings. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.059] [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: 10/25/2022] Open
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Peel T, Astbury S, Cheng AC, Paterson D, Buising K, Spelman T, Tran-Duy A, de Steiger RS. Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial. BMJ Open 2019; 9:e033718. [PMID: 31685516 PMCID: PMC6858103 DOI: 10.1136/bmjopen-2019-033718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Resistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established. METHODS AND ANALYSIS This randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums. TRIAL REGISTRATION NUMBER ACTRN12618000642280.
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Affiliation(s)
- Trisha Peel
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sarah Astbury
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Paterson
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kirsty Buising
- Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard S de Steiger
- Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Orthopaedics, Epworth HealthCare, Richmond, Victoria, Australia
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Calamera G, Li D, Ulsund AH, Kim JJ, Neely OC, Moltzau LR, Bjørnerem M, Paterson D, Kim C, Levy FO, Andressen KW. FRET-based cyclic GMP biosensors measure low cGMP concentrations in cardiomyocytes and neurons. Commun Biol 2019; 2:394. [PMID: 31701023 PMCID: PMC6820734 DOI: 10.1038/s42003-019-0641-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 10/02/2019] [Indexed: 01/13/2023] Open
Abstract
Several FRET (fluorescence resonance energy transfer)-based biosensors for intracellular detection of cyclic nucleotides have been designed in the past decade. However, few such biosensors are available for cGMP, and even fewer that detect low nanomolar cGMP concentrations. Our aim was to develop a FRET-based cGMP biosensor with high affinity for cGMP as a tool for intracellular signaling studies. We used the carboxyl-terminal cyclic nucleotide binding domain of Plasmodium falciparum cGMP-dependent protein kinase (PKG) flanked by different FRET pairs to generate two cGMP biosensors (Yellow PfPKG and Red PfPKG). Here, we report that these cGMP biosensors display high affinity for cGMP (EC50 of 23 ± 3 nM) and detect cGMP produced through soluble guanylyl cyclase and guanylyl cyclase A in stellate ganglion neurons and guanylyl cyclase B in cardiomyocytes. These biosensors are therefore optimal tools for real-time measurements of low concentrations of cGMP in living cells.
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Affiliation(s)
- Gaia Calamera
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Dan Li
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Andrea Hembre Ulsund
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Jeong Joo Kim
- Department of Pharmacology and Chemical Biology, Baylor College of Medicine, Houston, TX USA
| | - Oliver C. Neely
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Lise Román Moltzau
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Marianne Bjørnerem
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - David Paterson
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Choel Kim
- Department of Pharmacology and Chemical Biology, Baylor College of Medicine, Houston, TX USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX USA
| | - Finn Olav Levy
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Kjetil Wessel Andressen
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo and Oslo University Hospital, Oslo, Norway
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Kastury F, Smith E, Lombi E, Donnelley MW, Cmielewski PL, Parsons DW, Noerpel M, Scheckel KG, Kingston AM, Myers GR, Paterson D, de Jonge MD, Juhasz AL. Dynamics of Lead Bioavailability and Speciation in Indoor Dust and X-ray Spectroscopic Investigation of the Link between Ingestion and Inhalation Pathways. Environ Sci Technol 2019; 53:11486-11495. [PMID: 31460750 PMCID: PMC7416472 DOI: 10.1021/acs.est.9b03249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lead (Pb) exposure from household dust is a major childhood health concern because of its adverse impact on cognitive development. This study investigated the absorption kinetics of Pb from indoor dust following a single dose instillation into C57BL/6 mice. Blood Pb concentration (PbB) was assessed over 24 h, and the dynamics of particles in the lung and gastro-intestinal (GI) tract were visualized using X-ray fluorescence (XRF) microscopy. The influence of mineralogy on Pb absorption and particle retention was investigated using X-ray absorption near-edge structure spectroscopy. A rapid rise in PbB was observed between 0.25 and 4 h after instillation, peaking at 8 h and slowly declining during a period of 24 h. Following clearance from the lungs, Pb particles were detected in the stomach and small intestine at 4 and 8 h, respectively. Analysis of Pb mineralogy in the residual particles in tissues at 8 h showed that mineral-sorbed Pb and Pb-phosphates dominated the lung, while organic-bound Pb and galena were the main phases in the small intestines. This is the first study to visualize Pb dynamics in the lung and GI tract using XRF microscopy and link the inhalation and ingestion pathways for metal exposure assessment from dust.
