64 results on '"Marion Hemmersbach-Miller"'
Search Results
2. Human Rickettsia felis Infection, Canary Islands, Spain
- Author
-
Jose-Luis Pérez-Arellano, Florence Fenollar, Alfonso Angel-Moreno, Margarita Bolaños, Michele Hernández, Evora Santana, Marion Hemmersbach-Miller, Antonio-M Martín, and Didier Raoult
- Subjects
Rickettsia felis ,human infection ,fleas ,Western-Blot serology ,Canary Island ,Spain ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We report the first cases of human infection by Rickettsia felis in the Canary Islands. Antibodies against R. felis were found in 5 adsorbed serum samples from 44 patients with clinically suspected rickettsiosis by Western blot serology. Fleas from 1 patient's dog were positive for R. felis by polymerase chain reaction. more...
- Published
- 2005
- Full Text
- View/download PDF
Catalog
3. Cardiac Device Infections due to Mycobacterium fortuitum
- Author
-
Marion Hemmersbach-miller, Miguel A Cardenes-Santana, Alicia Conde-Martel, José A Bolanos-Guerra, and María I Campos-Herrero
- Subjects
Infectious and parasitic diseases ,RC109-216 ,Microbiology ,QR1-502 - Abstract
Two cases of cardiac device infection due to Mycobacterium fortuitum are reported along with a discussion of their clinical management. Long-term therapy and removal of the infected device is needed. The slow progression and absence of systemic signs and symptoms suggest a low pathogenicity of M fortuitum. more...
- Published
- 2005
- Full Text
- View/download PDF
4. Human Oestrus sp. Infection, Canary Islands
- Author
-
Marion Hemmersbach-Miller, Rita Sánchez-Andrade, Alicia Domínguez-Coello, Adnan Hawari Meilud, Adolfo Paz-Silva, Cristina Carranza, and Jose-Luis Pérez-Arellano
- Subjects
Oestrus ,eosinophilia ,serologic diagnosis ,letter ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2007
- Full Text
- View/download PDF
5. Population Pharmacokinetics of Piperacillin/Tazobactam across the Adult Lifespan
- Author
-
Marion Hemmersbach-Miller, Stephen J. Balevic, Patricia L. Winokur, Cornelia B. Landersdorfer, Kenan Gu, Austin W. Chan, Michael Cohen-Wolkowiez, Thomas Conrad, Guohua An, Carl M. J. Kirkpatrick, Geeta K. Swamy, Emmanuel B. Walter, and Kenneth E. Schmader more...
- Subjects
Pharmacology ,Pharmacology (medical) ,Article - Abstract
BACKGROUND: Piperacillin/tazobactam is one of the most frequently used antimicrobials in older adults. INTRODUCTION: Using an opportunistic study design we evaluated the pharmacokinetics (PK) of piperacillin/tazobactam as a probe drug to evaluate changes in antibacterial drug exposure and dosing requirements, including in older adults. METHODS: A total of 121 adult patients were included. The population PK models that best characterized the observed plasma concentrations of piperacillin and tazobactam were one-compartment structural models with zero-order input and linear elimination. RESULTS: Among all potential covariates, estimated creatinine clearance had the most substantial impact on the elimination clearance for both piperacillin and tazobactam. After accounting for renal function and body size, there was no remaining impact of frailty on the PK of piperacillin and tazobactam. Monte Carlo simulations indicated that renal function had a greater impact on the therapeutic target attainment than age, although these covariates were highly correlated. Frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale, was assessed in 60 patients who were ≥65 years of age. CONCLUSION: The simulations suggested that adults ≤50 years of age infected with organisms with higher minimum inhibitory concentrations (MICs) may benefit from continuous piperacillin/tazobactam infusions (12 g/day of piperacillin component) or extended infusions of 4 g every 8 hours. However, for a target of 50% fT>MIC, dosing based on renal function is generally preferable to dosing by age, and simulations suggested that patients with creatinine clearance ≥120 mL/min may benefit from infusions of 4 g every 8 hours for organisms with higher MICs. more...
- Published
- 2023
6. C4 article: Implications of COVID-19 in transplantation
- Author
-
Daniel E. Dulek, Michael G. Ison, Cristiano Amarelli, Atul Humar, Emily A. Blumberg, Maria Irene Bellini, Crystal Truax, Rebecca Pellett Madan, Ekamol Tantisattamo, Marwan M. Azar, Neeraj Singh, Camilla W. Nonterah, Santiago M.C. Lopez, Deepali Kumar, Lara Danziger-Isakov, Lilian M. Abbo, Nicole Theodoropoulos, Annelise Nolan, Marion Hemmersbach-Miller, Felipe Alconchel, Gustavo Fernandes Ferreira, Melissa A. Greenwald, Emmanouil Giorgakis, Alessandro Gambella, James R. Rodrigue, Kenneth J. Woodside, Michelle T Jesse, Jonathan Hand, Patti Niles, Valerie Demekhin, Wendy Balliet, Benito Valdepenas, Kristina L. Goff, Naoka Murakami, Armelle Perez Cortes Villalobos, Benjamin A. Miko, Melissa R. Gitman, Justin G. Aaron, Amany Sholkamy, Monica I. Ardura, Nicole A. Pilch, Kristin Kronsnoble, Andrés Jaramillo, Scott G. Westphal, Krista L. Lentine, Jamil Azzi, John W Baddley, Camille N. Kotton, Dhruva Sharma, Shweta Anjan, Mia Schmiedeskamp-Rahe, Sumit Mohan, Jeong M. Park, Yasemin Tezer, Lisa M. Potter, Heather Bruschwein, James A. Blumenthal, Michael Green, Ricardo M. La Hoz, Marcus R. Pereira, and Deborah Verran more...
- Subjects
infection and infectious agents ,medicine.medical_specialty ,infection and infectious agents - viral ,Tissue and Organ Procurement ,Coronavirus disease 2019 (COVID-19) ,infectious disease ,clinical research/practice ,Dexamethasone ,Humans ,Immunology and Allergy ,Medicine ,organ transplantation in general ,Pharmacology (medical) ,Child ,Intensive care medicine ,Transplantation ,business.industry ,infection and infectious agents – viral ,COVID-19 ,Original Articles ,Organ Transplantation ,Tissue Donors ,Clinical research/practice ,viral ,Infectious disease (medical specialty) ,COVID-19 Nucleic Acid Testing ,Original Article ,business - Abstract
A novel coronavirus has had global impact on individual health and health care delivery. In this C4 article, contributors discuss various aspects of transplantation including donor and recipient screening, management of infected patients, and prevention of coronavirus disease (COVID). Donor screening with SARS-CoV-2 nucleic acid testing (NAT) close to the time of procurement is recommended. Many programs are also screening all potential recipients at the time of admission. The management of COVID has evolved with remdesivir emerging as a new potential option for transplant recipients. Dexamethasone has also shown promise and convalescent plasma is under study. Prevention strategies for transplant candidates and recipients are paramount. Pediatric-specific issues are also discussed. Strategies for the psychological well-being of patients and providers are also imperative, in addition to future research priorities for transplantation. more...
- Published
- 2021
- Full Text
- View/download PDF
7. Prescribing rates and characteristics of recipients of tenofovir-containing regimens before and after market entry of tenofovir alafenamide
- Author
-
Matthew R. Sinclair, Daniel L. Edmonston, Anna Hung, Christina M. Wyatt, and Marion Hemmersbach-Miller
- Subjects
Oncology ,medicine.medical_specialty ,Alanine ,Tenofovir ,Anti-HIV Agents ,United States Food and Drug Administration ,business.industry ,Health Policy ,Pharmaceutical Science ,HIV Infections ,Comorbidity ,Pharmacy ,Antiviral Agents ,Tenofovir alafenamide ,United States ,Article ,Clinical trial ,Internal medicine ,medicine ,Humans ,Practice Patterns, Physicians' ,business ,Drug Approval ,medicine.drug - Abstract
BACKGROUND: Tenofovir alafenamide (TAF) is a new formulation of tenofovir disoproxil fumarate (TDF) that was approved in 2015. While clinical trial evidence suggests that TAF has more favorable outcomes related to kidney injury and loss of bone mineral density, TAF also leads to higher lipid levels compared to TDF. OBJECTIVE: To determine prescribing rates of TDF and TAF among new recipients from 2014 to 2018 in a large academic health system, and compare baseline patient characteristics of those newly prescribed TDF versus TAF before and after the approval of TAF in November 2015. METHODS: Electronic health record data were used to identify new recipients of TDF or TAF from 2014 to 2018 and describe their total monthly TDF and TAF prescriptions by indication. Patient characteristics were compared among new recipients of TDF before November 2015, new recipients of TDF after November 2015, and new recipients of TAF. RESULTS: Monthly TAF prescribing rates increased to match TDF prescribing rates by April 2018 (82 versus 88 prescriptions per month). TAF recipients and new recipients of TDF before November 2015 had similar racial distributions; both of these groups were more likely to be Black compared to new recipients of TDF after November 2015 (55% and 53% versus 37%; p more...
- Published
- 2020
- Full Text
- View/download PDF
8. Delayed mortality among solid organ transplant recipients hospitalized for COVID-19
- Author
-
Madeleine R, Heldman, Olivia S, Kates, Kassem, Safa, Camille N, Kotton, Ashrit, Multani, Sarah J, Georgia, Julie M, Steinbrink, Barbara D, Alexander, Emily A, Blumberg, Brandy, Haydel, Vagish, Hemmige, Marion, Hemmersbach-Miller, Ricardo M, La Hoz, Lisset, Moni, Yesabeli, Condor, Sandra, Flores, Carlos G, Munoz, Juan, Guitierrez, Esther I, Diaz, Daniela, Diaz, Rodrigo, Vianna, Giselle, Guerra, Matthias, Loebe, Julie M, Yabu, Kailey Hughes, Kramer, Sajal D, Tanna, Michael G, Ison, Robert M, Rakita, Maricar, Malinis, Marwan M, Azar, Margaret E, McCort, Pooja P, Singh, Arzu, Velioglu, Sapna A, Mehta, David, van Duin, Jason D, Goldman, Erika D, Lease, Anna, Wald, Ajit P, Limaye, Cynthia E, Fisher, and Heldman M. R., Kates O. S., Safa K., Kotton C. N., Multani A., Georgia S. J., Steinbrink J. M., Alexander B. D., Blumberg E. A., Haydel B., et al. more...
