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Levi L, Zamora D, Nastas I, Gonen I, Radu P, Matei V, Ciobanu AM, Nacu A, Boronin L, Karakrah L, Davidson M, Davis JM, Weiser M. Add-On Pramipexole for the Treatment of Schizophrenia and Schizoaffective Disorder: A Randomized Controlled Trial. J Clin Psychiatry 2022; 83. [PMID: 35921506 DOI: 10.4088/jcp.21m14233] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: Several small clinical trials have reported that the dopamine agonist pramipexole was beneficial in treating patients with schizophrenia. A confirmatory trial was conducted to test this hypothesis. Methods: This 16-week, multicenter, double-blind, randomized, placebo-controlled study included 200 subjects meeting DSM-IV-TR criteria for schizophrenia or schizoaffective disorder. Patients were randomized to receive either pramipexole (0.75 mg twice daily, n = 100) or placebo (n = 100) as an add-on to their regular antipsychotic treatment. The primary outcome measure was the total score on the Positive and Negative Syndrome Scale (PANSS); secondary outcome measures included PANSS subscale and cognitive functioning scores. Recruitment was performed in 30 sites in Romania and 1 site in the Republic of Moldova between January and June 2011. Results: Analysis of covariance models showed no significant difference between pramipexole and placebo for total PANSS (P > .99) and PANSS positive (P > .99), negative (P = .73), and general psychopathology (P = .99) subscale scores. Changes in Clinical Global Impressions-Severity of Illness scale and Brief Assessment of Cognition in Schizophrenia scores showed no significant difference between pramipexole and placebo. Conclusions: The results of this large randomized controlled trial indicated that pramipexole was not efficacious as an add-on to antipsychotic medications for schizophrenia. Trial Registration: ClinicalTrials.gov identifier NCT01320982.
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Affiliation(s)
- Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Igor Nastas
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | | | | | - Valentin Matei
- Department of Neuroscience, Discipline of Psychiatry, University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Adela M Ciobanu
- Department of Neuroscience, Discipline of Psychiatry, University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Anatol Nacu
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | - Larisa Boronin
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | - Lusian Karakrah
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | | | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, Illinois
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Corresponding author: Mark Weiser. MD, Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, 52621, Israel
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Weiser M, Zamora D, Levi L, Nastas I, Gonen I, Radu P, Matei V, Nacu A, Boronin L, Davidson M, Davis JM. Adjunctive Aspirin vs Placebo in Patients With Schizophrenia: Results of Two Randomized Controlled Trials. Schizophr Bull 2021; 47:1077-1087. [PMID: 33479775 PMCID: PMC8266648 DOI: 10.1093/schbul/sbaa198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two previous randomized controlled trials (RCTs) suggested that adjunctive aspirin is efficacious in treating schizophrenia. We conducted two 16-week double-blind randomized placebo-controlled RCTs of adjunctive 1000 mg aspirin vs placebo in schizophrenia. Study 1 included 200 patients, with Positive and Negative Syndrome Scale (PANSS) total score as the primary outcome. Study 2 included 160 patients with C-reactive protein (CRP) >1 mg/L at baseline; the primary outcome was PANSS-positive score. Dropout rates for aspirin/placebo were 12% in study 1 and 20% in study 2. Differences in outcome between aspirin and placebo were calculated with linear regression, adjusting for the baseline value of the outcome. No statistically significant between-group differences were found in primary or secondary outcomes in either study. Study 1: mean difference in PANSS at 16 weeks was -3.9 (95% CI: -8.4 to 0.5, P = .10, effect size (ES) = -0.25) and at 8 weeks was -3.5 (95% CI: -7.5 to 0.5, P = .11, ES = -0.22). Study 2: mean difference in PANSS at 16 weeks was 0.3 (95% CI: -4.1 to 4.7, P = .90, ES = 0.02) and in positive PANSS was 0.5 (95% CI: -1.0 to 2.1, P = .50, ES = 0.11). A meta-analysis of these data with the existing studies, excluding one with large baseline differences in total PANSS, found that the overall estimate of the effect of adjunctive aspirin on the PANSS total score comparing group means at the end of the study was -2.9 (95% CI: -6.6 to 0.7; P = .21), favoring aspirin. Our studies and meta-analysis failed to find a statistically significant improvement in the symptoms of schizophrenia from adjunctive aspirin therapy in comparison to placebo in schizophrenia. Trial registration: study 1: Clinicaltrials.gov: NCT01320982; study 2 (high CRP): EudraCT Number: 2014-000757-36.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,To whom correspondence should be addressed; Department of Psychiatry, Sheba Medical Center, Tel Hashomer, 52621, Israel; tel: +97235303773; +97235303773; fax: +97235353807; e-mail:
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Igor Nastas
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | | | | | - Valentin Matei
- Department of Psychiatry, Obrejia Hospital, Bucharest, Romania
| | - Anatol Nacu
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | - Larisa Boronin
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | | | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL