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Affiliation(s)
- Farzana Kastury
- Future Industries Institute , University of South Australia , Adelaide 5095 , Australia
| | - Euan Smith
- Future Industries Institute , University of South Australia , Adelaide 5095 , Australia
| | - Enzo Lombi
- Future Industries Institute , University of South Australia , Adelaide 5095 , Australia
| | - Martin W Donnelley
- Women's and Children's Hospital , Adelaide 5006 , Australia
- Adelaide Medical School , Adelaide 5000 , Australia
- Robinson Research Institute , University of Adelaide , Adelaide 5005 , Australia
| | - Patricia L Cmielewski
- Women's and Children's Hospital , Adelaide 5006 , Australia
- Adelaide Medical School , Adelaide 5000 , Australia
- Robinson Research Institute , University of Adelaide , Adelaide 5005 , Australia
| | - David W Parsons
- Women's and Children's Hospital , Adelaide 5006 , Australia
- Adelaide Medical School , Adelaide 5000 , Australia
- Robinson Research Institute , University of Adelaide , Adelaide 5005 , Australia
| | - Matt Noerpel
- Oak Ridge Institute for Science and Education , Cincinnati , Ohio 37830 , United States
| | - Kirk G Scheckel
- United States Environmental Protection Agency , Cincinnati , Ohio 45224 , United States
| | - Andrew M Kingston
- Department of Applied Mathematics , Australian National University , Canberra 0200 , Australia
| | - Glenn R Myers
- Department of Applied Mathematics , Australian National University , Canberra 0200 , Australia
| | - David Paterson
- Australian Synchrotron, ANSTO , Clayton 3168 , Australia
| | | | - Albert L Juhasz
- Future Industries Institute , University of South Australia , Adelaide 5095 , Australia
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Kastury F, Smith E, Doelsch E, Lombi E, Donnelley M, Cmielewski PL, Parsons DW, Scheckel KG, Paterson D, de Jonge MD, Herde C, Juhasz AL. In Vitro, in Vivo, and Spectroscopic Assessment of Lead Exposure Reduction via Ingestion and Inhalation Pathways Using Phosphate and Iron Amendments. Environ Sci Technol 2019; 53:10329-10341. [PMID: 31356748 PMCID: PMC7436645 DOI: 10.1021/acs.est.9b02448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study compared lead (Pb) immobilization efficacies in mining/smelting impacted soil using phosphate and iron amendments via ingestion and inhalation pathways using in vitro and in vivo assays, in conjunction with investigating the dynamics of dust particles in the lungs and gastro-intestinal tract via X-ray fluorescence (XRF) microscopy. Phosphate amendments [phosphoric acid (PA), hydroxyapatite, monoammonium phosphate (MAP), triple super phosphate (TSP), and bone meal biochar] and hematite were applied at a molar ratio of Pb:Fe/P = 1:5. Pb phosphate formation was investigated in the soil/post-in vitro bioaccessibility (IVBA) residuals and in mouse lung via extended X-ray absorption fine structure (EXAFS) and X-ray absorption near edge structures (XANES) spectroscopy, respectively. EXAFS analysis revealed that anglesite was the dominant phase in the ingestible (<250 μm) and inhalable (<10 μm) particle fractions. Pb IVBA was significantly reduced (p < 0.05) by phosphate amendments in the <250 μm fraction (solubility bioaccessibility research consortium assay) and by PA, MAP, and TSP in the <10 μm fraction (inhalation-ingestion bioaccessibility assay). A 21.1% reduction in Pb RBA (<250 μm fraction) and 56.4% reduction in blood Pb concentration (<10 μm fraction) were observed via the ingestion and inhalation pathways, respectively. XRF microscopy detected Pb in the stomach within 4 h, presumably via mucociliary clearance.