- Subjects
Microbiology (medical) ,Infectious Diseases - Abstract
Introduction Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. Methods We used data from a multicenter registry to calculate mortality by 90 days following initial SARS-CoV-2 detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional-hazards models to compare risk factors for death by days 28 and 90. Results Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19: 190 of 936 (20%) died by 28 days and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included: age > 65 years [aHR 1.8 (1.3-2.4), p = Conclusions In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment more...
- Published
- 2022
- Full Text
- View/download PDF
9. Histoplasmosis in Liver Transplant Recipients: Case Reports and a Review of the Literature
- Author
-
Udit Dhal, Amy Spallone, Laila Woc-Colburn, and Marion Hemmersbach-Miller
- Subjects
Mechanical ventilation ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Itraconazole ,medicine.medical_treatment ,Colonoscopy ,medicine.disease ,Histoplasmosis ,Surgery ,Transplantation ,surgical procedures, operative ,Epidemiology ,Extracorporeal membrane oxygenation ,Medicine ,Colonic Ulcer ,business ,medicine.drug - Abstract
We report two cases of histoplasmosis in orthotopic liver transplant (OLT) recipients to illustrate the variable presentations, complications encountered during treatment, the spectrum of diagnostic modalities, and case outcomes. Case 1 describes the insidious presentation of presumed gastrointestinal histoplasmosis 12 years after OLT, which was defined by months of intermittent diarrhea and focal colonic disease on colonoscopy. A diagnosis of Histoplasma capsulatum was ultimately made by broad range PCR performed on colonic tissue. Due to the patient’s inability to tolerate itraconazole, treatment consisted of two weeks of liposomal amphotericin B with resolution of colonic ulcers on follow-up colonoscopy. Case 2 illustrates a case of severe pulmonary histoplasmosis with dissemination in an OLT recipient one year after transplantation. Treatment was complicated by the development of acute respiratory distress syndrome requiring mechanical ventilation and hemodynamic shock requiring extracorporeal membrane oxygenation therapy. A review of the literature on histoplasmosis in OLT recipients accompanies our cases and emphasizes the epidemiology, clinical manifestations, diagnosis, treatment, and prevention. more...
- Published
- 2020
- Full Text
- View/download PDF
10. Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus–positive kidney transplant recipient
- Author
-
Carl F. Pieper, Barbara D. Alexander, Kenneth E. Schmader, and Marion Hemmersbach-Miller
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Congenital cytomegalovirus infection ,Cytomegalovirus ,Viremia ,Comorbidity ,Serogroup ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Outcome Assessment, Health Care ,Humans ,Medicine ,030212 general & internal medicine ,Risk factor ,Kidney transplantation ,Aged ,Aged, 80 and over ,First episode ,Thymoglobulin ,business.industry ,Age Factors ,Disease Management ,virus diseases ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Kidney Transplantation ,Infectious Diseases ,Cytomegalovirus Infections ,Cohort ,Female ,Virus Activation ,business ,Serostatus - Abstract
PURPOSE: Evaluate risk factors for cytomegalovirus (CMV) reactivation during the first year after kidney transplantation in the CMV seropositive older recipient. METHODS: Retrospective single-center study. RESULTS: Between 2011-2015, 91 patients ≥65 years received a kidney transplant; these were matched with 91 controls, aged 40-60. Risk of CMV reactivation in the CMV seropositive recipients was analyzed. Sixty-three older and 54 younger recipients were included; 50% had received CMV-directed prophylaxis. CMV reactivation was significantly more frequent in the older group (71.4% vs 44.4%, p=0.003) and occurred earlier (p=0.003). A multivariate model showed that only age was associated with CMV reactivation (OR 2.48, p=0.03). After excluding patients that received thymoglobulin, older age group remained the only risk factor of CMV reactivation (OR 3.81, p=0.014). Recurrent event analysis showed that the older cohort had an HR of 1.94 (p=0.01) of CMV viremia; there was significant episode-cohort interaction (p more...
- Published
- 2019
- Full Text
- View/download PDF
11. COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study
- Author
-
Carlos G. Munoz, Sarah J. Georgia, Adrienne Maximin, David van Duin, Omer E. Beaird, Barbara D. Alexander, Camille N. Kotton, Michael G. Ison, Ashrit Multani, Sapna A. Mehta, Rade Tomic, Maria M. Crespo, Zohra S Chaudhry, Daniela Diaz, Kailey Hughes, Yesabeli Condor, Maricar Malinis, Reda E. Girgis, Cynthia E. Fisher, Julie M Yabu, Sajal D Tanna, Madeleine R. Heldman, Julie M Steinbrink, Marwan M. Azar, Juan Guitierrez, Kassem Safa, Sameep Sehgal, Erika D. Lease, Dana Weisshaar, Olivia S Kates, Marion Hemmersbach-Miller, Esther I. Diaz, Carlene Gilbert, Ariella Candace Derenge, Margaret E McCort, Pooja Singh, Robert M. Rakita, Jason D Goldman, Joanna Nelson, Rodrigo Vianna, Vagish Hemmige, Arzu Velioglu, Matthias Loebe, Emily A. Blumberg, Jose A. Morillis, Ajit P. Limaye, Ricardo M. La Hoz, Sandra Flores, Giselle Guerra, Brandy Haydel, Angelica Lewis, Lisset Moni, Heldman, Madeleine R., Kates, Olivia S., Safa, Kassem, Kotton, Camille N., Georgia, Sarah J., Steinbrink, Julie M., Alexander, Barbara D., Hemmersbach-Miller, Marion, Blumberg, Emily A., Crespo, Maria M., Multani, Ashrit, Lewis, Angelica, V, Beaird, Omer Eugene, Haydel, Brandy, La Hoz, Ricardo M., Moni, Lisset, Condor, Yesabeli, Flores, Sandra, Munoz, Carlos G., Guitierrez, Juan, Diaz, Esther, I, Diaz, Daniela, Vianna, Rodrigo, Guerra, Giselle, Loebe, Matthias, Rakita, Robert M., Malinis, Maricar, Azar, Marwan M., Hemmige, Vagish, McCort, Margaret E., Chaudhry, Zohra S., Singh, Pooja, Hughes, Kailey, Velioglu, Arzu, Yabu, Julie M., Morillis, Jose A., Mehta, Sapna A., Tanna, Sajal D., Ison, Michael G., Tomic, Rade, Derenge, Ariella Candace, van Duin, David, Maximin, Adrienne, Gilbert, Carlene, Goldman, Jason D., Sehgal, Sameep, Weisshaar, Dana, Girgis, Reda E., Nelson, Joanna, Lease, Erika D., Limaye, Ajit P., and Fisher, Cynthia E. more...
- Subjects
Adult ,medicine.medical_specialty ,infection and infectious agents ,lung disease ,Coronavirus disease 2019 (COVID-19) ,viruses ,infectious disease ,Logistic regression ,Article ,Cohort Studies ,Internal medicine ,medicine ,lung transplantation ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,organ transplantation in general ,Lung ,pulmonology ,Aged ,Transplantation ,dysfunction ,business.industry ,SARS-CoV-2 ,COVID-19 ,Organ Transplantation ,medicine.disease ,Obesity ,Transplant Recipients ,practice ,lung (allograft) function ,infectious ,medicine.anatomical_structure ,clinical research ,Heart failure ,business ,Solid organ transplantation ,Cohort study ,viral - Abstract
Lung transplant recipients (LTR) with Covid-19 may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with Covid-19 to compare mortality by 28-days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with Covid-19, 1,051 (65%) were hospitalized including 117/159 (74%) LTR and 934/1457 (64%) non-lung SOTR (p=0.02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p=0.035) and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p=0.05). Among LTR, independent risk factors for mortality included single lung transplant (aOR 2.8, 95% CI 1.0-7.7, p=0.04) and chronic lung allograft dysfunction (aOR 3.6, 95% CI 1.0-12.4, p=0.05), but not age >65 years, heart failure, or obesity. Among SOTR hospitalized for Covid-19, LTR had higher mortality than non-lung SOTR. In LTR, single lung transplant and chronic allograft dysfunction were independently associated with mortality. more...
- Published
- 2021
12. Outcomes of Novel Coronavirus 2019 in Solid Organ Transplant Recipients: Yet Again, Race Matters
- Author
-
N. Thao N. Galvan, John A. Goss, Matthew Goss, Abbas Rana, Marion Hemmersbach-Miller, Nicolas F. Moreno, and Chun-Sing Huang
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Population ,Immunosuppression ,Disease ,Transplantation ,Vaccination ,Internal medicine ,Cohort ,Pandemic ,medicine ,education ,business ,Socioeconomic status - Abstract
Background: The Coronavirus 2019 pandemic has posed a particular challenge for transplant programs across the world as little was understood regarding how the virus would affect immunocompromised hosts. In addition it was unclear if race and socioeconomic status affected hospitalization rates. Methods: We describe a cohort of 25 solid organ transplant recipients (SOTR) within a single-center who were subsequently hospitalized for COVID-19 infection. In addition, we compared baseline characteristics of our cohort with all of our transplants from 1/2/2015 until 11/5/2020. Results: Transplant recipients infected with COVID-19 have many comorbidities (96% with hypertension, 60% with heart failure or ischemic heart disease, and 60% with diabetes). Overall SOTR patients frequently presented with AKI (44%), frequently required ICU stay (52%), and frequently required intubation (36%). We discovered a statistically significant racial disparity in COVID-19 infection in minorities within our cohort compared to our baseline transplant recipient population. Conclusion: Transplant recipients tended to have more atypical symptoms such as diarrhea and tolerated a stepwise reduction of immunosuppression. Solid organ transplant recipients - particularly minorities and low income patients-may benefit from additional COVID-19 precautions such as earlier access to vaccination. [ABSTRACT FROM AUTHOR] Copyright of Trends in Transplantation is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...