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Abstract
Abstract
One previous small single-center clinical trial showed that a single intravenous administration of sodium nitroprusside added-on to antipsychotics improved a wide spectrum of schizophrenia (SCZ) symptoms more than placebo, and the improvement persisted for 4 weeks after infusion even though no additional drug was given. Our study attempted to replicate these data in a 4-week, add-on, double-blind, randomized, placebo-controlled trial on 20 patients performed in a site in Romania and a site in Moldova. This study’s sample size and protocol were identical to the previous trial, including patients with a diagnosis of SCZ, within the first 5 years after diagnosis. Patients recruited needed to have a baseline total positive and negative syndrome scale (PANSS) score of 60 or above. Ten participants received a single dose of 0.5 µg/kg/min intravenous sodium nitroprusside over 4 hours, and 10 participants received matching placebo infusion, added-on to antipsychotics. The primary outcomes were the PANSS total score and the PANSS negative subscale. There were no significant between-group differences in PANSS total scores or negative subscale scores during the infusion on daily evaluations for the next 7 days nor on weekly evaluations at weeks 2, 3, and 4. No significant differences were found between the 2 study groups in adverse events. Meta-analyses including all 5 published randomized controlled trials on the topic, representing 155 subjects, do not show a statistically significant benefit of sodium nitroprusside. We conclude that the current evidence does not support the efficacy of sodium nitroprusside in the treatment of SCZ.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
- Stanley Medical Research Institute, Kensington, MD
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
| | - Valentin Matei
- Department of Psychiatry, Obrejia Hospital, Bucharest, Romania
| | | | | | - Michael Davidson
- Department of psychiatry, University of Nicosia Medical School, Nicosia, Cyprus
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL
- Department of Psychiatry, Johns Hopkins University Baltimore, MD
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Weiser M, Levi L, Zamora D, Biegon A, SanGiovanni JP, Davidson M, Burshtein S, Gonen I, Radu P, Slobozean Pavalache K, Nastas I, Hemi R, Ryan T, Davis JM. Effect of Adjunctive Estradiol on Schizophrenia Among Women of Childbearing Age: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:1009-1017. [PMID: 31365044 PMCID: PMC6669788 DOI: 10.1001/jamapsychiatry.2019.1842] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Several lines of evidence suggest that estradiol influences the course of schizophrenia, and a previous randomized controlled trial demonstrated that transdermal estradiol improved symptoms in female patients of childbearing age. However, many initial positive findings in schizophrenia research are not later replicated. OBJECTIVE To independently replicate the results of the effect of estradiol on schizophrenia in women of childbearing age. DESIGN, SETTING, AND PARTICIPANTS An 8-week randomized, placebo-controlled trial performed in the Republic of Moldova between December 4, 2015, and July 29, 2016, among 200 premenopausal women aged 19 to 46 years with schizophrenia or schizoaffective disorder as defined by the DSM-5. INTERVENTION Patients were randomized to receive a 200-μg estradiol patch or placebo patch changed twice a week added to their antipsychotic treatment. MAIN OUTCOMES AND MEASURES The primary outcome was the positive subscale of the Positive and Negative Syndrome Scale (PANSS; lower scores indicated fewer symptoms and higher scores indicated more symptoms), analyzed with mixed models for repeated measures on an intention-to-treat basis. RESULTS A total of 100 women (median age, 38 years; interquartile range, 34-42 years) were randomized to receive an estradiol patch and 100 women (median age, 38 years; interquartile range, 31-41 years) were randomized to receive a placebo patch; the median age at baseline for the entire group of 200 women was 38.0 years (range, 19.5-46.0 years). At baseline, the mean positive PANSS score was 19.6 for both groups combined; at week 8, the mean positive PANSS score was 14.4 in the placebo group and 13.4 in the estradiol group. Compared with placebo, participants receiving add-on estradiol patches had statistically significant improvements in the primary outcome measure, PANSS positive subscale points (-0.94; 95% CI, -1.64 to -0.24; P = .008; effect size = 0.38). Post hoc heterogeneity analyses found that this effect occurred almost entirely in 100 participants older than 38.0 years (46 in placebo group vs 54 in estradiol group; difference, -1.98 points on the PANSS positive subscale; 95% CI, -2.94 to -1.02; P < .001). Younger participants did not benefit from estradiol (difference, 0.08 points on the PANSS positive subscale; 95% CI, -0.91 to 1.07; P = .87). Breast tenderness was more common in the estradiol group (n = 15) than in the placebo group (n = 1) as was weight gain (14 in estradiol group vs 1 in placebo group). CONCLUSIONS AND RELEVANCE The results independently replicate the finding that transdermal estradiol is an effective add-on treatment for women of childbearing age with schizophrenia and extend it, finding improvements in negative symptoms and finding that the effect could be specific to those older than 38 years. The results should be viewed in the context of the differences in the natural course of schizophrenia between females and males. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03848234.