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Affiliation(s)
- Farzana Kastury
- Future Industries Institute, University of South Australia, Adelaide 5095, Australia
| | - Euan Smith
- Future Industries Institute, University of South Australia, Adelaide 5095, Australia
| | - Emmanuel Doelsch
- Future Industries Institute, University of South Australia, Adelaide 5095, Australia
- CIRAD, UPR Recyclage et risque, F-34398 Montpellier, France
- Recyclage et Risque, Univ Montpellier, CIRAD, Montpellier, France
| | - Enzo Lombi
- Future Industries Institute, University of South Australia, Adelaide 5095, Australia
| | - Martin Donnelley
- Women’s and Children’s Hospital, Adelaide 5006, Australia
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide 5000, Australia
| | - Patricia L. Cmielewski
- Women’s and Children’s Hospital, Adelaide 5006, Australia
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide 5000, Australia
| | - David W. Parsons
- Women’s and Children’s Hospital, Adelaide 5006, Australia
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide 5000, Australia
| | - Kirk G. Scheckel
- United States Environmental Protection Agency, Cincinnati 45224, United States
| | | | | | - Carina Herde
- South Australian Health and Medical Research Institute, Adelaide 5086, Australia
| | - Albert L. Juhasz
- Future Industries Institute, University of South Australia, Adelaide 5095, Australia
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Cuddihy T, Forde B, Rhodes N, Paterson D, Gorse D, Beatson S, Harris P. SRA Down Under: Cache and Analysis Platform for Infectious Disease. Stud Health Technol Inform 2019; 266:76-82. [PMID: 31397305 DOI: 10.3233/shti190776] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
SRA, NCBI's Sequence Read Archive, is a valuable resource holding a near definitive collection of the world's collective sequenced reads for academic purposes. Increasingly, these reads are being used for both basic research and clinical investigations. When time is a critical factor in analysis, such as during bacterial outbreaks, the geographical separation between Australia and the offshore NCBI SRA servers can result in significant delays that may have adverse clinical outcomes. To address this, Queensland Genomics commissioned a pilot program for the establishment of a local Australian SRA Cache. Utilizing the hosting capabilities of the NeCTAR Research Cloud, QRIScloud's HTC infrastructure and the MeDiCI data fabric as a storage solution, and the software stack of Cromwell for workflow management, PostgreSQL database for sample and job metadata, and a coordinator Python Flask application, a local cache of seventeen bacterial species was established. Furthermore, the workflow capabilities of Cromwell were leveraged to provide analysis solutions for cached sample data, including quality control and taxonomic profiling, and individual and multiple sample analysis. Moving forward to a broader rollout of increased bacterial species, it was found that the initial storage estimation did not keep up with the exponential increase sequencing reads uploaded to NCBI SRA, which while highlighting the increasing availability and importance in modern research, will need to be addressed.