- Published
- 2021
- Full Text
- View/download PDF
13. Healthcare resource use among solid organ transplant recipients hospitalized with COVID‐19
- Author
-
Cynthia E. Fisher, Maricar Malinis, Jose A Morillas, Marwan M. Azar, Sander Florman, Sajal D Tanna, Madeleine R. Heldman, Erika D. Lease, Michael G. Ison, Marion Hemmersbach-Miller, Rachel J. Friedman-Moraco, Kassem Safa, Jason D Goldman, Aneela Majeed, Afrah S Sait, Henry J Neumann, Behdad Besharatian, Carlos Ortiz-Bautista, Meenakshi Rana, Robert M. Rakita, Mario Spaggiari, Sapna A. Mehta, Sameep Sehgal, Mayur Ramesh, Olivia S Kates, Zohra S Chaudhry, Margaret E McCort, Emily A. Blumberg, Camille N. Kotton, Brandy Haydel, Valida Bajrovic, Vagish Hemmige, Anuradha Lala, Abbasali Badami, Amy Jeng, and Ajit P. Limaye more...
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Transplantation ,Inpatients ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,COVID-19 ,Organ Transplantation ,medicine.disease_cause ,Letter to the Editors ,Transplant Recipients ,United States ,Health care ,medicine ,Resource use ,Health Resources ,Humans ,Solid organ transplantation ,business ,Intensive care medicine ,Letter to the Editor ,Pandemics ,Coronavirus - Published
- 2020
14. Donor evaluation in the era of HIV-positive organ transplantation. The importance of the Infectious Diseases specialist
- Author
-
Marion Hemmersbach-Miller, Robert P. Wood, and Cameron R. Wolfe
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Human immunodeficiency virus (HIV) ,virus diseases ,Disease ,030230 surgery ,medicine.disease_cause ,Kidney transplant ,Organ transplantation ,Article ,03 medical and health sciences ,Organ procurement ,0302 clinical medicine ,Infectious disease (medical specialty) ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,DONOR EVALUATION ,Intensive care medicine ,business - Abstract
A 61-year-old female with well-controlled human immunodeficiency virus (HIV) and end-stage renal disease was on the kidney transplant waitlist awaiting an organ offer, including from HIV-positive donors through the HIV Organ Policy Equity (HOPE) Act. We present three different scenarios where HIV-positive donor offers were evaluated for this one recipient, discuss the donor evaluation process, explain where the infectious diseases provider fits in this scheme, and describe the challenges encountered by organ procurement organizations. This is the first case under the HOPE Act at our center where discovery of an HIV-specific issue led to a turndown of an organ offer. more...
- Published
- 2020
15. Single-center analysis of infectious complications in older adults during the first year after kidney transplantation
- Author
-
Barbara D. Alexander, Marion Hemmersbach-Miller, Debra L. Sudan, Carl F. Pieper, and Kenneth E. Schmader
- Subjects
Graft Rejection ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Urinary system ,030106 microbiology ,Single Center ,Article ,03 medical and health sciences ,0302 clinical medicine ,Medical microbiology ,Internal medicine ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Kidney transplantation ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Infectious Diseases ,Cytomegalovirus Infections ,Urinary Tract Infections ,Female ,Complication ,business - Abstract
PURPOSE: Infections are among the top three causes of death of older adults in the first year after kidney transplantation (KT). Our aim was to describe infectious complications among KT recipients aged ≥65 during the first 12 months post-transplant. METHODS: Single center retrospective cohort study. RESULTS: Ninety-one KTs had been performed in patients ≥ 65 years of age between 2011–2015. 92.3% of the patients developed at least one infection. Infectious episodes increased the risk of future infection by 10% (p=0.0018) with each infection portending a greater risk. At a patient level, viral (71.4%) and bacterial (70.2%) infections predominated. Urinary tract infections were the most frequent complication (30.3%), followed by cytomegalovirus infections (22.7%). Infections were the main reason for readmission. 7.7% of the patients developed rejection; and overall 3.3% lost their graft. Mortality at one year was 9.9%. CONCLUSIONS: Older KT recipients have a high incidence of infectious complications the first year after KT. Infections were the number one reason for readmission, and an infection episode predicted future infections for the individual patient. Despite these complications, the majority of older KT recipients were alive with a functioning graft at one-year. more...
- Published
- 2018
- Full Text
- View/download PDF
16. Mortality hospital of nonagenarian patients in Internal Medicine
- Author
-
José Juan Ruiz-Hernández, B. Alonso Ortiz, Marion Hemmersbach-Miller, J. Arencibia Borrego, M. Singer, and Alicia Conde-Martel
- Subjects
medicine.medical_specialty ,Functional impairment ,business.industry ,Mean age ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Logistic regression ,Comorbidity ,Sepsis ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Respiratory failure ,Heart failure ,Internal medicine ,medicine ,030212 general & internal medicine ,business - Abstract
Objectives To describe the predictors of hospital mortality in nonagenarian patients. Patients and method We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analyzed the association between demographic, clinical and functional parameters and hospital mortality. Results The mean age was 92.5 years (SD ± 2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD ± 8.6). During the hospitalization, 96 patients died (22.8%). The predictors of mortality were age (p = .002), functional state (p = .006), comorbidity (p = .018) and diagnoses of pneumonia (p = .001), sepsis (p = .012) and respiratory failure (p Conclusion The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment. more...
- Published
- 2018
- Full Text
- View/download PDF
17. Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna
- Author
-
M. Singer, Alicia Conde-Martel, J. Arencibia Borrego, B. Alonso Ortiz, José Juan Ruiz-Hernández, and Marion Hemmersbach-Miller
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,medicine ,030212 general & internal medicine ,General Medicine ,030204 cardiovascular system & hematology ,business - Abstract
Resumen Objetivos Describir los factores predictivos de mortalidad hospitalaria en pacientes nonagenarios. Pacientes y metodo Se estudio retrospectivamente a 421 pacientes ≥ 90 anos ingresados en un servicio de Medicina Interna. Se analizo mediante regresion logistica la asociacion de parametros demograficos, clinicos y funcionales con la mortalidad intrahospitalaria. Resultados La edad media (DE) fue de 92,5 anos (2,5), con 265 (62,9%) mujeres. Los principales diagnosticos fueron enfermedades infecciosas (257 pacientes, 61%) e insuficiencia cardiaca (183, 43,5%), y la estancia media fue de 11,9 dias (8,6). Durante el ingreso fallecieron 96 pacientes (22,8%). Los factores predictivos de mortalidad fueron la edad (p = 0,002), el estado funcional (p = 0,006), la comorbilidad (p = 0,018) y los diagnosticos de neumonia (p = 0,001), sepsis (p = 0,012) e insuficiencia respiratoria (p Conclusion La mortalidad hospitalaria de pacientes nonagenarios atendidos en Medicina Interna supera el 20% y se asocia a neumonia, carga de comorbilidad y deterioro funcional. more...
- Published
- 2018
- Full Text
- View/download PDF
18. Detection of Donor’s HIV Strain in HIV-Positive Kidney-Transplant Recipient
- Author
-
Christina M. Wyatt, Hannah Stadtler, Feng Gao, Jerry Chang, Marion Hemmersbach-Miller, Mary E. Klotman, Maria Blasi, Paul E. Klotman, and Cameron R. Wolfe
- Subjects
Kidney ,Extramural ,business.industry ,Human immunodeficiency virus (HIV) ,virus diseases ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease_cause ,medicine.disease ,Virology ,Article ,Kidney transplant recipient ,Transplantation ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,030212 general & internal medicine ,business ,Kidney transplantation - Abstract
HIV Transfer in Renal Transplantation despite ART In this case report, a low level of human immunodeficiency virus was shown to be transferred during transplantation of a kidney from an HIV-positiv... more...
- Published
- 2020
19. Updates on Nocardia Skin and Soft Tissue Infections in Solid Organ Transplantation
- Author
-
Jelena Catania, Marion Hemmersbach-Miller, and Jennifer L. Saullo
- Subjects
0301 basic medicine ,medicine.medical_specialty ,biology ,Isolation (health care) ,business.industry ,030106 microbiology ,Soft tissue ,Nocardia ,biology.organism_classification ,Dermatology ,Organ transplantation ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Tolerability ,Epidemiology ,Medicine ,030212 general & internal medicine ,business ,Nocardia Infections - Abstract
Due to their immunocompromised status, solid organ transplant (SOT) recipients are at risk for Nocardia infections. These infections often necessitate early invasive diagnostics alongside prolonged, often combination antimicrobial therapy. This review summarizes the importance of this pathogen in skin and soft tissue infections (SSTIs) in SOT recipients inclusive of recently reported cases in the literature and an update on the epidemiology, diagnostics, and management. Six studies with 13 isolated SSTIs due to Nocardia have been published in the last 5 years in SOT recipients. The most common underlying type of transplant was kidney and time from transplantation to infection varied from 6 months to 16 years. Misdiagnosis was frequent. Available identified species included N. brasiliensis (2), N. farcinica (2), N. flavorosea (1), N. abscessus (1), N. anaemiae (1), N. asteroides (1), N. nova (1), and N. vinacea (1). Treatment choice and duration varied widely, and trimethoprim-sulfamethoxazole was utilized most often with no documented infection relapse. Nocardia SSTIs can occur both in isolation and as a component of a disseminated infection. Overall, isolated Nocardia SSTIs are uncommon in SOT recipients and are often initially misdiagnosed. They present multiple challenges to the clinician including evaluation for potential co-pathogens and/or non-infectious processes and ruling out the presence of disseminated infection. While trimethoprim-sulfamethoxazole remains the agent of choice for management of most isolated SSTIs, therapy must be tailored to the individual patient based on species-specific susceptibility patterns and formal susceptibility testing, site(s) of infection, and patient tolerability. more...
