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151. HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort.

Author

Revest M., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Lum L.-N., Tan R.-S., Lejko-Zupanc T., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castan~eda X., Cervera C., Rio A., Falces C., Garcia-de-la-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Mun~oz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., de Alarcon A., Parra R., Alestig E., Johansson M., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., DiPersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Baloch K., Corey G.R., Dixon C.C., Fowler Jr. V.G., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Chu V.H., Karchmer A.W., Murdoch D.R., Sexton D.J., Wang A., Bayer A.S., Cabell C.H., Chu V., Durack D.T., Eykyn S., Hoen B., Moreillon P., Olaison L., Raoult D., Rubinstein E., Chambers S.T., Murdoch D., Bouza E., Hannan M.M., Kanafani Z.A., Lang S., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., Altclas J., Silvia Kogan S., Spelman D., Athan E., Harris O., Kennedy K., Tan R., Gordon D., Papanicolas L., Eisen D., Grigg L., Street A., Korman T., Kotsanas D., Dever R., Konecny P., Lawrence R., Rees D., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Ryan S., Gattringer R., Wiesbauer F., Andrade A.R., de Brito A.C.P., Guimara~es A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., de Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., de Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Vincelj J., Freiberger T., Pol J., Zaloudikova B., Ashour Z., Kholy A.E., Mishaal M., Rizk H., Aissa N., Alauzet C., Alla F., Campagnac C., Doco-Lecompte T., Selton-Suty C., Casalta J.-P., Fournier P.-E., Habib G., Thuny F., Delahaye F., Delahaye A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Sharma G., Tattevin P., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Tribouilloy C., Bernard Y., Chirouze C., Leroy J., Plesiat P., Naber C., Mazaheri B., Neuerburg C., Athanasia S., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Francis J., Nair L., Thomas V., Venugopal K., Hannan M., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Tripodi M.F., Casillo R., Cuccurullo S., Dialetto G., Durante-Mangoni E., Irene M., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., Imazio M., Trinchero R., Tebini A., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Carosi G., Magri S., Signorini L., Baban T., Kanafani Z., Kanj S.S., Sfeir J., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., van der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Revest M., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Lum L.-N., Tan R.-S., Lejko-Zupanc T., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castan~eda X., Cervera C., Rio A., Falces C., Garcia-de-la-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Miro J.M., Moreno A., Ninot S., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Mun~oz P., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Fernandez-Hidalgo N., Tornos P., de Alarcon A., Parra R., Alestig E., Johansson M., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Fowler V.G., Holland T., Lalani T., Mudrick D., Samad Z., Sexton D., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., DiPersio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Baloch K., Corey G.R., Dixon C.C., Fowler Jr. V.G., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Chu V.H., Karchmer A.W., Murdoch D.R., Sexton D.J., Wang A., Bayer A.S., Cabell C.H., Chu V., Durack D.T., Eykyn S., Hoen B., Moreillon P., Olaison L., Raoult D., Rubinstein E., Chambers S.T., Murdoch D., Bouza E., Hannan M.M., Kanafani Z.A., Lang S., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., Altclas J., Silvia Kogan S., Spelman D., Athan E., Harris O., Kennedy K., Tan R., Gordon D., Papanicolas L., Eisen D., Grigg L., Street A., Korman T., Kotsanas D., Dever R., Konecny P., Lawrence R., Rees D., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Ryan S., Gattringer R., Wiesbauer F., Andrade A.R., de Brito A.C.P., Guimara~es A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., de Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., de Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Vincelj J., Freiberger T., Pol J., Zaloudikova B., Ashour Z., Kholy A.E., Mishaal M., Rizk H., Aissa N., Alauzet C., Alla F., Campagnac C., Doco-Lecompte T., Selton-Suty C., Casalta J.-P., Fournier P.-E., Habib G., Thuny F., Delahaye F., Delahaye A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Sharma G., Tattevin P., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Tribouilloy C., Bernard Y., Chirouze C., Leroy J., Plesiat P., Naber C., Mazaheri B., Neuerburg C., Athanasia S., Giannitsioti E., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Francis J., Nair L., Thomas V., Venugopal K., Hannan M., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Tripodi M.F., Casillo R., Cuccurullo S., Dialetto G., Durante-Mangoni E., Irene M., Ragone E., Utili R., Cecchi E., De Rosa F., Forno D., Imazio M., Trinchero R., Tebini A., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Carosi G., Magri S., Signorini L., Baban T., Kanafani Z., Kanj S.S., Sfeir J., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., van der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., and Chipigina N.

Abstract

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences. © 2013 Chambers et al.

Published
2013

153. Methicillin-susceptible staphylococcus aureus endocarditis isolates Are associated with clonal complex 30 genotype and a distinct repertoire of enterotoxins and adhesins.

Author

Sharma Kuinkel B.K., Woods C.W., Chu V.H., Marin M., Bukovski S., Garcia P., Corey G.R., Korman T., Doco-Lecompte T., Murdoch D.R., Reller L.B., Fowler Jr. V.G., Clarke-Pearson M., Nienaber J.J.C., Rude T.H., Park L., Barriere S., Lamlertthon S., Sharma Kuinkel B.K., Woods C.W., Chu V.H., Marin M., Bukovski S., Garcia P., Corey G.R., Korman T., Doco-Lecompte T., Murdoch D.R., Reller L.B., Fowler Jr. V.G., Clarke-Pearson M., Nienaber J.J.C., Rude T.H., Park L., Barriere S., and Lamlertthon S.