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Affiliation(s)
- Thom Cuddihy
- QFAB Bioinformatics - Research Computing Centre, University of Queensland, Australia
| | - Brian Forde
- School of Chemistry and Molecular Biosciences, University of Queensland, Australia
| | - Nicholas Rhodes
- QFAB Bioinformatics - Institute for Molecular Bioscience, University of Queensland, Australia
| | - David Paterson
- UQ Centre for Clinical Research, University of Queensland, Australia
| | - Dominique Gorse
- QFAB Bioinformatics - Institute for Molecular Bioscience, University of Queensland, Australia
| | - Scott Beatson
- School of Chemistry and Molecular Biosciences, University of Queensland, Australia
| | - Patrick Harris
- UQ Centre for Clinical Research, University of Queensland, Australia
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Machuca I, Gutiérrez-Gutiérrez B, Rivera-Espinar F, Cano A, Gracia-Ahufinger I, Guzman-Puche J, Marfil-Pérez E, Pérez-Nadales E, Castón JJ, Bonomo RA, Carmeli Y, Paterson D, Pascual Á, Martínez-Martínez L, Rodríguez-Baño J, Torre-Cisneros J. External validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistance. Int J Antimicrob Agents 2019; 54:442-448. [PMID: 31377343 DOI: 10.1016/j.ijantimicag.2019.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/15/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
External validation of the INCREMENT-CPE risk score (ICS) for 30-day all-cause mortality is needed. There is also scarce information about whether colistin resistance influences the prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKp) bacteraemia. In this study, the ability of ICS to predict all-cause mortality in the KAPECOR cohort was calculated using the area under the receiver operating characteristic (AUROC) curve. The association of colistin resistance with mortality was studied. The ICS showed an AUROC curve of 0.77 (95% CI 0.68-0.86). A cut-off of 8 points showed 96.8% sensitivity and 50.7% specificity. Mortality of low-risk patients was not different in those treated with monotherapy versus combination therapy. However, mortality of high-risk patients treated with combination therapy (37.8%) was significantly lower than in those treated with monotherapy (68.4%) (P = 0.008). To study the prognostic significance of colistin resistance, 83 selected cases of bacteraemia due to colistin-susceptible CRKp were obtained from the INCREMENT cohort for comparison. Colistin resistance could not be shown to be associated with higher mortality in either the high-risk ICS group [adjusted odds ratio (aOR) = 1.56, 95% CI 0.69-3.33; P = 0.29] or in 37 ICS-matched pairs (aOR = 1.38, 95% CI 0.55-3.42; P = 0.49), or in a sensitivity analysis including only KPC isolates (aOR = 1.81, 95% CI 0.73-4.57; P = 0.20), but the precision of estimates was low. These results validate ICS for all-cause mortality and to optimise targeted therapy for CRKp bacteraemia. Colistin resistance was not clearly associated with increased mortality.
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Affiliation(s)
- Isabel Machuca
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Infectious Diseases Unit, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Belén Gutiérrez-Gutiérrez
- Infectious Diseases, Clinical Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen Macarena and Virgen del Rocío-IBiS, and Department of Medicine, Universidad de Sevilla, Seville, Spain
| | | | - Angela Cano
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Infectious Diseases Unit, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Irene Gracia-Ahufinger
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unit of Microbiology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Julia Guzman-Puche
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unit of Microbiology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Eduardo Marfil-Pérez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unit of Microbiology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Elena Pérez-Nadales
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Infectious Diseases Unit, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Juan José Castón
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Infectious Diseases Unit, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yehuda Carmeli
- Sackler Faculty of Medicine, Tel Aviv University, Israel; National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - David Paterson
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, QLD, Australia
| | - Álvaro Pascual
- Infectious Diseases, Clinical Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen Macarena and Virgen del Rocío-IBiS, and Department of Medicine, Universidad de Sevilla, Seville, Spain
| | - Luís Martínez-Martínez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unit of Microbiology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases, Clinical Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen Macarena and Virgen del Rocío-IBiS, and Department of Medicine, Universidad de Sevilla, Seville, Spain.
| | - Julián Torre-Cisneros
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Infectious Diseases Unit, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain.