- Published
- 2019
- Full Text
- View/download PDF
20. Bilateral Lung Transplantation for End-Stage Respiratory Failure from COVID-19 Pneumonia
- Author
-
G. Li, Gabriel Loor, N. Maniar, J. Segraves, Puneet Garcha, Kenneth Liao, Marion Hemmersbach-Miller, J. Coster, Alexis E. Shafii, and A. Matar
- Subjects
Pulmonary and Respiratory Medicine ,Mechanical ventilation ,Transplantation ,medicine.medical_specialty ,ARDS ,Lung ,Basiliximab ,business.industry ,medicine.medical_treatment ,(1266) ,medicine.disease ,Pulmonary hypertension ,Surgery ,Pneumonia ,medicine.anatomical_structure ,surgical procedures, operative ,Respiratory failure ,medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Lung allocation score - Abstract
Introduction The SARS-CoV-2 virus is causing severe end-stage fibrosis and respiratory failure in otherwise healthy individuals. Lung transplant (LTX) has been performed internationally in select patients for this indication, but there is limited evidence on its role in COVID-19. We describe a patient who received a bilateral LTX 12 weeks after an initial diagnosis of COVID-19 pneumonia. Case Report A 51-year-old male with hypertension and presented to an outlying hospital with dyspnea, fever and exposure to SARS-CoV-2. He was hypoxic and a diagnosis of COVID-19 pneumonia was made by nasopharyngeal swab. He was treated with dexamethasone, remdesivir, and convalescent plasma, mechanical ventilation and eventually femoral VV-ECMO cannulation to maintain oxygenation. He was extubated and was transitioned to a left subclavian dual-limb 30 Fr VV-ECMO cannula for improved rehabilitation. He was then transferred to our center for LTX consideration given refractory ARDS. Evaluation for LTX revealed pulmonary hypertension, negative SARS-CoV-2 PCR and deconditioning but no absolute contraindications. He participated in intensive rehabilitation and progressed to assisted steps despite severe deconditioning and hypoxia. He was listed for a bilateral lung transplant with a lung allocation score of 90 and received a donor offer 7 days after listing and after 82 days on ECMO. He underwent bilateral LTX via clamshell exposure with central VA ECMO support. Intraoperatively, the lungs were densely consolidated with severe hilar adenopathy without peripheral adhesions. Post-operatively, he was transitioned back to his original VV ECMO circuit and then decannulated on post-op day 3. Standard induction with basiliximab and immunosuppression with IV methylprednisolone, mycophenolate and tacrolimus was administered. He had a transient elevation of liver enzymes on post-operative day 1 and an early planned tracheostomy was performed due to deconditioning. He has since, been progressing well on oxygen via tracheostomy collar and is able to speak with a one-way valve and participate in rehabilitation. Summary For patients with irreversible end-stage lung disease after COVID-19 pneumonia, LTX is a viable option. Timely transfer to a lung transplant center and intensive rehabilitation are essential. Standard established immunosuppression and post-transplant protocols should be followed. more...
- Published
- 2021
21. COVID-19 in Lung-Transplant Recipients: A Descriptive Study
- Author
-
Puneet Garcha, D. Daoud, Gabriel Loor, J. Segraves, Marion Hemmersbach-Miller, B. Rodrigues, and G. Li
- Subjects
Pulmonary and Respiratory Medicine ,Mechanical ventilation ,Transplantation ,medicine.medical_specialty ,education.field_of_study ,business.industry ,medicine.medical_treatment ,Population ,Retrospective cohort study ,Immunosuppression ,(778) ,Intensive care unit ,Tacrolimus ,law.invention ,Hypoxemia ,Prednisone ,law ,Internal medicine ,Medicine ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,education ,medicine.drug - Abstract
Purpose Transplant recipients are more susceptible to infection, however the medical literature lacks sufficient data regarding COVID-19 post transplantation, especially in lung-transplant recipients. This population appears to be at higher risk for critical illness due to comorbidities and chronic immunosuppressive state Methods This was a single-center, retrospective study of 7 lung-transplant recipients who were symptomatic and tested positive for COVID-19 between Feb 2020 and Oct 2020. Demographics, including single vs double lung transplantation, time from transplant were included. Laboratory data on admission, immunosuppressive regimen and adjustment during hospitalization, oxygen requirements and outcomes were also collected Results To date, 7 out of 227 post-lung transplant patients followed at our center became symptomatic with COVID-19 infection. The average age was 60.5 years and 70% were female. All patients had double lung transplantation performed between Apr 2010 and Nov 2019. The average body mass index was 27.0 kg/m2. 85% required hospitalization, three had to be admitted to the intensive care unit, two required invasive mechanical ventilation. Two patients died (one due to acute kidney injury and refractory shock and one refused intubation). One patient on mechanical ventilation required VV ECMO 3 days after admission as a bridge to recovery. All patients were on standard triple immunosuppressive regimen [tacrolimus, mycophenolate, and prednisone]. Mycophenolate was stopped for all patients at the time of the infection, and those who required oxygen supplementation (n=5) received dexamethasone and convalescent plasma. Two of them were not eligible for Remdesivir. Elevated d-dimer (0.78 - 5.57 mg/L), LDH (253 - 985 U/L) and the degree of hypoxemia on admission correlated to worse outcomes Conclusion COVID-19 infection in lung transplant patients has a variable course. In our study, d-dimer, LDH and the degree of hypoxemia on admission had a linear correlation with unfavorable outcome, similar to what has been reported for non lung-transplant patients with COVID-19. Intubation and mechanical ventilation portend a poor prognosis. In our cohort reduction in net immunosuppression (stopping anti-metabolite) and supportive treatment was utilized. Prevention remains the best intervention for COVID-19 more...
- Published
- 2021
22. A Multicenter Prospective Registry Study of Lung Transplant Recipients Hospitalized with COVID-19
- Author
-
Kassem Safa, Michael G. Ison, P Camargo, R. M. La Hoz, Omer E. Beaird, K Saharia, Angelica Lewis, Cynthia E. Fisher, Rade Tomic, F Meloni, H Wilkens, Robert M. Rakita, Joanna Nelson, Ashrit Multani, Aaron Mishkin, Barbara D. Alexander, Sameep Sehgal, E A Blumberg, Olivia S Kates, Camille N. Kotton, Julie M Steinbrink, Zohra S Chaudhry, Ajit P. Limaye, Erika D. Lease, Marion Hemmersbach-Miller, Jose A Morillas, Afrah S Sait, Sajal D Tanna, and Madeleine R. Heldman more...
- Subjects
Pulmonary and Respiratory Medicine ,Mechanical ventilation ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Bacterial pneumonia ,medicine.disease ,Logistic regression ,Intensive care unit ,(323) ,law.invention ,law ,Heart failure ,Internal medicine ,Diabetes mellitus ,Cohort ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business - Abstract
Purpose Outcomes of lung transplant recipients (LTR) hospitalized for COVID-19 and comparisons to non-lung solid organ transplant recipients (SOTR) are incompletely described. Methods Using a multicenter prospective registry of SOTR, we examined 28-day outcomes (mortality [primary outcome], intensive care unit (ICU) admission, mechanical ventilation, and bacterial pneumonia) among both LTR and non-lung SOTR hospitalized with laboratory-confirmed COVID-19 diagnosed between March 1, 2020 and September 21, 2020. Data were analyzed using Stata (StataCorp, College Station, TX); chi-square tests were used to compare categorical variables and multivariable logistic regression was used to assess risk factors for mortality. Results The cohort included 72 LTR and 392 non-lung SOTR (Table 1). Overall, 28-day mortality trended higher in LTR vs. non-lung SOTR (27.8% vs. 19.9%, P=0.136). Other 28-day outcomes were similar between LTR and non-lung SOTR: ICU admission (45.8% vs. 39.1%, P=0.28), mechanical ventilation (32.9% vs. 31.1%, P=0.78), and bacterial pneumonia (15.3% vs. 8.2%, P=0.063). Congestive heart failure, diabetes, age >65 years, and obesity (BMI >= 30) were independently associated with mortality in non-lung SOTR, but not in LTR (Table 2). Conclusion In this large prospective cohort comparing lung and non-lung SOTR hospitalized for COVID-19, there were high but not significantly different rates of short-term morbidity and mortality. Baseline comorbidities appeared to drive mortality in non-lung SOTR but not LTR. Further studies are needed to identify risk factors for mortality among LTR. more...
- Published
- 2021
23. Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction
- Author
-
Sara E. Miller, John Roberts, Marion Hemmersbach-Miller, J Duronville, S Sethi, David N. Howell, Barbara D. Alexander, and Nancy G. Henshaw
- Subjects
Transplantation ,business.industry ,viruses ,Interstitial nephritis ,medicine.medical_treatment ,030232 urology & nephrology ,Immunosuppression ,030230 surgery ,medicine.disease_cause ,medicine.disease ,Virology ,Virus ,03 medical and health sciences ,0302 clinical medicine ,Herpes simplex virus ,Infectious disease (medical specialty) ,Immunology ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,business ,Solid organ transplantation ,Nephritis ,Kidney transplantation - Abstract
Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression. more...
- Published
- 2017
- Full Text
- View/download PDF
24. The Great Masquerade: Donor-derived Infections with Uncommon Central Nervous System Pathogens
- Author
-
Marion Hemmersbach-Miller and Amy Spallone
- Subjects
medicine.medical_specialty ,business.industry ,Transmission (medicine) ,Central nervous system ,Meningoencephalitis ,medicine.disease ,medicine.anatomical_structure ,Epidemiology ,medicine ,Etiology ,Solid organ ,business ,Intensive care medicine ,Solid organ transplantation ,Encephalitis - Abstract
Donor-derived infections (DDI) are an infrequent event in solid organ transplant (SOT) due to advances in screening recommendations, prophylaxis, and surveillance of common infections. However, unexpected pathogen transmission can still occur when a donor is not known to be infected prior to organ procurement, which can lead to significant morbidity and mortality in the organ recipient. Solid organ donors with central nervous system (CNS) pathogens are an uncommon but deadly source of unexpected DDI. Clinically recognizing these CNS infections in a potential deceased donor is enormously challenging as many are clinically silent or overshadowed by other confounding events. Because of this, expert panels caution against transplanting organs from decedents who die with possible or proven encephalitis of unknown etiology. In this review, we discuss the epidemiology, donor characteristics, and outcomes of cases of DDI in SOT recipients with unusual CNS pathogens, and provide a discussion on methods of identifying and reporting possible DDI with these pathogens. more...