Abstract

Background. Using multinational collections of methicillin-susceptible Staphylococcus aureus (MSSA) isolates from infective endocarditis (IE) and soft tissue infections (STIs), we sought to (1) validate the finding that S. aureus in clonal complex (CC) 30 is associated with hematogenous complications and (2) test the hypothesis that specific genetic characteristics in S. aureus are associated with infection severity. Methods. IE and STI isolates from 2 cohorts were frequency matched by geographic origin. Isolates underwent spa typing to infer CC and multiplex polymerase chain reaction for presence of virulence genes. Results. 114 isolate pairs were genotyped. IE isolates were more likely to be CC30 (19.5% vs 6.2%; P = .005) and to contain 3 adhesins (clfB, cna, map/eap; P <.0001 for all) and 5 enterotoxins (tst, sea, sed, see, and sei; P <=.005 for all). CC30 isolates were more likely to contain cna, tst, sea, see, seg, and chp (P < .05 for all). Conclusions. MSSA IE isolates were significantly more likely to be CC30 and to possess a distinct repertoire of virulence genes than MSSA STI isolates from the same region. The genetic basis of this association requires further study. © The Author 2011.

Published
2012

155. Hospitalized patients' participation and its impact on quality of care and patient safety.

Author

Weingart, S.N., Zhu, J., Chiappetta, L., Stuver, S.O., Schneider, E.C., Epstein, A.M., David-Kasdan, J.A., Annas, C.L., Fowler Jr, F.J., Weissman, J.S., Weingart, S.N., Zhu, J., Chiappetta, L., Stuver, S.O., Schneider, E.C., Epstein, A.M., David-Kasdan, J.A., Annas, C.L., Fowler Jr, F.J., and Weissman, J.S.

Abstract

1 juni 2011, Item does not contain fulltext, OBJECTIVE: To understand the extent to which hospitalized patients participate in their care, and the association of patient participation with quality of care and patient safety. DESIGN: Random sample telephone survey and medical record review. SETTING: US acute care hospitals in 2003. PARTICIPANTS: A total of 2025 recently hospitalized adults. MAIN OUTCOME MEASURES: Hospitalized patients reported participation in their own care, assessments of overall quality of care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. RESULTS: Of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of >4 activities) was strongly associated with patients' favorable ratings of the hospital quality of care (adjusted OR: 5.46, 95% CI: 4.15-7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR = 0.49, 0.31-0.78). CONCLUSIONS: Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event.

Published
2011

156. Feedback Loop: Testing a Patient Experience Survey in the Safety Net

Author

Dale Shaller, Dale Shaller, Floyd J. Fowler, Jr., Julie Brown, Patricia Gallagher, Susan Edgman-Levitan, Dale Shaller, Dale Shaller, Floyd J. Fowler, Jr., Julie Brown, Patricia Gallagher, and Susan Edgman-Levitan

Abstract

Presents outcomes of a project to develop a toolkit on patient experience of care surveys for safety-net clinics, design and test in-clinic and Internet surveys, and compare feasibility, cost, response rates, and data quality with existing mail surveys.

Published
2011

157. Identifying and Aligning Expectations in a Mentoring Relationship

Author

Huskins, W. Charles, Huskins, W. Charles, Silet, Karin, Weber-Main, Anne Marie, Begg, Melissa D., Fowler Jr, Vance G., Hamilton, John, Fleming, Michael, Huskins, W. Charles, Huskins, W. Charles, Silet, Karin, Weber-Main, Anne Marie, Begg, Melissa D., Fowler Jr, Vance G., Hamilton, John, and Fleming, Michael