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Henderson A, Harris P, Hartel G, Paterson D, Turnidge J, Davis JS, Tong SYC. Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study. Int J Antimicrob Agents 2019; 54:491-495. [PMID: 31181352 DOI: 10.1016/j.ijantimicag.2019.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
In clinical practice, differing opinions exists regarding the optimal management of patients with penicillin-susceptible Staphylococcus aureus (PSSA) bloodstream infection (BSI). The aim of this study was to compare the 30-day mortality of patients treated with benzylpenicillin or flucloxacillin for PSSA BSI from a large prospectively collected data set from Australia and New Zealand. A logistic regression model and propensity score treatment analysis using inverse probability of treatment weighting were used. A total of 915 patients were included in the study, with an overall mortality rate of 12.9% (118/915) [benzylpenicillin 10.5% (33/315) and flucloxacillin 14.2% (85/600)]. Endocarditis was associated with benzylpenicillin treatment choice, whereas skin and soft-tissue infection was associated with flucloxacillin treatment choice. In the multivariate analysis, increased 30-day mortality was associated with flucloxacillin compared with benzylpenicillin [odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.0-2.5; P = 0.05). When adjusted for treatment choice in the propensity score analysis, flucloxacillin was again associated with increased 30-day mortality (OR = 1.06, 95% CI 1.01-1.1; P = 0.03). An increase in 30-day mortality associated with flucloxacillin use suggests a potential benefit for benzylpenicillin therapy in patients with PSSA BSI.
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Affiliation(s)
- A Henderson
- Infection Management Services, Building 17, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia; School of Chemistry and Molecular Sciences, University of Queensland, Brisbane, QLD 4072, Australia.
| | - P Harris
- Infection Management Services, Building 17, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia; Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia
| | - G Hartel
- Department of Statistics, QIMR Berghofer Institute of Medical Research, Herston, QLD 4006, Australia; School of Population Health, University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia
| | - D Paterson
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia
| | - J Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - J S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT 0811, Australia; Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - S Y C Tong
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT 0811, Australia; Victorian Infectious Disease Service, The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia; Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
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Redhwan A, Choudhury M, Al Harbi B, Kutbi A, Alfaresi M, AlJindan R, Balkhy H, Al Johani S, Ibrahim E, Deshmukh A, Ahmed M, AlJardani A, Al-Abri S, AlSalman J, Dashti A, Abdelrahman S, Shabban M, Aqel A, AlZoubi H, Sidjabat H, Walsh T, Paterson D, Zowawi H. A Snapshot about the Mobile Colistin Resistance (mcr) in The Middle East and North Africa Region. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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Ayfan A, Reed S, Paterson D, Zowawi H. Next Generation Antibiotic Susciptability Testing (Ngast): The Potential Use of Matrix-Assisted Laser Desorption Ionization Mass Spectrometer as a Tool for Rapid Antibiotic Susceptibility Testing. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.122] [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: 11/27/2022] Open
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Terzano R, Denecke MA, Falkenberg G, Miller B, Paterson D, Janssens K. Recent advances in analysis of trace elements in environmental samples by X-ray based techniques (IUPAC Technical Report). PURE APPL CHEM 2019; 91:1029-1063. [PMID: 32831407 PMCID: PMC7433040 DOI: 10.1515/pac-2018-0605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Trace elements analysis is a fundamental challenge in environmental sciences. Scientists measure trace elements in environmental media in order to assess the quality and safety of ecosystems and to quantify the burden of anthropogenic pollution. Among the available analytical techniques, X-ray based methods are particularly powerful, as they can quantify trace elements in situ. Chemical extraction is not required, as is the case for many other analytical techniques. In the last few years, the potential for X-ray techniques to be applied in the environmental sciences has dramatically increased due to developments in laboratory instruments and synchrotron radiation facilities with improved sensitivity and spatial resolution. In this report, we summarize the principles of the X-ray based analytical techniques most frequently employed to study trace elements in environmental samples. We report on the most recent developments in laboratory and synchrotron techniques, as well as advances in instrumentation, with a special attention on X-ray sources, detectors, and optics. Lastly, we inform readers on recent applications of X-ray based analysis to different environmental matrices, such as soil, sediments, waters, wastes, living organisms, geological samples, and atmospheric particulate, and we report examples of sample preparation.