- Published
- 2021
- Full Text
- View/download PDF
25. Transplant Drug Interactions and a Word of Caution for the HIV Provider. A Case Report
- Author
-
Julia A. Messina, Cameron R. Wolfe, Marion Hemmersbach-Miller, and Carl L. Berg
- Subjects
0301 basic medicine ,Drug ,medicine.medical_specialty ,medicine.medical_treatment ,media_common.quotation_subject ,030106 microbiology ,Human immunodeficiency virus (HIV) ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,electronic medical records ,medicine ,Protease inhibitor (pharmacology) ,030212 general & internal medicine ,Intensive care medicine ,media_common ,Protease ,business.industry ,Cobicistat ,HIV ,drug interactions ,Id Case ,3. Good health ,Calcineurin ,Transplantation ,Editor's Choice ,Infectious Diseases ,Oncology ,Ritonavir ,business ,transplantation ,medicine.drug - Abstract
Electronic medical record platforms fail to support provider alerts when a drug is discontinued. Protease inhibitors, often boosted by ritonavir or cobicistat, increase the serum concentration of calcineurin inhibitors. This case demonstrates acute liver transplant rejection in an HIV-positive recipient due to a failure to recognize the loss of protease inhibitor interaction with his immunosuppressive regimen. more...
- Published
- 2018
- Full Text
- View/download PDF
26. Nocardia infections in the transplanted host
- Author
-
Gary M. Cox, Michael H. Woodworth, Marion Hemmersbach-Miller, Jason E. Stout, and Jennifer L. Saullo
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,030106 microbiology ,Nocardia Infections ,Nocardia ,Article ,03 medical and health sciences ,Immunocompromised Host ,Young Adult ,Risk Factors ,Internal medicine ,Trimethoprim, Sulfamethoxazole Drug Combination ,medicine ,Humans ,Child ,Aged ,Retrospective Studies ,Transplantation ,biology ,business.industry ,Sulfamethoxazole ,Incidence (epidemiology) ,Incidence ,Nocardiosis ,Hematopoietic Stem Cell Transplantation ,Infant ,Organ Transplantation ,Antibiotic Prophylaxis ,Middle Aged ,medicine.disease ,biology.organism_classification ,bacterial infections and mycoses ,Trimethoprim ,Anti-Bacterial Agents ,Infectious Diseases ,surgical procedures, operative ,Treatment Outcome ,Child, Preschool ,Chemoprophylaxis ,Female ,business ,medicine.drug - Abstract
BACKGROUND Nocardia are uncommon pathogens that disproportionately afflict the immunocompromised host. Epidemiology and outcome data of Nocardia infections in transplant recipients are limited. METHODS We performed a retrospective chart review of all patients at Duke University Hospital with a history of solid organ transplant (SOT) or hematopoietic cell transplant (HCT) and at least one positive culture for Nocardia between 1996 and 2013. Our aim was to describe the epidemiology and outcomes of Nocardia infections in the transplanted host. RESULTS During the 18-year study period, 51 patients (14 HCT and 37 SOT recipients) had Nocardia infection. Nocardia incidence was stable during the study period in all populations except heart transplants, whose incidence declined. Infection occurred earlier in the HCT group than the SOT group (median time to diagnosis of 153 and 370 days, respectively). In both groups, the most common site involved was the lung. Outcomes were overall poor, especially in the HCT group with a cure rate of 29%. Heart transplant recipients had significantly better overall survival (P more...
- Published
- 2017
27. Supervivencia a los 10 años de nonagenarios tras el alta hospitalaria
- Author
-
Margit Singer, Marion Hemmersbach-Miller, and Alicia Conde-Martel
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Emergency medicine ,Hospital discharge ,medicine ,030212 general & internal medicine ,General Medicine ,030204 cardiovascular system & hematology ,business - Published
- 2018
- Full Text
- View/download PDF
28. Infections after kidney transplantation. Does age matter?
- Author
-
Kenneth E. Schmader, Marion Hemmersbach-Miller, Carl F. Pieper, Barbara D. Alexander, and Debra L. Sudan
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Urinary system ,Population ,Congenital cytomegalovirus infection ,Cytomegalovirus ,Viremia ,030230 surgery ,Article ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,education ,Kidney transplantation ,Aged ,Retrospective Studies ,Transplantation ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Graft Survival ,Age Factors ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Kidney Transplantation ,Hospitalization ,Cytomegalovirus Infections ,Urinary Tract Infections ,Kidney Failure, Chronic ,Female ,030211 gastroenterology & hepatology ,business ,Follow-Up Studies - Abstract
Infections threaten successful outcomes after kidney transplantation. Our aim was to determine if the number, types of infections and the risk factors for common infections differed between older compared to younger kidney transplant (KT) recipients in the first year after surgery. We performed a single-center retrospective cohort study. Between 2011 and 2015, 91 KTs were performed in patients ≥65 years of age; these were matched 1:1 (by year of transplantation, sex and race) to controls aged 40-60 years. Over 90% of both groups had an infectious complication. Urinary tract infections (UTIs) and cytomegalovirus (CMV) viremia were significantly more frequent in older recipients. Older adults had more late onset UTIs, including after stent removal. CMV viremia was more frequent in older adults in the 1-6 months post-transplant period. Due to our center-specific protocol utilizing pre-emptive monitoring in the CMV recipient-seropositive population, the higher CMV incidence in the aged recipient was driven by this subpopulation of older adults. No difference in pneumonias or bloodstream infections were found, nor in surgical complications, rejection or graft loss. Mortality was higher at 1-year post-transplant in the older recipients (9.9% vs 1.1%; P = 0.018). Prophylactic and immunosuppressive strategies may need to be altered for older KT recipients. more...
- Published
- 2019
- Full Text
- View/download PDF
29. Implicaciones de los síntomas depresivos en los ancianos hospitalizados por afección médica
- Author
-
Miriam Serrano-Fuentes, Natacha Sujanani Afonso, Basilio Javier Anía Lafuente, Marion Hemmersbach-Miller, and Alicia Conde Martel
- Subjects
Aging ,Medicine (miscellaneous) ,Geriatrics and Gerontology - Abstract
Resumen Introduccion Los sintomas depresivos en los pacientes mayores hospitalizados son muy frecuentes, y se han asociado a una mayor mortalidad . Nos planteamos estimar la prevalencia de los sintomas depresivos en los ancianos hospitalizados y su relacion con distintas afecciones, asi como con su situacion funcional, mental y mortalidad. Material y metodos Se estudiaron prospectivamente 115 pacientes mayores de 64 anos. Se utilizo la escala de depresion geriatrica de Yesavage en su version de 15 items validada en espanol. Se considero la presencia de los sintomas depresivos si se obtenian de 6 o mas puntos. Se recogieron las caracteristicas demograficas, el indice de comorbilidad de Charlson, los diagnosticos de ingreso, la situacion funcional evaluada mediante el indice de Barthel y de Lawton-Brody, la capacidad mental evaluada mediante el cuestionario de Pfeiffer, la estancia y la mortalidad hospitalaria. Resultados De los 115 pacientes estudiados con una edad media de 70,5 anos, 71 (61,7%) eran mujeres. Se observaron sintomas depresivos en 46 pacientes (40%; IC 95%: 34,8-43,9). Los pacientes que fallecieron mostraron una puntuacion significativamente superior en la prueba de Yesavage (p = 0,04). En el analisis multivariante se observo la asociacion significativa independiente entre los sintomas depresivos y la capacidad funcional (p = 0,026), la capacidad mental (p = 0,021), la insuficiencia renal (p = 0,001), la hepatopatia (p = 0,018) y la artrosis (p = 0.017), perdiendose la significacion obtenida previamente para la diabetes (p = 0,43). Conclusiones La prevalencia de sintomas depresivos en los ancianos hospitalizados es elevada, y se asocia con los diagnosticos de insuficiencia renal, hepatopatia y artrosis, con una mayor comorbilidad y especialmente con una peor capacidad funcional. more...
- Published
- 2013
- Full Text
- View/download PDF
30. Red blood cell disorders in recently arrived African immigrants to Gran Canaria, Spain
- Author
-
Teresa Molero-Labarta, Cristina Carranza-Rodríguez, Paloma Ropero-Gradilla, José Luis Pérez-Arellano, Marion Hemmersbach-Miller, Fernando-Ataúlfo González-Fernández, and Silvia de-la-Iglesia-Iñigo
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Anemia ,Thalassemia ,Population ,Helminthiasis ,Emigrants and Immigrants ,Asymptomatic ,Young Adult ,Eosinophilia ,Prevalence ,medicine ,Humans ,Prospective Studies ,education ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Microcytosis ,Public Health, Environmental and Occupational Health ,Complete blood count ,General Medicine ,medicine.disease ,Hemoglobinopathies ,Infectious Diseases ,Spain ,Africa ,Immunology ,Female ,Parasitology ,medicine.symptom ,business - Abstract
BACKGROUND In the last decade immigration to Europe has increased, with Africa being the source of a large number of immigrants. In addition to infections, this group has other less known health problems, such as erythrocyte abnormalities. METHODS The objectives of this study were: the systematic evaluation of red cell abnormalities in 200 newly arrived asymptomatic African immigrants on the Canaries; the systematic evaluation of haemoglobinopathies and their characterization in this population; and the relationship of red blood cell disorders and parasitic infections. RESULTS Of the studied immigrants 53 (26.5%) had red cell disorders according to their CBC parameters (Hb and/or MCV). In 48 people (24.0%) one or more etiologic diagnoses were made. Specifically, in order of frequency, a total of 26 structural haemoglobinopathies, 14 α-thalassemias, 2 β-thalassemias and 14 iron deficiencies were diagnosed. There was a statistically significant association between the presence of anemia, microcytosis, structural haemoglobinopathies or α thalassemia and sub-Saharan origin. However, no statistically significant association between the abovementioned parameters and eosinophilia or helminthic infection was observed. CONCLUSIONS These results suggest that, even in the presence of normal Hb and MCV values, including haemoglobinopathies in the initial screening of newly arrived sub-Saharan immigrants would be very useful. more...