Published
2011

158. Non-HACEK gram-negative bacillus endocarditis.

Author

Delahaye F., Patel M., Dismukes W., Pan A., Caros G., Tribouilloy A.B.M.C., Ramallo V., Raoult D., Thuny F., Habib G., Casalta J.-P., Fournier P.-E., Chipigina N., Kirill O., Vinogradova T., Kulichenko V.P., Butkevich O.M., Lion C., Selton-Suty C., Alla F., Coyard H., Doco-Lecompte T., Durante-Mangoni E., Ragone E., Dialetto G., Tripodi M.F., Utili R., Casillo R., Kumar A.S., Sharma G., Street A., Eisen D.P., McBryde E.S., Grigg L., Abrutyn E., Michelet C., Donnio P.Y., Fortes C.Q., Edathodu J., Al-Hegelan M., Font B., Anguera I., Guma J.R., Cereceda M., Oyonarte M.J., Mella R.M., Garcia P., Jones S.B., Paiva M.G., Tranchesi R.A.D.M., Woon L.L., Lum L.-N., Tan R.-S., Rees D., Kornecny P., Lawrence R., Dever R., Post J., Jones P., Ryan S., Harkness J., Feneley M., Rubinstein E., Strahilewitz J., Ionac A., Mornos C., Dragulescu S., Forno D., Cecchi E., De Rosa F., Imazio M., Trinchero R., Wiesbauer F., Gattringer R., Deans G., Andrasevic A.T., Barsic B., Klinar I., Vincelj J., Bukovski S., Krajinovic V., Stafford J., Baloch K., Redick T., Harding T., Bayer A.S., Durack D.T., Moreillon P., Eykyn S., Morpeth S., Murdoch D., Cabell C.H., Karchmer A.W., Pappas P., Levine D., Nacinovich F., Tattevin P., Fernandez-Hidalgo N., Dickerman S., Bouza E., Del Rio A., Lejko-Zupanc T., De Oliveira Ramos A., Iarussi D., Klein J., Chirouze C., Bedimo R., Corey G.R., Fowler Jr. V.G., Gordon D., Devi U., Spelman D., Van Der Meer J.T.M., Kauffman C., Bradley S., Armstrong W., Giannitsioti E., Giamarellou H., Lerakis S., Moreno A., Mestres C.A., Pare C., Garcia De La Maria C., De Lazzario E., Marco F., Gatell J.M., Miro J.M., Almela M., Azqueta M., Jimenez-Exposito M.J., De Benito N., Perez N., Almirante B., Rodriguez De Vera P., Tornos P., Falco V., Claramonte X., Armero Y., Sidani N., Kanj-Sharara S., Kanafani Z., Raglio A., Goglio A., Gnecchi F., Suter F., Valsecchi G., Rizzi M., Ravasio V., Hoen B., Leroy J., Plesiat P., Bernard Y., Casey A., Lambert P., Watkin R., Elliott T., Goissen T., Delahaye A., Vandenesch F., Vizzotti C., Nacinovich F.M., Trivi M., Lombardero M., Cortes C., Casabe J.H., Altclas J., Kogan S., Clara L., Sanchez M., Commerford A., Hansa C., Deetlefs E., Ntsekhe M., Commerford P., Wray D., Steed L.L., Church P., Cantey R., Morris A., Chambers S., Read K., Raymond N., Holland D., Lang S., Kotsanas D., Korman T.M., Peterson G., Purcell J., Southern Jr. P.M., Shah M., Reddy A., Dhar G., Hanlon-Feeney A., Hannan M., Kelly S., Wang A., Woods C.W., Sexton D.J., Benjamin Jr. D., McDonald J.R., Federspiel J., Engemann J.J., Reller L.B., Drew L., Caram L.B., Stryjewski M., Lalani T., Chu V., Mazaheri B., Neuerburg C., Naber C., Athan E., Henry M., Harris O., Alestig E., Olaison L., Wikstrom L., Snygg-Martin U., Francis J., Venugopal K., Nair L., Thomas V., Chaiworramukkun J., Pachirat O., Chetchotisakd P., Suwanich T., Kamarulzaman A., Tamin S.S., Mueller Premru M., Logar M., Orezzi C., Moreno M., Rodriguez-Creixems M., Marin M., Fernandez M., Munoz P., Fernandez R., Delahaye F., Patel M., Dismukes W., Pan A., Caros G., Tribouilloy A.B.M.C., Ramallo V., Raoult D., Thuny F., Habib G., Casalta J.-P., Fournier P.-E., Chipigina N., Kirill O., Vinogradova T., Kulichenko V.P., Butkevich O.M., Lion C., Selton-Suty C., Alla F., Coyard H., Doco-Lecompte T., Durante-Mangoni E., Ragone E., Dialetto G., Tripodi M.F., Utili R., Casillo R., Kumar A.S., Sharma G., Street A., Eisen D.P., McBryde E.S., Grigg L., Abrutyn E., Michelet C., Donnio P.Y., Fortes C.Q., Edathodu J., Al-Hegelan M., Font B., Anguera I., Guma J.R., Cereceda M., Oyonarte M.J., Mella R.M., Garcia P., Jones S.B., Paiva M.G., Tranchesi R.A.D.M., Woon L.L., Lum L.-N., Tan R.-S., Rees D., Kornecny P., Lawrence R., Dever R., Post J., Jones P., Ryan S., Harkness J., Feneley M., Rubinstein E., Strahilewitz J., Ionac A., Mornos C., Dragulescu S., Forno D., Cecchi E., De Rosa F., Imazio M., Trinchero R., Wiesbauer F., Gattringer R., Deans G., Andrasevic A.T., Barsic B., Klinar I., Vincelj J., Bukovski S., Krajinovic V., Stafford J., Baloch K., Redick T., Harding T., Bayer A.S., Durack D.T., Moreillon P., Eykyn S., Morpeth S., Murdoch D., Cabell C.H., Karchmer A.W., Pappas P., Levine D., Nacinovich F., Tattevin P., Fernandez-Hidalgo N., Dickerman S., Bouza E., Del Rio A., Lejko-Zupanc T., De Oliveira Ramos A., Iarussi D., Klein J., Chirouze C., Bedimo R., Corey G.R., Fowler Jr. V.G., Gordon D., Devi U., Spelman D., Van Der Meer J.T.M., Kauffman C., Bradley S., Armstrong W., Giannitsioti E., Giamarellou H., Lerakis S., Moreno A., Mestres C.A., Pare C., Garcia De La Maria C., De Lazzario E., Marco F., Gatell J.M., Miro J.M., Almela M., Azqueta M., Jimenez-Exposito M.J., De Benito N., Perez N., Almirante B., Rodriguez De Vera P., Tornos P., Falco V., Claramonte X., Armero Y., Sidani N., Kanj-Sharara S., Kanafani Z., Raglio A., Goglio A., Gnecchi F., Suter F., Valsecchi G., Rizzi M., Ravasio V., Hoen B., Leroy J., Plesiat P., Bernard Y., Casey A., Lambert P., Watkin R., Elliott T., Goissen T., Delahaye A., Vandenesch F., Vizzotti C., Nacinovich F.M., Trivi M., Lombardero M., Cortes C., Casabe J.H., Altclas J., Kogan S., Clara L., Sanchez M., Commerford A., Hansa C., Deetlefs E., Ntsekhe M., Commerford P., Wray D., Steed L.L., Church P., Cantey R., Morris A., Chambers S., Read K., Raymond N., Holland D., Lang S., Kotsanas D., Korman T.M., Peterson G., Purcell J., Southern Jr. P.M., Shah M., Reddy A., Dhar G., Hanlon-Feeney A., Hannan M., Kelly S., Wang A., Woods C.W., Sexton D.J., Benjamin Jr. D., McDonald J.R., Federspiel J., Engemann J.J., Reller L.B., Drew L., Caram L.B., Stryjewski M., Lalani T., Chu V., Mazaheri B., Neuerburg C., Naber C., Athan E., Henry M., Harris O., Alestig E., Olaison L., Wikstrom L., Snygg-Martin U., Francis J., Venugopal K., Nair L., Thomas V., Chaiworramukkun J., Pachirat O., Chetchotisakd P., Suwanich T., Kamarulzaman A., Tamin S.S., Mueller Premru M., Logar M., Orezzi C., Moreno M., Rodriguez-Creixems M., Marin M., Fernandez M., Munoz P., and Fernandez R.