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Affiliation(s)
- Mark Weiser
- Stanley Medical Research Institute, Kensington, Maryland,Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill,Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Anat Biegon
- Department of Radiology, Stony Brook University Medical School, Stony Brook, New York,Department of Neurology, Stony Brook University Medical School, Stony Brook, New York
| | - John Paul SanGiovanni
- Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland,Department of Biochemistry and Molecular & Cellular Biology, Georgetown School of Medicine, Washington, DC
| | - Michael Davidson
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel,University of Nicosia Medical School, Engomi, Cyprus
| | - Shimon Burshtein
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Igor Nastas
- Psychiatry, Narcology, and Medical Psychology, State University of Medicine and Pharmaceuticals, “Nicolae Testemianu,” Chisinau, Moldova
| | - Rina Hemi
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Timothy Ryan
- Department of Psychiatry, University of Illinois, Chicago
| | - John M. Davis
- Department of Psychiatry, University of Illinois, Chicago,Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland
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Weiser M, Levi L, Burshtein S, Chiriță R, Cirjaliu D, Gonen I, Yolken R, Davidson M, Zamora D, Davis JM. The effect of minocycline on symptoms in schizophrenia: Results from a randomized controlled trial. Schizophr Res 2019; 206:325-332. [PMID: 30455075 DOI: 10.1016/j.schres.2018.10.023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have hypothesized that immunological abnormalities might contribute to schizophrenia, and basic science studies, as well as several clinical trials suggest that minocycline could be efficacious in ameliorating both positive and negative symptoms of schizophrenia. In this study we examined the effect of minocycline on schizophrenia in a large randomized controlled trial. METHODS We performed a 16-week, multi-center, double-blind, randomized, placebo-controlled study on 200 subjects with schizophrenia or schizoaffective disorder randomized to receive either minocycline (200 mg/day, n = 100), or placebo (n = 100) as an add-on to anti-psychotic treatment. The primary outcome measure was the PANSS total score. RESULTS Mixed models for repeated measures showed no significant difference between minocycline and placebo for total PANSS (p = 0.862), PANSS subscales, CGI or BACS. CONCLUSIONS Minocycline did not improve symptoms or cognition in schizophrenia.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Shimon Burshtein
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Roxana Chiriță
- Spitalul Clinic de Psihiatrie Socola, Iași. Șos. Bucium 36, Iași, Romania
| | - Diana Cirjaliu
- Clinica de Psihiatrie Palazu Mare, Constanta, Tomis 145, Constanța, Romania
| | | | - Robert Yolken
- Dept. of Pediatrics, John's Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University of Nicosia Medical School, Cyprus
| | - Daisy Zamora
- Dept. of Psychiatry, University of North Carolina, Chappel Hill, NC, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL 60607, USA
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Erdem H, Elaldi N, Ak O, Gulsun S, Tekin R, Ulug M, Duygu F, Sunnetcioglu M, Tulek N, Guler S, Cag Y, Kaya S, Turker N, Parlak E, Demirdal T, Ataman Hatipoglu C, Avci A, Bulut C, Avci M, Pekok A, Savasci U, Kaya S, Sozen H, Tasbakan M, Guven T, Bolukcu S, Cesur S, Sahin-Horasan E, Kazak E, Denk A, Gonen I, Karagoz G, Haykir Solay A, Alici O, Kader C, Senturk G, Tosun S, Turan H, Baran A, Ozturk-Engin D, Bozkurt F, Deveci O, Inan A, Kadanali A, Sayar M, Cetin B, Yemisen M, Naz H, Gorenek L, Agalar C. Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect 2014; 20:O847-53. [DOI: 10.1111/1469-0691.12680] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 01/15/2023]
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Erdem H, Ozturk-Engin D, Yesilyurt M, Karabay O, Elaldi N, Celebi G, Korkmaz N, Guven T, Sumer S, Tulek N, Ural O, Yilmaz G, Erdinc S, Nayman-Alpat S, Sehmen E, Kader C, Sari N, Engin A, Cicek-Senturk G, Ertem-Tuncer G, Gulen G, Duygu F, Ogutlu A, Ayaslioglu E, Karadenizli A, Meric M, Ulug M, Ataman-Hatipoglu C, Sirmatel F, Cesur S, Comoglu S, Kadanali A, Karakas A, Asan A, Gonen I, Kurtoglu-Gul Y, Altin N, Ozkanli S, Yilmaz-Karadag F, Cabalak M, Gencer S, Umut Pekok A, Yildirim D, Seyman D, Teker B, Yilmaz H, Yasar K, Inanc Balkan I, Turan H, Uguz M, Kilic S, Akkoyunlu Y, Kaya S, Erdem A, Inan A, Cag Y, Bolukcu S, Ulu-Kilic A, Ozgunes N, Gorenek L, Batirel A, Agalar C. Evaluation of tularaemia courses: a multicentre study from Turkey. Clin Microbiol Infect 2014; 20:O1042-51. [PMID: 24975504 DOI: 10.1111/1469-0691.12741] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/30/2022]