- Published
- 2012
- Full Text
- View/download PDF
31. Solid Organ Transplantation in Older Adults. Infectious and Other Age-Related Considerations
- Author
-
Cameron R. Wolfe, Marion Hemmersbach-Miller, and Kenneth E. Schmader
- Subjects
Aging ,Immunocompromised Host ,Pediatrics ,medicine.medical_specialty ,Increased risk ,business.industry ,Age related ,Medicine ,Infections ,Solid organ transplantation ,business ,Article - Abstract
In the U.S., older adults aged 65 or above comprise nearly one quarter of the solid organ transplant (SOT) waitlists, and the number of transplants performed in this age group continues to increase. There are no specific guidelines for the assessment and follow up of the older SOT candidate or recipient. Older adults are at increased risk of infectious complications after SOT. Despite these complications and even with the use of suboptimal donors, overall outcomes are favorable. We provide an overview to specific consideration as they relate to the older SOT candidate and recipient. more...
- Published
- 2018
- Full Text
- View/download PDF
32. 1017. Impact of Enterococcal Bloodstream Infection on Mortality in Patients With Acute Myelogenous Leukemia
- Author
-
Barbara D. Alexander, Nelson J. Chao, Anthony D. Sung, Marion Hemmersbach Miller, and Julia A. Messina
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Abstracts ,Myelogenous ,Leukemia ,Infectious Diseases ,B. Poster Abstracts ,Oncology ,Bloodstream infection ,Internal medicine ,Medicine ,In patient ,business - Abstract
Background Though enterococcal bloodstream infection (EBSI) is common in patients with acute myelogenous leukemia (AML), its impact on mortality requires further elucidation. Our objectives were to: (1) determine attributable mortality to EBSI and (2) compare overall, 1-year, relapse-related mortality (RRM), and treatment-related mortality (TRM) between AML patients with and without EBSI. Methods This was a retrospective cohort receiving intensive chemotherapy for AML from 2010 to 2015. EBSI was defined by _1 positive blood culture for E. faecium or faecalis and fever, hypotension, or chills. Attributable mortality to EBSI was defined by failure to achieve BSI Clearance (_1 negative culture _24 hr after last positive culture and defervescence) by the date of death. Student’s t-test was used to compare continuous variables, and C2 test was used for categorical variables. Kaplan–Meier was used for survival analyses (unadjusted), and P-values were computed by log-rank. Results Three hundred eight patients were identified during the study period: 80 with EBSI and 228 without EBSI. 5/80 patients died with EBSI (6%) although 4/5 patients had concurrent infections at the time of death (Clostridium difficile colitis, candidemia, proven invasive aspergillosis, and probable invasive fungal disease, respectively). There were no significant differences between overall and 1-year mortality (Table 1). In the survival analyses, EBSI did not significantly impact overall survival, 1-year mortality, RRM, and TRM (Figure 1). However, patients with vancomycin-resistant EBSI (VRE) trended toward increased overall mortality. Conclusion Attributable mortality to EBSI is uncommon (6%) in AML. Additionally, EBSI does not significantly impact mortality in this vulnerable patient population that already has very high rates of RRM and TRM. However, as EBSI inflicted 26% of patients over the course of this study period, further investigation is needed to elucidate the morbidity suffered from this common infection and identify potentially modifiable risk factors. Table 1. Disclosures A. Sung, Merck: Grant Investigator, Grant recipient. Enterome: Grant Investigator, Grant recipient. more...
- Published
- 2018
- Full Text
- View/download PDF
33. Genomic characterization of recurrent mold infections in thoracic transplant recipients
- Author
-
Julia A. Messina, John R. Perfect, Marion Hemmersbach-Miller, Barbara D. Alexander, Wiley A. Schell, Cameron R. Wolfe, Jamie L. Todd, Carmelo A. Milano, Christina A. Cuomo, and John Reynolds
- Subjects
Male ,0301 basic medicine ,Recurrent infections ,medicine.medical_specialty ,Antifungal Agents ,Biopsy ,030106 microbiology ,Disease ,Article ,Organ transplantation ,Aspergillus fumigatus ,03 medical and health sciences ,Fatal Outcome ,Recurrence ,Humans ,Medicine ,DNA, Fungal ,Aged ,Transplantation ,Whole Genome Sequencing ,biology ,Molecular epidemiology ,business.industry ,Invasive disease ,technology, industry, and agriculture ,Middle Aged ,biology.organism_classification ,Transplant Recipients ,030104 developmental biology ,Infectious Diseases ,Verruconis gallopava ,Saccharomycetales ,Immunology ,Heart Transplantation ,business ,Complication ,Invasive Fungal Infections ,Lung Transplantation - Abstract
Invasive mold disease in thoracic organ transplant recipients is a well-recognized complication, but the long-term persistence of molds within the human body and evasion of host defenses has not been well-described. We present two cases of invasive mold disease (Verruconis gallopava and Aspergillus fumigatus) in thoracic transplant recipients who had the same mold cultured years prior to the invasive disease presentation. The paired isolates from the index and recurrent infections in both patients were compared using whole genome sequencing to determine if the same strain of mold caused both the index and recurrent infections. In Case 1, the isolates were found to be of the same strain indicating that the initial colonizing isolate identified pre-transplant eventually caused invasive mold disease post-transplant while in Case 2, the two isolates were not of the same strain. These results demonstrate the distinct possibility of molds both persisting within the human body for years prior to invasive mold disease or the long-term risk of recurrent, persistent infection with more than one strain. Further studies of long-term molecular epidemiology of IMD and risk factors for mold persistence in transplant recipients are encouraged. more...
- Published
- 2018
- Full Text
- View/download PDF
34. El índice de comorbilidad de Charlson ajustado por edad como variable pronóstica en pacientes con isquemia mesentérica aguda
- Author
-
Marion Hemmersbach-Miller, Cristina Roque-Castellano, Alicia Conde-Martel, María Asunción Acosta-Mérida, Juan Hernandez-Romero, and Joaquín Marchena-Gómez
- Subjects
General Computer Science - Abstract
La isquemica mesenterica aguda (IMA) es un proceso quirurgico catastrofico, en particular en pacientes ancianos con comorbilidades multiples. El objetivo del presente estudio fue evaluar la influencia de la comorbilidad en la mortalidad perioperatoria y en la supervivencia global de los pacientes tratados quirurgicamente de IMA. Se estudio retrospectivamente una serie de 186 pacientes consecutivos (106 hombres y 80 mujeres) que se sometieron a cirugia por IMA en un centro universitario de asistencia terciaria. En cada paciente se calculo la puntuacion del indice de comorbilidad de Charlson (ICC), no ajustado y ajustado por edad. Tambien se registraron la mortalidad perioperatoria y la supervivencia global. Se analizo la asociacion entre el ICC no ajustado y ajustado por edad y la mortalidad perioperatoria y la supervivencia global. La edad media de la poblacion estudiada fue de 72,1 (EE ± 13,7 anos). La mortalidad hospitalaria fue del 64,5%. Tras tratamiento quirurgico de IMA, la supervivencia estimada global a 1 ano, 3 anos y 5 anos fue del 26%, 23% y 21%, respectivamente, segun el metodo de Kaplan-Meier. La mortalidad perioperatoria no se relaciono con el ICC preoperatorio no ajustado (p = 0,093). No obstante, se encontro una asociacion estadisticamente significativa entre la mortalidad y el ICC ajustado (p = 0,007). Igualmente, el ICC no ajustado casi se relaciono con la supervivencia global (p = 0,055), pero los valores del ICC clasificado, ajustado por edad, mostraron una diferencia estadisticamente significativa de la supervivencia global (p = 0,012). En el analisis multivariante, el ICC ajustado por edad siguio siendo un factor pronostico independiente de la mortalidad. La comorbilidad ajustada por edad puede desempenar un papel como factor predictivo de la mortalidad perioperatoria y la supervivencia a largo plazo en pacientes operados por IMA. more...
- Published
- 2009
- Full Text
- View/download PDF
35. The Age-Adjusted Charlson Comorbidity Index as an Outcome Predictor of Patients with Acute Mesenteric Ischemia
- Author
-
Joaquín Marchena-Gómez, Alicia Conde-Martel, Marion Hemmersbach-Miller, Juan Hernandez-Romero, Cristina Roque-Castellano, and María Asunción Acosta-Mérida
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Age adjustment ,Population ,Comorbidity ,Kaplan-Meier Estimate ,Risk Assessment ,Severity of Illness Index ,Acute mesenteric ischemia ,Ischemia ,Predictive Value of Tests ,Risk Factors ,Outcome predictor ,Internal medicine ,medicine ,Humans ,Mesentery ,Hospital Mortality ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,Patient Selection ,Age Factors ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Charlson comorbidity index ,Acute Disease ,Regression Analysis ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Acute mesenteric ischemia (AMI) is a catastrophic surgical condition, especially in older patients with multiple comorbidities. The aim of this study was to evaluate the impact of comorbidity on perioperative mortality and overall survival in patients surgically treated for AMI. A series of 186 consecutive patients (106 men and 80 women) who underwent surgery because of AMI in a university tertiary care center between 1990 and 2006 were retrospectively studied. The Charlson Comorbidity Index (CCI) score, unadjusted and adjusted by age, was preoperatively calculated in each patient. Perioperative mortality and overall survival were also recorded. The association between unadjusted and adjusted by age CCI and perioperative mortality and overall survival were analyzed. The mean age of the studied population was 72.1 years (SE +/-13.7 years). Hospital mortality was 64.5%. One-year, 3-year, and 5-year overall estimated survival by the Kaplan-Meier method after surgery for AMI was 26%, 23% and 21%, respectively. Perioperative mortality was not related to the unadjusted preoperative CCI (p = 0.093). Nevertheless, a statistically significant association was found between mortality and preoperative adjusted CCI (p = 0.007). Likewise, CCI unadjusted was almost related to overall survival (p = 0.055), but the values of the categorized CCI adjusted by age showed a statistically significant difference in overall survival (p = 0.012). In multivariate analysis, CCI adjusted by age remained independent prognostic factor of mortality. Comorbidity adjusted by age may play a role as a predictive factor for perioperative mortality and long-term survival in patients operated on for AMI. more...