Abstract

Background: Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. Objective(s): To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. Design(s): Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. Setting(s): 61 hospitals in 28 countries. Patient(s): Hospitalized patients with definite endocarditis. Measurements: Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens. Result(s): Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%). Limitation(s): Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make. Conclusion(s): In this large, prospective, multinational

Published
2008

159. Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis

Author

Chu, Vivian H., Woods, Christopher W., Miro, Jose M., Hoen, Bruno, Cabell, Christopher H., Pappas, Paul A., Federspiel, Jerome, Athan, Eugene, Stryjewski, Martin E., Nacinovich, Francisco, Marco, Francesc, Levine, Donald P., Elliot, Tom S., Fortes, Claudio Q., Tornos, Pilar, Gordon, David L., Utili, Riccardo, Delahaye, Francois, Corey, G. Ralph, Fowler, Jr. Vance G., Chu, Vivian H., Woods, Christopher W., Miro, Jose M., Hoen, Bruno, Cabell, Christopher H., Pappas, Paul A., Federspiel, Jerome, Athan, Eugene, Stryjewski, Martin E., Nacinovich, Francisco, Marco, Francesc, Levine, Donald P., Elliot, Tom S., Fortes, Claudio Q., Tornos, Pilar, Gordon, David L., Utili, Riccardo, Delahaye, Francois, Corey, G. Ralph, and Fowler, Jr. Vance G.

Published
2008

161. MASTERMIND: Bringing Microbial Diagnostics to the Clinic.

Author

Patel, Robin, Tsalik, Ephraim L., Petzold, Elizabeth, Fowler Jr., Vance G., Klausner, Jeffrey D., and Evans, Scott

Subjects
ANTI-infective agents, DRUG resistance in microorganisms, COMMUNICABLE disease treatment, ROUTINE diagnostic tests, STANDARDIZATION
Abstract

New diagnostics are urgently needed to address emerging antimicrobial resistance. The Antibacterial Resistance Leadership Group proposes a strategy called MASTERMIND (Master Protocol for Evaluating Multiple Infection Diagnostics) for advancement of infectious diseases diagnostics. The goal of this strategy is to generate the data necessary to support US Food and Drug Administration clearance of new diagnostic tests by promoting research that might not have otherwise been feasible with conventional trial designs. MASTERMIND uses a single subject's sample(s) to evaluate multiple diagnostic tests at the same time, providing efficiencies of specimen collection and characterization. MASTERMIND also offers central trial organization, standardization of methods and definitions, and common comparators. [ABSTRACT FROM AUTHOR]

Published
2017
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162. Occupational Contact Dermatitis in Mechanics and Repairers Referred for Patch Testing: Retrospective Analysis From the North American Contact Dermatitis Group 1998-2014.

Author

Warshaw, Erin M., Hagen, Solveig L., Sasseville, Denis, Maibach, Howard I., DeKoven, Joel G., Belsito, Donald V., Fowler Jr, Joseph F., Zug, Kathryn A., Taylor, James S., Mathias, C. G. Toby, Fransway, Anthony F., DeLeo, Vincent A., Marks Jr, James G., Pratt, Melanie D., Zirwas, Matthew J., and Storrs, Frances J.

Abstract

Background: Contact dermatoses are common in mechanic and repair occupations. Objectives: This study aimed to (1) estimate the prevalence of occupationally related contact dermatitis among mechanics/repairers patch tested from 1998 to 2014 by the North American Contact Dermatitis Group, (2) characterize responsible allergens and irritants, and their sources, and (3) compare results among 3 occupational subgroups (mechanics, electrical/electronic, and other). Methods: A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 1998 and 2014. Results: Of 38,784 patients patch tested, 691 (1.8%) were mechanics/repairers. Male sex (93.5%) and hand involvement (59.5%) were common overall. Occupationally related skin disease was more prevalent among vehicle and mobile equipment mechanics/repairers (52.7%) and other mechanics/repairers (41.4%) than electrical/electronic equipment mechanics/repairers (21.3%). Overall, carba mix, thiuram mix, and methylchloroisothiazolone/methylisothiazolone were the most common occupation-related clinically relevant allergens. Gloves, automotive vehicles, solvents, oils, lubricants, and fuels were the most common sources of responsible allergens. Conclusions: Common occupationally related allergens included rubber accelerators and the preservative methylchloroisothiazolone/methylisothiazolone. [ABSTRACT FROM AUTHOR]

Published
2017
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163. Wet Wipe Allergens: Retrospective Analysis From the North American Contact Dermatitis Group 2011-2014.

Author

Warshaw, Erin M., Aschenbeck, Kelly A., Zug, Kathryn A., Belsito, Donald V., Zirwas, Matthew J., Fowler Jr, Joseph F., Taylor, James S., Sasseville, Denis, Fransway, Anthony F., DeLeo, Vincent A., Marks Jr, James G., Pratt, Melanie D., Maibach, Howard I., Mathias, C. G. Toby, and DeKoven, Joel G.

Abstract

Background: Although there are several case reports of wet wipe-associated contact dermatitis, the prevalence of wipes as a source of allergic contact dermatitis in larger populations and the responsible allergens are largely unknown. Objective: The aim of the study was to determine the prevalence of wet wipes as a source of contact allergy and the most commonly associated allergens in a North American tertiary referral patch test population. Methods: Data collected from 2011 to 2014 by the North American Contact Dermatitis Group was used to conduct a retrospective cross-sectional analysis of patient demographics and patch test results associated with the triple-digit source code for "wet wipe". Results: Of the 9037 patients patch tested during the study period, 79 (0.9%) had a positive patch test reaction to an allergen identified with a wet wipe source. The most commonly associated allergens were preservatives, including the following: methylisothiazolinone (MI) (59.0%), methylchloroisothiazolinone (MCI)/MI (35.6%), bronopol (2-bromo-2-nitropropane-1,3-diol) (27.4%), and iodopropynyl butylcarbamate (12.3%). Fragrance (combined) represented 12.3%. Anal/genital dermatitis was 15 times more likely (P G 0.0001) in those with wet wipe allergy. More than 92% of patients with wipeYassociated contact allergy had their contact allergens detected by the North American Contact Dermatitis Group screening series. Conclusions: Wet wipes are an important source of contact allergy. Preservatives are the main allergens, especially isothiazolinones. [ABSTRACT FROM AUTHOR]

Published
2017
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164. Patch Test Reactions to Corticosteroids: Retrospective Analysis From the North American Contact Dermatitis Group 2007-2014.

Author

Pratt, Melanie D., Mufti, Asfandyar, Lipson, Jennifer, Warshaw, Erin M., Maibach, Howard I., Taylor, James S., Sasseville, Denis, DeKoven, Joel G., Zirwas, Matthew J., Fransway, Anthony F., Mathias, C. G. Toby, Zug, Kathryn A., DeLeo, Vincent A., Fowler Jr, Joseph F., Marks, James G., Storrs, Frances J., and Belsito, Donald V.