Abstract
In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (n = 653, 63%) and/or pharyngitis (n = 146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1%) and oculoglandular (n = 105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (n = 599, 58%), submandibular (n = 401, 39%), and periauricular (n = 55, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with β-lactam/β-lactamase inhibitors (n = 793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8 ± 37.5 days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), the formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite 2 weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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Ozturk-Engin D, Erdem H, Gencer S, Kaya S, Baran AI, Batirel A, Tekin R, Celen MK, Denk A, Guler S, Ulug M, Turan H, Pekok AU, Mermut G, Kaya S, Tasbakan M, Tulek N, Cag Y, Inan A, Yalci A, Ataman-Hatipoglu C, Gonen I, Dogan-Celik A, Bozkurt F, Gulsun S, Sunnetcioglu M, Guven T, Duygu F, Parlak E, Sozen H, Tosun S, Demirdal T, Guclu E, Karabay O, Uzun N, Gunal O, Diktas H, Haykir-Solay A, Erbay A, Kader C, Aydin O, Erdem A, Elaldi N, Kadanali A, Yulugkural Z, Gorenek L, Altındis M, Bolukcu S, Agalar C, Ormeci N. Liver involvement in patients with brucellosis: results of the Marmara study. Eur J Clin Microbiol Infect Dis 2014; 33:1253-62. [PMID: 24557334 DOI: 10.1007/s10096-014-2064-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/20/2014] [Indexed: 12/27/2022]
Abstract
Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.
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Affiliation(s)
- D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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9
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Batirel A, Balkan II, Karabay O, Agalar C, Akalin S, Alici O, Alp E, Altay FA, Altin N, Arslan F, Aslan T, Bekiroglu N, Cesur S, Celik AD, Dogan M, Durdu B, Duygu F, Engin A, Engin DO, Gonen I, Guclu E, Guven T, Hatipoglu CA, Hosoglu S, Karahocagil MK, Kilic AU, Ormen B, Ozdemir D, Ozer S, Oztoprak N, Sezak N, Turhan V, Turker N, Yilmaz H. Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections. Eur J Clin Microbiol Infect Dis 2014; 33:1311-22. [PMID: 24532009 DOI: 10.1007/s10096-014-2070-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/24/2014] [Indexed: 02/06/2023]
Abstract
The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7%): colistin-carbapenem (CC), 69 (32.2%): colistin-sulbactam (CS), and 43 (20.1%: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.
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Affiliation(s)
- A Batirel
- Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Semsi Denizer Cd. E-5 Karayolu Cevizli Mevkii, 34890, Kartal, Istanbul, Turkey,
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Siegman-Igra Y, Schwartz D, Gonen I, Konforti N. Bacteremic infections in granulopenic patients in Israel. Isr J Med Sci 1987; 23:1214-8. [PMID: 3440744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Forty-four bacteremic, granulopenic patients hospitalized during a 4-year period (between 1980 and 1983) in the Tel Aviv Medical Center are reviewed. Fifty-four organisms were recovered from the 44 patients, including 17 strains in 8 patients (18%) in mixed infections. Eighty-three percent of the organisms were gram-negative and 17% gram-positive. The most common organism was Pseudomonas aeruginosa. Seventy percent of the infections were hospital acquired, and the most common focus of infection was the urinary tract. The most resistant strains of microorganisms grew in hospital-acquired infections and in people who were already receiving antimicrobials. These findings differ somewhat from previously published data.
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Affiliation(s)
- Y Siegman-Igra
- Infectious Disease Unit, Rokach (Hadassah) Hospital, Tel Aviv, Israel
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