- Published
- 2009
- Full Text
- View/download PDF
36. Le score de comorbidités de Charlson ajusté à l'âge comme facteur pronostique des patients présentant une ischémie mésentérique aiguë
- Author
-
Joaquín Marchena-Gómez, Juan Hernandez-Romero, Alicia Conde-Martel, Marion Hemmersbach-Miller, María Asunción Acosta-Mérida, and Cristina Roque-Castellano
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Electrical and Electronic Engineering ,business ,Atomic and Molecular Physics, and Optics - Abstract
L'ischemie mesenterique aigue (IMA) est une pathologie chirurgicale catastrophique, particulierement chez les patients les plus âges presentant des comorbidites multiples. Le but de cette etude etait d'evaluer l'impact des comorbidites sur la mortalite perioperatoire et la survie globale pour les patients traites chirurgicalement d'une IMA. Une serie de 186 patients consecutifs (106 hommes et 80 femmes) ayant subi une chirurgie pour IMA dans un centre universitaire tertiaire entre 1990 et 2006 a ete retrospectivement etudiee. Le score de comorbidites de Charlson (SCC), non ajuste et ajuste a âge, ont ete calcules en preoperatoire pour chaque patient. La mortalite perioperatoire et la survie globale ont ete egalement enregistrees. L'association entre SCC non ajuste et ajuste a l'âge et la mortalite perioperatoire et la survie globale ont ete analysees. L'âge moyen de la population etudiee etait de 72,1 ans (± 13,7 ans). La mortalite hospitaliere etait de 64,5%. La survie globale a un an, trois ans, et cinq ans selon la methode de Kaplan-Meier apres chirurgie pour IMA etaient de 26%, 23% et 21%, respectivement. La mortalite perioperatoire n'etait pas ete liee au SCC preoperatoire non ajuste (p = 0,093). Neanmoins, une association statistiquement significative etait trouvee entre la mortalite et le SCC preoperatoire ajuste (p = 0,007). De meme, le SCC non ajuste etait presque lie a la survie globale (p = 0,055), mais les valeurs du SCC ajuste a l'âge montrait une difference statistiquement significative de survie globale (p = 0,012). Par analyse multivariee, le SCC ajuste a l'âge restait un facteur pronostique independant de mortalite. Les comorbidites ajustees a l'âge peuvent jouer un role comme facteur predictif de mortalite perioperatoire et de survie a long terme pour les patients operes d'IMA. more...
- Published
- 2009
- Full Text
- View/download PDF
37. Candida Isolation in Patients Hospitalized on a Surgical Ward: Significance and Mortality-Related Factors
- Author
-
María Asunción Acosta-Mérida, Alicia Conde-Martel, A. Bordes-Benı́tez, V. Morales-Leon, Marion Hemmersbach-Miller, Joaquín Marchena-Gómez, and T. Saez-Guzman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anemia ,Candida parapsilosis ,Risk Factors ,Internal medicine ,Epidemiology ,Prevalence ,medicine ,Humans ,Medical history ,Hospital Mortality ,Aged ,Candida ,Retrospective Studies ,Aged, 80 and over ,Cross Infection ,Univariate analysis ,Chi-Square Distribution ,biology ,business.industry ,Incidence ,Incidence (epidemiology) ,Candidiasis ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,biology.organism_classification ,Surgery ,Logistic Models ,General Surgery ,Female ,business ,Abdominal surgery - Abstract
Infections caused by Candida are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by Candida spp. in this setting. A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for Candida were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined. The prevalence of patients colonized and/or infected by Candida on our surgical ward was 0.98% (CI 95%: 0.79–1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD ± 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (p = 0.001); transfusions (p = 0.003), and an ICU stay (p = 0.002) were associated with mortality. Candidemia was associated with neoplasms (p = 0.02) and the infection caused by Candida parapsilosis (p = 0.04). The only independent factor related to mortality was the anemia (p = 0.028; Odds Ratio: 6.43; 95% CI: 1.23–33.73). Colonization and/or infection by Candida spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality. more...
- Published
- 2009
- Full Text
- View/download PDF
38. Nocardia infections in the transplanted host
- Author
-
Jennifer L. Saullo, Michael H. Woodworth, Jason E. Stout, Gary M. Cox, and Marion Hemmersbach-Miller
- Subjects
Infectious Diseases ,Oncology ,Host (biology) ,Biology ,Nocardia Infections ,Virology ,Microbiology - Published
- 2016
- Full Text
- View/download PDF
39. Pyogenic liver abscesses: mortality-related factors
- Author
-
Alicia Conde-Martel, Pedro Betancor-León, Magdalena León-Mazorra, Marion Hemmersbach-Miller, Joaquín Marchena-Gómez, and José Juan Ruiz-Hernández
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pleural effusion ,Gastroenterology ,Sepsis ,Internal medicine ,Humans ,Medicine ,Risk factor ,Aged ,Aged, 80 and over ,Pyogenic liver abscess ,Past medical history ,Hepatology ,business.industry ,Septic shock ,Mortality rate ,Middle Aged ,Prognosis ,medicine.disease ,Shock, Septic ,Surgery ,Hospitalization ,Pleural Effusion ,Treatment Outcome ,Liver Abscess, Pyogenic ,Female ,Epidemiologic Methods ,business ,Liver abscess - Abstract
Goal To analyse the characteristics and mortality-related factors in a series of patients hospitalized for pyogenic liver abscess (PLA). Background Pyogenic liver abscesses are infrequent but potentially life threatening. Factors related to mortality have been less studied. Study The medical records of 84 patients, 56 men and 28 women, mean age of 64.4 years (SD: 14) who were hospitalized between 1992 and 2005 owing to a PLA were reviewed. The past medical history, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatment, complications and mortality were recorded. Factors related to complications and mortality were analysed. Results One or more bacteria were isolated in 65 patients (77.4%), being Streptococcus spp. (40.5%), Escherichia coli (27.4%), Klebsiella spp. (14.3%) and anaerobics (17.9%) the most frequent isolates. Complications developed in 60.7% of the cases, the most common one being a right pleural effusion (34.5%). Mortality rate was 19% (95% confidence interval: 10-28%). Mortality was associated with age (P=0.005), a previous history of coronary heart disease (P=0.016), absence of fever (P=0.001), development of sepsis and/or septic shock (P more...
- Published
- 2007
- Full Text
- View/download PDF
40. Identification of Risk Factors for Perioperative Mortality in Acute Mesenteric Ischemia
- Author
-
Juan Hernandez-Romero, Joaquín Marchena-Gómez, Marion Hemmersbach-Miller, María Asunción Acosta-Mérida, and Cristina Roque-Castellano
- Subjects
Male ,medicine.medical_specialty ,Embolism ,Ischemia ,Gastroenterology ,chemistry.chemical_compound ,Mesenteric Veins ,Mesenteric Artery, Superior ,Risk Factors ,Internal medicine ,Mesenteric Vascular Occlusion ,Risk of mortality ,Humans ,Medicine ,Risk factor ,Survival rate ,Digestive System Surgical Procedures ,Aged ,Aged, 80 and over ,Creatinine ,business.industry ,Thrombosis ,Perioperative ,Middle Aged ,medicine.disease ,Mesenteric Arteries ,Surgery ,Intestines ,Acute Intestinal Ischemia ,chemistry ,Female ,business ,Vascular Surgical Procedures ,Abdominal surgery - Abstract
Acute intestinal ischemia is in most cases a lethal condition with a low survival rate. Risk factors of perioperative mortality are poorly defined. The aim of this study was to define risk factors that predict an adverse outcome of acute mesenteric ischemia (AMI). A total of 132 consecutive patients (73 men, 59 women), mean ± SD age 71.96 ± 13.64 years, who underwent surgery because of AMI in a university tertiary care center were evaluated over a period of 10 years. Clinical features, laboratory findings, etiologic factors, and surgical procedures were recorded and assessed as possible risk factors for perioperative mortality. Of 132 patients, 86 (65.2%) died during the perioperative period as a direct result of AMI. Significant univariate predictors of perioperative mortality were age (P = 0.01), cardiopathy (P = 0.002), digoxin intake (P = 0.015), shock (P = 0.01), urea plasma level (P < 0.001), creatinine (P < 0.001), potassium (P = 0.042), low pH (P = 0.015) and bicarbonate (P = 0.035); hemoglobin ≥ 2.48 mmol/L (P = 0.035); time delay to surgery (P = 0.023); colonic involvement (P < 0.001); small and large bowel involvement (P < 0.001); arterial versus venous ischemia (P = 0.007); and intestinal resection (P < 0.001). In the multivariate analysis, the variables previous cardiac illness (P = 0.045), urea plasma levels (P < 0.001), and small and large bowel involvement were identified as independent risk factors of perioperative mortality. Intestinal resection (P < 0.001) was a favorable predictor. Age, time delay to surgery, shock, and acidosis significantly increase the risk of mortality due to AMI, whereas intestinal resection has a protective effect. However, only previous cardiac illness, acute renal failure, and large bowel ischemia have a negative effect as independent risk factors of mortality of AMI. more...
- Published
- 2006
- Full Text
- View/download PDF
41. Brain Abscess due to Nocardia otitidiscaviarum: Report of a Case and Review
- Author
-
Ana Bordes Benítez, Ana Ojeda Sosa, Alicia Conde Martel, and Marion Hemmersbach-Miller
- Subjects
Adult ,Male ,Microbiology (medical) ,Pathology ,medicine.medical_specialty ,Fatal outcome ,Brain Abscess ,Nocardia Infections ,Bacteremia ,Risk Assessment ,Severity of Illness Index ,Nocardia ,Immunocompromised Host ,Fatal Outcome ,X ray computed ,medicine ,Humans ,Brain abscess ,General Immunology and Microbiology ,biology ,business.industry ,General Medicine ,bacterial infections and mycoses ,medicine.disease ,biology.organism_classification ,Combined Modality Therapy ,Anti-Bacterial Agents ,Infectious Diseases ,NOCARDIA OTITIDISCAVIARUM ,Drainage ,Drug Therapy, Combination ,Tomography, X-Ray Computed ,business - Abstract
We present a case of brain abscess caused by Nocardia otitidiscaviarum in an immunocompromized 44-y-old male. Only 7 other cases of N. otitidiscaviarum brain abscess or involvement were found in the literature. The mortality was 75% despite treatment among cases reviewed. There is a lack of therapeutic guidelines regarding brain abscesses due to Nocardia. more...