Abstract

Introduction: Corticosteroids may cause delayed hypersensitivity. On the basis of structure, the following 4 groups of corticosteroids are recognized: A, B, C, and D (subdivided into D1 and D2). More recently, a newer classification system subdivides corticosteroids into groups 1, 2, and 3. Cross-reactions are unpredictable. The objective of this study was to describe positive patch test and co-reaction patterns to corticosteroids. Methods and Results: A retrospective analysis of 17,978 patients patch tested by the North American Contact Dermatitis Group between 2007 and 2014 was performed. Corticosteroids tested during this period included the following: tixocortol-21-pivalate 1.0% petroleum (pet), budesonide 0.1% pet, triamcinolone acetonide 1.0% pet, desoximetasone 1.0% pet, clobetasol-17-propionate 1.0% pet, and hydrocortisone-17-butyrate (HC-17-B) 1.0% (pet and alcohol). Overall, 4.12% (n = 741) of patients had 1 or more positive reactions to corticosteroids. Tixocortol-21-pivalate positivity was the most common (2.26%), followed by budesonide (0.87%), HC-17-B (0.43%), clobetasol-17-proprionate (0.32%), and desoximetasone (0.16%). Reaction strength was strong (++ or +++) in almost twice as many tixocortol and budesonide reactions (964%) as compared with the other 3 corticosteroids (G34.5%). Of the patients with positive corticosteroid reactions (n = 741), most (70.7%) had sensitivity to only 1 corticosteroid. Co-reactivity was highest between desoximetasone and budesonide. Conclusions: Sensitivity to corticosteroids is important. Consistent with other studies, the highest frequency of corticosteroid positivity was seen in group A (tixocortol-21-pivalate), followed by group B (budesonide) and D2 (HC-17-B). Co-reactivity varied; more studies are needed to fully understand structural cross-reactivity. [ABSTRACT FROM AUTHOR]

Published
2017
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165. North American Contact Dermatitis Group Patch Test Results 2013-2014.

Author

DeKoven, Joel G., Warshaw, Erin M., Belsito, Donald V., Sasseville, Denis, Maibach, Howard I., Taylor, James S., Marks, James G., Fowler Jr, Joseph F., Mathias, C. G. Toby, DeLeo, Vince A., Pratt, Melanie D., Zirwas, Matthew J., and Zug, Kathryn A.

Abstract

Background: Patch testing is the most important diagnostic tool for the assessment of allergic contact dermatitis. Objective: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2013, to December 31, 2014. Methods: At 13 centers in North America, patients were tested in a standardized manner with a screening series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends were analyzed using &#957² test. Results: A total of 4871 patients were tested. There were 3255 patients (66.8%) who had at least 1 positive reaction and 2412 patients (49.5%) who were ultimately determined to have a primary diagnosis of allergic contact dermatitis. A total of 434 patients (8.9%) had occupationally related skin disease. There were 9726 positive allergic reactions. Compared with the previous reporting periods (2011-2012 and 2001-2012, including at least three 2-year cycles), positive reaction rates for the top 25 screening allergens statistically increased for 2 allergens: methylchloroisothiazolinone/methylisothiazolinone (6.4%; risk ratios, 1.26 [1.07-1.50] and 2.08 [1.84-2.37]) and hydroxyethyl methacrylate (2.6%; risk ratios, 1.34 [1.02-1.76] and 1.23 [1.00-1.51]). Methylisothiazolinone, which was added to the screening series for this 2013-2014 cycle, had the third highest positive reaction rate of allergens tested (10.9%). Four other newly added allergen preparations--formaldehyde2%(7%), diphenylguanidine (3.8%), propylene glycol 100%(2.8%), and benzophenone-4 (2.1%)--all had reaction rates greater than 2%. Twenty-one percent of tested patients had at least 1 relevant allergic reaction to an allergen not on the NACDGseries; 14.6%of thesewere occupationally related. The T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed one quarter to one third of reactions detected by the NACDG screening series. Conclusions: These results confirm that the epidemic of sensitivity to methylisothiazolinone previously documented in Europe is also occurring in North America. Patch testing with allergens beyond a standard screening tray is necessary for the complete evaluation of occupational and nonoccupational allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

Published
2017
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166. History of AIDS in HIV-Infected Patients Is Associated With Higher In-Hospital Mortality Following Admission for Acute Myocardial Infarction and Stroke.

Author

Okeke, Nwora Lance, Hicks, Charles B., McKellar, Mehri S., Fowler Jr, Vance G., Federspiel, Jerome J., and Fowler, Vance G Jr

Subjects
HIV-positive persons, CARDIOVASCULAR diseases risk factors, MYOCARDIAL infarction, STROKE, MORTALITY
Abstract

Background: Although human immunodeficiency virus (HIV)-infected persons are at increased risk for major cardiovascular events, short-term prognosis after these events is unclear.Methods: To determine the association between HIV infection and acute myocardial infarction (AMI) and stroke outcomes, we analyzed hospital discharge data from the Nationwide Inpatient Sample (NIS) between 2002 and 2012. Multivariable logistic regression was used to evaluate the association between HIV infection and in-hospital death after AMI or stroke.Results: Overall, 18 369 785 AMI/stroke hospitalizations were included in the analysis. Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke (odds ratio, 3.03 [95% confidence interval {CI}, 1.71-5.38] for AMI and 2.59 [95% CI, 1.97-3.41] for stroke). Additionally, patients with AIDS were more likely than HIV-uninfected patients to be discharged to nonhospital inpatient facilities after admission for AMI (OR, 3.14 [95% CI, 1.72-5.74]) or stroke (OR, 1.45; 95% CI, 1.12-1.87). There was a minimal difference in either outcome between HIV-infected patients without a history of AIDS and uninfected patients.Conclusions: Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke. This disparity was not observed when infected patients without a history of AIDS were compared to uninfected patients, implying that preserving immune function may improve cardiovascular outcomes in HIV-infected persons. [ABSTRACT FROM AUTHOR]

Published
2016
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167. CAMERA2 - combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial.