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Affiliation(s)
- Roberto Terzano
- Department of Soil, Plant and Food Sciences, University of Bari, Via Amendola 165/A, 70126 Bari, Italy
| | - Melissa A. Denecke
- The University of Manchester, Dalton Nuclear Institute, Oxford Road, Manchester M14 9PL, UK
| | - Gerald Falkenberg
- Deutsches Elektronen-Synchrotron DESY, Photon Science, Notkestr. 85, 22603 Hamburg, Germany
| | - Bradley Miller
- United States Environmental Protection Agency, National Enforcement Investigations Center, Lakewood, Denver, CO 80225, USA
| | - David Paterson
- Australian Synchrotron, ANSTO Clayton Campus, Clayton, Victoria 3168, Australia
| | - Koen Janssens
- Department of Chemistry, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp, Belgium
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Zowawi H, Thomas M, Abdelrahman S, Shabban M, Harris P, Paterson D. Molecular Characterization of Multidrug-Resistant Gram-negative Bacilli in Egypt: A Snapshot Study. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.081] [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: 11/25/2022] Open
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44
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Ayfan A, Chambers H, Paterson D, Zowawi H. Matrix-Assisted Laser Desorption Ionization Mass Spectrometer (MALDI-TOF MS) based Antibiotic Susceptibility Testing. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.121] [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: 11/25/2022] Open
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45
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Lintern M, Anand R, Ryan C, Paterson D. Correction: Publisher Correction: Natural gold particles in Eucalyptus leaves and their relevance to exploration for buried gold deposits. Nat Commun 2018; 9:16199. [PMID: 29799528 PMCID: PMC6026907 DOI: 10.1038/ncomms16199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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46
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Rielli A, Tomkins AG, Nebel O, Brugger J, Etschmann B, Paterson D. Garnet peridotites reveal spatial and temporal changes in the oxidation potential of subduction. Sci Rep 2018; 8:16411. [PMID: 30401916 PMCID: PMC6219559 DOI: 10.1038/s41598-018-34669-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 05/08/2018] [Accepted: 10/17/2018] [Indexed: 11/09/2022] Open
Abstract
Changes in the oxygen fugacity (fO2) of the Earth's mantle have been proposed to control the spatial and temporal distribution of arc-related ore deposits, and possibly reflect the evolution of the atmosphere over billions of years. Thermodynamic calculations and natural evidence indicate that fluids released from subducting slabs can oxidise the mantle, but whether their oxidation potential varied in space and time remains controversial. Here, we use garnet peridotites from western Norway to show that there is a linear decrease in maximum fO2 with increasing depth in the mantle wedge. We ascribe this relation to changes in the speciation of sulfur released in slab fluids, with sulfate, controlling maximum oxidation, preferentially released at shallow depths. Even though the amount of sulfate in the Precambrian oceans, and thus in subducted lithologies, is thought to have been dramatically lower than during the Phanerozoic, garnet peridotites metasomatised during these two periods have a comparable fO2 range. This opens to the possibility that an oxidised mantle with fO2 similar to modern-day values has existed since the Proterozoic and possibly earlier. Consequently, early magmas derived from partial melting of metasomatised mantle may have had suitable fO2 to generate porphyry Cu-Au and iron-oxide Cu-Au deposits.
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Affiliation(s)
- Andrea Rielli
- Dipartimento di Scienze della Terra, Università di Pisa, Via S. Maria 53, 56126, Pisa, Italy.