Author

Tong, Steven Y. C., Nelson, Jane, Paterson, David L., Fowler Jr., Vance G., Howden, Benjamin P., Cheng, Allen C., Chatfield, Mark, Lipman, Jeffrey, Van Hal, Sebastian, O'Sullivan, Matthew, Robinson, James O., Yahav, Dafna, Lye, David, Davis, Joshua S., Fowler, Vance G Jr, and CAMERA2 study group and the Australasian Society for Infectious Diseases Clinical Research Network

Subjects
BACTEREMIA treatment, METHICILLIN-resistant staphylococcus aureus, DRUG resistance in bacteria, VANCOMYCIN, ANTIBIOTICS, BETA lactam antibiotics, PEPTIDE antibiotics, CEFAZOLIN, OXACILLIN, CLOXACILLIN, COMBINATION drug therapy, COMPARATIVE studies, EXPERIMENTAL design, RESEARCH methodology, MEDICAL cooperation, RESEARCH protocols, METHICILLIN resistance, RESEARCH, STAPHYLOCOCCAL diseases, TIME, EVALUATION research, RANDOMIZED controlled trials, TREATMENT effectiveness, DIAGNOSIS, THERAPEUTICS
Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20-50 % 90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia.Methods/design: We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint.Discussion: Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia include their safety profile, low cost, and wide availability.Trial Registration: ClinicalTrials.gov Identifier: NCT02365493 . Registered 24 February 2015. [ABSTRACT FROM AUTHOR]

Published
2016
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173. Heterogeneous Vancomycin‐Intermediate Susceptibility Phenotype in Bloodstream Methicillin‐ResistantStaphylococcus aureusIsolates from an International Cohort of Patients with Infective Endocarditis: Prevalence, Genotype, and Clinical Significance

Author

Bae, In‐Gyu, primary, Federspiel, Jerome J., additional, Miró, José M., additional, Woods, Christopher W., additional, Park, Lawrence, additional, Rybak, Michael J., additional, Rude, Thomas H., additional, Bradley, Suzanne, additional, Bukovski, Suzana, additional, de la Maria, Cristina Garcia, additional, Kanj, Souha S., additional, Korman, Tony M., additional, Marco, Francesc, additional, Murdoch, David R., additional, Plesiat, Patrick, additional, Rodriguez‐Creixems, Marta, additional, Reinbott, Porl, additional, Steed, Lisa, additional, Tattevin, Pierre, additional, Tripodi, Marie‐Françoise, additional, Newton, Karly L., additional, Corey, G. Ralph, additional, and Fowler Jr, Vance G., additional

Published
2009
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174. Reply to Bruss

Author

Cosgrove, Sara E., primary, Fowler, Jr, Vance G., additional, Corey, G. Ralph, additional, Karchmer, Adolf W., additional, and Boucher, Helen W., additional

Published
2009
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176. Initial Low‐Dose Gentamicin forStaphylococcus aureusBacteremia and Endocarditis Is Nephrotoxic

Author

Cosgrove, Sara E., primary, Vigliani, Gloria A., additional, Campion, Marilyn, additional, Fowler, Jr., Vance G., additional, Abrutyn, Elias, additional, Corey, G. Ralph, additional, Levine, Donald P., additional, Rupp, Mark E., additional, Chambers, Henry F., additional, Karchmer, Adolf W., additional, and Boucher, Helen W., additional

Published
2009
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179. Expression of Antimicrobial Peptides in the Normal and Involved Skin of Patients with Infective Cellulitis

Author

Stryjewski, Martin E., primary, Hall, Russell P., additional, Chu, Vivian H., additional, Kanafani, Zeina A., additional, O’Riordan, William D., additional, Weinstock, Michael S., additional, Stienecker, R. Scott, additional, Streilein, Robert, additional, Dorschner, Robert A., additional, Fowler, Jr., Vance G., additional, Corey, G. Ralph, additional, and Gallo, Richard L., additional

Published
2007
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180. Pseudomonas aeruginosa Bacteremic Patients Exhibit Nonprotective Antibody Titers Against Therapeutic Antibody Targets PcrV and Psl Exopolysaccharide.

Author

Thaden, Joshua T., Keller, Ashley E., Shire, Norah J., Margarita Camara, M., Otterson, Linda, Huband, Mike, Guenther, Caitlin M., Wei Zhao, Warrener, Paul, Kendall Stover, C., Fowler Jr, Vance G., DiGiandomenico, Antonio, Camara, M Margarita, Zhao, Wei, Stover, C Kendall, and Fowler, Vance G Jr

Subjects
PSEUDOMONAS aeruginosa infections, BISPECIFIC antibodies, IMMUNOGLOBULIN G, BACTEREMIA, MONOCLONAL antibodies, MICROBIAL exopolysaccharides, ANTIBIOTICS, BACTERIAL antigens, IMMUNITY, IMMUNOGLOBULINS, LONGITUDINAL method, MICROBIAL sensitivity tests, PHAGOCYTOSIS, PSEUDOMONAS, PSEUDOMONAS diseases, BACTERIAL antibodies, PHARMACODYNAMICS
Abstract

Background: The type 3 secretion protein PcrV and Psl exopolysaccharide are promising therapeutic antibody targets against Pseudomonas aeruginosa. We examined P. aeruginosa bloodstream infection (BSI) isolates for the ability to express PcrV and Psl and evaluated corresponding patient serum for active titers to these targets. Methods: We identified 114 patients with acute P. aeruginosa BSI; 56 cases were accompanied by acute sera. Serum was evaluated for PcrV- and Psl-specific immunoglobulin G (IgG) and for cytotoxicity and opsonophagocytosis. Isolates were evaluated for susceptibility to antibiotics, expression of PcrV and Psl, and susceptibility to the anti-PcrV/Psl bispecific antibody and clinical candidate MEDI3902. Results: In-hospital mortality for patients with P. aeruginosa BSI was 39%. A total of 26% of isolates were resistant to ≥3 antibiotic classes. Although PcrV and/or Psl were detected in 99% of isolates, a majority of patients lacked active titers to PcrV (100%) and Psl (98%). In addition, MEDI3902 was active against all tested isolates. Conclusions: A vast majority of P. aeruginosa BSI isolates express PcrV and Psl; however, patient sera most often lacked IgG and functionally active responses to these targets. These results suggest that therapies directed at PcrV and Psl could be a promising approach for combating P. aeruginosa bloodstream infections. [ABSTRACT FROM AUTHOR]

Published
2016
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181. Rapid Molecular Diagnostics, Antibiotic Treatment Decisions, and Developing Approaches to Inform Empiric Therapy: PRIMERS I and II.

Author

Evans, Scott R., Hujer, Andrea M., Hongyu Jiang, Hujer, Kristine M., Hall, Thomas, Marzan, Christine, Jacobs, Michael R., Sampath, Rangarajan, Ecker, David J., Manca, Claudia, Chavda, Kalyan, Pan Zhang, Fernandez, Helen, Liang Chen, Mediavilla, Jose R., Hill, Carol B., Perez, Federico, Caliendo, Angela M., Fowler Jr, Vance G., and Chambers, Henry F.

Subjects
EMPIRICAL medicine, MOLECULAR diagnosis, ANTIBIOTICS, DISEASE susceptibility, MEDICAL decision making
Abstract

Background: Rapid molecular diagnostic (RMD) platforms may lead to better antibiotic use. Our objective was to develop analytical strategies to enhance the interpretation of RMDs for clinicians. Methods: We compared the performance characteristics of 4 RMD platforms for detecting resistance against β-lactams in 72 highly resistant isolates of Escherichia coli and Klebsiella pneumoniae (PRIMERS I). Subsequently, 2 platforms were used in a blinded study in which a heterogeneous collection of 196 isolates of E. coli and K. pneumoniae (PRIMERS II) were examined. We evaluated the genotypic results as predictors of resistance or susceptibility against β-lactam antibiotics. We designed analytical strategies and graphical representations of platform performance, including discrimination summary plots and susceptibility and resistance predictive values, that are readily interpretable by practitioners to inform decision-making. Results: In PRIMERS I, the 4 RMD platforms detected β-lactamase (bla) genes and identified susceptibility or resistance in >95% of cases. In PRIMERS II, the 2 platforms identified susceptibility against extended-spectrum cephalosporins and carbapenems in >90% of cases; however, against piperacillin/tazobactam, susceptibility was identified in <80% of cases. Applying the analytical strategies to a population with 15% prevalence of ceftazidime-resistance and 5% imipenem-resistance, RMD platforms predicted susceptibility in >95% of cases, while prediction of resistance was 69%-73% for ceftazidime and 41%-50% for imipenem. Conclusions: RMD platforms can help inform empiric β-lactam therapy in cases where bla genes are not detected and the prevalence of resistance is known. Our analysis is a first step in bridging the gap between RMDs and empiric treatment decisions. [ABSTRACT FROM AUTHOR]

Published
2016
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184. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.

Author

Baddour, Larry M., Wilson, Walter R., Bayer, Arnold S., Fowler, Jr, Vance G., Tleyjeh, Imad M., Rybak, Michael J., Barsic, Bruno, Lockhart, Peter B., Gewitz, Michael H., Levison, Matthew E., Bolger, Ann F., Steckelberg, James M., Baltimore, Robert S., Fink, Anne M., O'Gara, Patrick, Taubert, Kathryn A., Fowler, Vance G Jr, and American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council

Published
2015
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185. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.

Author

Lantos, Paul M., Nigrovic, Lise E., Auwaerter, Paul G., Fowler Jr., Vance G., Ruffin, Felicia, Brinkerhoff, R. Jory, Reber, Jodi, Williams, Carl, Broyhill, James, Pan, William K., and Gaines, David N.

Subjects
LYME disease, ENDEMIC diseases, GEOGRAPHIC information systems
Abstract

Background. The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods. We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results. There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions. The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years. [ABSTRACT FROM AUTHOR]

Published
2015
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187. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

Author

Evans, Scott R., Rubin, Daniel, Follmann, Dean, Pennello, Gene, Huskins, W. Charles, Powers, John H., Schoenfeld, David, Chuang-Stein, Christy, Cosgrove, Sara E., Fowler Jr, Vance G., Lautenbach, Ebbing, and Chambers, Henry F.

Subjects
ANTIBIOTICS, HEALTH outcome assessment, ADVERSE health care events, URINARY tract infections, CLOSTRIDIOIDES difficile, TREATMENT duration
Abstract

Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use. [ABSTRACT FROM AUTHOR]

Published
2015
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189. Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis.

Author

Lauridsen, Trine K., Park, Lawrence, Tong, Steven Y. C., Selton-Suty, Christine, Peterson, Gail, Cecchi, Enrico, Afonso, Luis, Habib, Gilbert, Paré, Carlos, Tamin, Syahidah, Dickerman, Stuart, Bayer, Arnold S., Johansson, Magnus C., Chu, Vivian H., Samad, Zainab, Bruun, Niels E., Fowler Jr, Vance G., and Crowley, Anna Lisa

Abstract

Background -- Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. Methods and Results -- Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality. Conclusions -- S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality. [ABSTRACT FROM AUTHOR]

Published
2015
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190. Potential Influence of Staphylococcus aureus Clonal Complex 30 Genotype and Transcriptome on Hematogenous Infections.

Author

Sharma-Kuinkel, Batu K., Mongodin, Emmanuel F., Myers, Jason R., Vore, Kelly L., Canfield, Greg S., Fraser, Claire M., Rude, Thomas H., Fowler Jr, Vance G., and Gill, Steven R.