| | - Andrew G Tomkins
- School of Earth, Atmosphere and the Environment, Monash University, Melbourne, Victoria, 3800, Australia
| | - Oliver Nebel
- School of Earth, Atmosphere and the Environment, Monash University, Melbourne, Victoria, 3800, Australia
| | - Joël Brugger
- School of Earth, Atmosphere and the Environment, Monash University, Melbourne, Victoria, 3800, Australia
| | - Barbara Etschmann
- School of Earth, Atmosphere and the Environment, Monash University, Melbourne, Victoria, 3800, Australia
| | - David Paterson
- Australian Synchrotron, 800 Blackburn Road, Clayton, Victoria, 3168, Australia
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Hurst T, Doidge M, Hajkowicz K, Harris P, Forde B, Bergh H, Jennison A, Roberts L, Allworth T, Nimmo G, Beatson S, Paterson D. Mastering resistant bacteria using whole genome sequencing. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.09.043] [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: 10/27/2022]
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48
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Le T, Mackey J, Paterson D, Davies N. IMPROVING COMPLIANCE AND ACCESS TO NITROGLYCERIN AND ASPIRIN IN PEOPLE WITH CORONARY ARTERY DISEASE: DEVELOPMENT AND VALIDATION OF THE SMHEARTCARD SYSTEM. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.249] [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: 11/30/2022] Open
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49
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Mason-Roberts S, Bradley A, Karatzias T, Brown M, Paterson D, Walley R, Truesdale M, Taggart L, Sirisena C. Multiple traumatisation and subsequent psychopathology in people with intellectual disabilities and DSM-5 PTSD: a preliminary study. J Intellect Disabil Res 2018; 62:730-736. [PMID: 29856097 DOI: 10.1111/jir.12505] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 03/18/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Individuals with intellectual disability (ID) are at greater risk of exposure to traumatic life events compared with the non-ID population. Yet no study to date has examined the role of multiple traumatisation and subsequent psychopathology in people with ID. The aim of this study was to explore the association between multiple traumatisation and subsequent mental health. METHODS A preliminary cross-sectional study involving 33 participants with DSM-5 post-traumatic stress disorder completed self-report questionnaires on exposure to traumatic life events and post-traumatic stress disorder symptoms, anxiety, depression and general distress. RESULTS A proportion of 42.4% of the sample reported multiple traumatisation, including exposure to life events in both childhood and adulthood. Those who reported exposure to life events in childhood and adulthood reported significantly higher risk of harm, depression and general psychological distress compared with those who reported exposure to life events only in adulthood. CONCLUSIONS Preliminary results indicate that more severe psychopathology is associated with multiple traumatisation in childhood and adulthood compared with trauma experienced solely in adulthood.
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Affiliation(s)
- S Mason-Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - A Bradley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - T Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - M Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - D Paterson
- Learning Disability Service, NHS Ayrshire & Arran, Crosshouse, UK
| | - R Walley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - M Truesdale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - L Taggart
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Newtownabbey, UK
| | - C Sirisena
- Learning Disability Service, NHS Borders, Newstead, UK
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Glenister A, Chen CKJ, Tondl EM, Paterson D, Hambley TW, Renfrew AK. Targeting curcumin to specific tumour cell environments: the influence of ancillary ligands. Metallomics 2018; 9:699-705. [PMID: 28488704 DOI: 10.1039/c6mt00275g] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tumour-activation of prodrugs has the potential to improve the efficacy of anticancer agents while minimising systemic toxicity. Cobalt complexes are of interest in this respect as chaperones to deliver and release anticancer agents in the low oxygen, reducing environment of solid tumours. In addition to being able to release a cytotoxic ligand under the conditions of the tumour microenvironment, it is fundamental that the chaperone complex must also be able to penetrate through multiple cell layers to deliver the cytotoxin to all regions of the tumour. Herein, we report an investigation of the distribution and metabolism of two chaperone complexes of the anticancer agent curcumin within monolayer tumour cells and multicellular tumour spheroids. Using a combination of X-ray fluorescence microscopy, confocal fluorescence microscopy, and X-ray absorption spectroscopy, we demonstrate how the nature of the chaperone complex can profoundly influence the cellular uptake, distribution, and release mechanism of curcumin, providing key insights into the design of this class of prodrug.
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Affiliation(s)
- A Glenister
- School of Chemistry, University of Sydney, New South Wales, 2006, Australia.
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