Subjects
METHICILLIN-resistant staphylococcus aureus, GENOTYPES, SINGLE nucleotide polymorphisms
Abstract

Background. The contemporary Staphylococcus aureus clonal complex (CC) 30 lineage is associated with complicated infections, including endocarditis and osteomyelitis. This lineage diverged from the phage-type 80/81 S aureus clone responsible for a major bacterial epidemic of the 20th century. The genome and transcriptome features that contribute to complicated infections of the CC30 lineage are unknown. Methods. Twenty-nine clinical methicillin-resistant S aureus (MRSA) strains (8 from CC30 and 21 from other major CCs were evaluated for virulence using murine and Galleria mellonella sepsis models. Genomic features of CC30 were identified by comparative genome sequencing and RNA-Seq transcriptome analysis of the 29 strains and 31 previously sequenced S aureus genomes. Results. The CC30 isolates displayed lower virulence in the sepsis models compared with other CCs [P < .0001]. Comparisons of orthologous proteins and transcriptome analysis identified genes (eg, nitric oxide reductase) and changes in metabolic pathways (eg, pyrimidine metabolism) that contribute to the distinct CC30 phenotype. Previously reported nonsynonymous single-nucleotide polymorphisms (SNPs) were found in accessory gene regulator C (agrC) and α-hemolysin (hla), molecules important for virulence. Additional nonsynonymous SNPs conserved across clinical CC30 isolates when compared with the first sequenced contemporary CC30 clone, MRSA-16, were identified in multiple genes, suggesting continuing evolutionary divergence in this lineage. Conclusions. Genomic and transcriptional analyses suggest that the CC30 lineage has acquired metabolic features that contribute to persistent and complicated infections. Absence of sepsis-induced mortality in animal models may be due in part to its unique genomic profile and suggests that specific genotypes of S aureus elicit distinct types of infection types. [ABSTRACT FROM AUTHOR]

Published
2015
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193. Impact of therapy and strain type on outcomes in urinary tract infections caused by carbapenem-resistant Klebsiella pneumoniae.

Author

van Duin, David, Cober, Eric, Richter, Sandra S., Perez, Federico, Kalayjian, Robert C., Salata, Robert A., Evans, Scott, Fowler Jr, Vance G., Kaye, Keith S., and Bonomo, Robert A.

Subjects
KLEBSIELLA pneumoniae, CARBAPANEMS, DRUG resistance in bacteria, URINARY tract infection treatment, BACTERIURIA, UNIVARIATE analysis, MULTIVARIATE analysis
Abstract

Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an important healthcare-associated pathogen. We evaluated the impact of CRKP strain type and treatment on outcomes of patients with CRKP bacteriuria. Patients and Methods: Physician-diagnosed CRKP urinary tract infection (UTI)--defined as those patients who received directed treatment for CRKP bacteriuria--was studied in the multicentre, prospective Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle) cohort. Strain typing by repetitive extragenic palindromic PCR (rep-PCR) was performed. Outcomes were classified as failure, indeterminate or success. Univariate and multivariate ordinal analyses to evaluate the associations between outcome, treatment and strain type were followed by binomial analyses. Results: One-hundred-and-fifty-seven patients with physician-diagnosed CRKP UTI were included. After adjustment for CDC/National Healthcare Safety Network (NHSN)-defined UTI, critical illness and receipt of more than one active antibiotic, patients treated with aminoglycosides were less likely to fail therapy [adjusted OR (aOR) for failure 0.34, 95% CI 0.15-0.73, P=0.0049]. In contrast, patients treated with tigecycline were more likely to fail therapy (aOR for failure 2.29, 95% CI 1.03-5.13, P=0.0425). Strain type data were analysed for 55 patients. The predominant clades were ST258A (n=18, 33%) and ST258B (n=26, 47%). After adjustment for CDC/NHSN-defined UTI and use of tigecycline and aminoglycosides, infection with strain type ST258A was associated with clinical outcome in ordinal analysis (P=0.0343). In multivariate binomial models, strain type ST258A was associated with clinical failure (aOR for failure 5.82, 95% CI 1.47-28.50, P=0.0113). Conclusions In this nested cohort study of physician-diagnosed CRKP UTI, both choice of treatment and CRKP strain type appeared to impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

Published
2015
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195. Persistent Bacteremia Due to Methicillin‐ResistantStaphylococcus aureusInfection Is Associated withagrDysfunction and Low‐Level In Vitro Resistance to Thrombin‐Induced Platelet Microbicidal Protein

Author

Fowler, Jr., Vance G., primary, Sakoulas, George, additional, McIntyre, Lauren M., additional, Meka, Venkata G., additional, Arbeit, Robert D., additional, Cabell, Christopher H., additional, Stryjewski, Martin E., additional, Eliopoulos, George M., additional, Reller, L. Barth, additional, Corey, G. Ralph, additional, Jones, Tiffanny, additional, Lucindo, Natalie, additional, Yeaman, Michael R., additional, and Bayer, Arnold S., additional

Published
2004
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196. Candida Endocarditis: Contemporary Cases from the International Collaboration of Infectious Endocarditis Merged Database (ICE-MD)

Author

Benjamin, Jr, Daniel K., primary, Miro, Jose M., additional, Hoen, Bruno, additional, Steinbach, William J., additional, Fowler Jr, Vance G., additional, Olaison, Lars, additional, Habib, Gilbert, additional, Abrutyn, Elias, additional, Perfect, John, additional, Zass, Amy, additional, Corey, G. Ralph, additional, Eykyn, Susannah, additional, Thuny, Franck, additional, Jiménez-expósito, María-jesús, additional, Cabell, Christopher H., additional, and Group, the Ice-md Study, additional

Published
2004
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198. Photodynamic Therapy With Aminolevulinic Acid Topical Solution andVisible Blue Light in the Treatment of Multiple Actinic Keratoses of the Faceand Scalp

Author

Piacquadio, Daniel J., primary, Chen, Diana M., additional, Farber, Harold F., additional, Fowler, Jr, Joseph F., additional, Glazer, Scott D., additional, Goodman, J. John, additional, Hruza, Luciann L., additional, Jeffes, Edward W. B., additional, Ling, Mark R., additional, Phillips, Tania J., additional, Rallis, Tena M., additional, Scher, Richard K., additional, Taylor, Charles R., additional, and Weinstein, Gerald David, additional

Published
2004
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