- Published
- 2004
- Full Text
- View/download PDF
42. RESPONSE LETTER TO DR. ENRIQUE ANTON
- Author
-
Alicia Conde-Martel and Marion Hemmersbach-Miller
- Subjects
business.industry ,Medicine ,Geriatrics and Gerontology ,Theology ,business - Published
- 2005
- Full Text
- View/download PDF
43. Cardiac Device Infections due to Mycobacterium fortuitum
- Author
-
Alicia Conde-Martel, Marion Hemmersbach-Miller, Miguel A Cardenes-Santana, José A Bolanos-Guerra, and María I Campos-Herrero
- Subjects
Microbiology (medical) ,Article Subject ,biology ,business.industry ,Signs and symptoms ,Case Report ,Infectious and parasitic diseases ,RC109-216 ,biochemical phenomena, metabolism, and nutrition ,Pathogenicity ,biology.organism_classification ,equipment and supplies ,bacterial infections and mycoses ,Microbiology ,QR1-502 ,Infectious Diseases ,Slow progression ,Immunology ,Medicine ,bacteria ,Mycobacterium fortuitum ,business ,Cardiac device - Abstract
Two cases of cardiac device infection due toMycobacterium fortuitumare reported along with a discussion of their clinical management. Long-term therapy and removal of the infected device is needed. The slow progression and absence of systemic signs and symptoms suggest a low pathogenicity ofM fortuitum. more...
- Published
- 2005
44. Characteristics and Early Outcomes of Older Adults Undergoing Kidney Transplantation
- Author
-
Kenneth E. Schmader and Marion Hemmersbach Miller
- Subjects
0303 health sciences ,medicine.medical_specialty ,030306 microbiology ,business.industry ,Poster Abstract ,medicine.disease ,3. Good health ,Abstracts ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Text mining ,Oncology ,medicine ,030212 general & internal medicine ,Intensive care medicine ,business ,Kidney transplantation - Abstract
Background Kidney transplantation (KT) has increased over the last decades due to longer life expectancy and a higher incidence of end stage renal disease (ESRD). Knowledge gaps remain regarding outcomes and infectious complications in older adults. Our primary aim was to describe the infectious complications, rejection episodes, graft and patient survival among older KT recipients (KTr) during the first 12-months post-transplant. Methods Retrospective cohort study of all KT performed at Duke on older adults aged ≥65 years between 2011 and 2015. Demographic, clinical and outcome data were collected from the medical chart. Descriptive analyses were performed. Results Ninety-one kidney-only transplants had been performed between 2011–2015. 60.4% were males, predominantly Caucasian (61.5%) and had a median age of 68 (range 65–75). 73.6% were on chronic dialysis prior to transplant. Frequent comorbidities included hypertension (93.4%), diabetes mellitus (47.3%), cardiovascular disease (49.5%) and obesity (36.3%). 92.3% of this KTr population encountered at least one infectious complication in the 12 months after transplant, while only 7.7% had a rejection episode. Delayed graft function occurred in 26.4%. 71.4% were admitted at least once in the 12 months after KT. The most frequent reason for admission were infections (58% of the admissions), followed by lab abnormalities (25.5%) and surgical complications (20.4%), while only 1.3% were due to a cardiovascular event. Mortality at one year was 9.9%, graft loss 3.3%. Conclusion Infectious complications occur at very high frequency in older KTr which in turn results in frequent hospital readmissions in the year following transplants. Despite these complications, the majority of older KTr were alive with a functioning graft one-year post-transplant. Cardiovascular events in this population are not as frequent as described in the literature. We postulate that a better understanding of immunosuppressive regimens and antimicrobial prophylaxis might be able to mitigate infectious complications. Disclosures M. Hemmersbach Miller, T32 Research Grant (NIH): I’m currently on a T32 Transplant ID Training Grant, Grant recipient and T32 Training Grant recipient - 4T32AI100851-04. K. Schmader, Merck: Investigator, Research grant. GlaxoSmithKline: Investigator, Research grant more...
- Published
- 2017
- Full Text
- View/download PDF
45. [Prevalence of depressive symptoms in hospitalized elderly medical patients]
- Author
-
Alicia, Conde Martel, Marion, Hemmersbach-Miller, Basilio J, Anía Lafuente, Natacha, Sujanani Afonso, and Miriam, Serrano-Fuentes
- Subjects
Male ,Depression ,Prevalence ,Humans ,Female ,Hospital Mortality ,Prospective Studies ,Middle Aged ,Aged - Abstract
Depressive symptoms in hospitalized patients are very common, and they have been related to higher mortality. The aim of the study was to estimate the prevalence of depressive symptoms in hospitalized elderly patients and its relationship to various diseases, as well as their functional and mental status and mortality.A total of 115 patients over 64 years of age were prospectively studied. The validated Spanish version of the Geriatric Depression Scale of Yesavage (15-item version) was used. Patients were considered to have depressive symptoms if ≥6 points were obtained. The demographic characteristics, the Charlson comorbidity index, the diagnosis at admission, the functional status assessed by the Barthel and Lawton-Brodie index, the mental capacity assessed by the Pfeiffer questionnaire, the length of the hospital stay, and hospital mortality were recorded.Out of the 115 patients studied, with a mean age of 70.5 years, 71 (61.7%) were female. Depressive symptoms were observed in 46 patients (40%, 95% CI:34.8-43.9). Patients who died showed a significantly higher score on the Yesavage scale (P=.04). The multivariate analysis showed a significantly independent association between depressive symptoms and functional capacity (P=.026), mental status (P=.021), renal failure (P=.001), liver disease (P=.018), and osteoarthritis (P=.017), but losing the previously seen significant association with diabetes (P=.43).The prevalence of depressive symptoms in hospitalized elderly patients is high, and is associated with the diagnoses of renal failure, liver disease and osteoarthritis, with a higher comorbidity and especially with a poorer functional capacity. more...
- Published
- 2012
46. Five-year survival and prognostic factors in a cohort of hospitalized nonagenarians
- Author
-
Marion Hemmersbach-Miller, Pedro Saavedra-Santana, Alicia Conde-Martel, Joaquín Marchena-Gómez, and Pedro Betancor-León
- Subjects
Male ,medicine.medical_specialty ,Activities of daily living ,Multivariate analysis ,Barthel index ,Nutritional Status ,Comorbidity ,Cohort Studies ,Risk Factors ,Internal medicine ,Activities of Daily Living ,Internal Medicine ,medicine ,Humans ,Longitudinal Studies ,Geriatric Assessment ,Survival analysis ,Aged, 80 and over ,Inpatients ,business.industry ,medicine.disease ,Prognosis ,Survival Analysis ,Heart failure ,Cohort ,Multivariate Analysis ,Physical therapy ,Female ,business ,Cohort study - Abstract
Background The number of hospitalized nonagenarians is increasing. Only a few studies have evaluated long-term predictors of survival in these patients. The aim of this study was to determine the 5-year outcome of a cohort of hospitalized nonagenarians, and to identify predictors of long-term survival. Methods In 124 consecutive medical hospitalized patients older than 89 years, and followed up during 5 years, the following variables were prospectively recorded: sociodemographic characteristics, main diagnoses, Charlson comorbidity index, Barthel index, Lawton–Brody test, Mini-Mental State Examination, Short Portable Mental Status Questionnaire of Pfeiffer, Mini Nutritional Assessment, albumin levels, and the 5-year survival. Results Out of the 124 patients, 109 died (87.9%) during the follow-up. The probability of being alive at 1, 3 and 5 years was 45%, 22% and 12%, respectively. A worse 5-year survival was significantly related to the diagnoses of pneumonia ( p = 0.037), heart failure ( p = 0.045), higher Charlson index ( p = 0.026), poorer functional status measured by the Barthel index ( p = 0.003), and the Lawton–Brody test ( p = 0.007), cognitive impairment measured by the Pfeiffer test ( p = 0.011), and lower levels of albumin ( p = 0.028). In the multivariate analysis, the Charlson index ( p p = 0.003) were independently related to 5-year survival. These two variables were also 5-year survival prognostic factors in the subgroup of discharged patients. A prognostic index using these two variables was created: PI = (0.2 × Charlson index + 0.6 × Barthel index) × 0.92. Conclusions In hospitalized nonagenarian patients, poor scores in the Barthel Index and a higher comorbidity evaluated by the Charlson index are independently related to 5-year survival. more...
- Published
- 2011
47. Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann's procedure
- Author
-
Juan Hernandez-Romero, Asuncion Acosta-Merida, Cristina Roque-Castellano, Roberto Fariña-Castro, Álvaro Rodríguez-Méndez, Joaquín Marchena-Gómez, and Marion Hemmersbach-Miller
- Subjects
Male ,medicine.medical_specialty ,Colon ,medicine.medical_treatment ,Dehiscence ,Surgical anastomosis ,Colon surgery ,Colon, Sigmoid ,Colostomy ,medicine ,Humans ,Risk factor ,Gastrointestinal Transit ,Colectomy ,Digestive System Surgical Procedures ,Retrospective Studies ,business.industry ,Gastroenterology ,Retrospective cohort study ,Perioperative ,Middle Aged ,Surgery ,Gastrointestinal Tract ,Female ,business - Abstract
Hartmann’s operation is widely used for the surgical treatment of complicated left colonic disease. However, many patients never undergo reanastomosis. This study analyzes the factors related to the decision of restoring intestinal continuity. Between 1997 and 2004, 162 patients underwent Hartmann’s operation in our institution. Age, sex, anesthetic risk evaluation (ASA score), underlying disorder (neoplastic vs non-neoplastic), prevalence of colonic reconstruction, as well as postoperative length of hospital stay, perioperative mortality and complications due to the latter procedure were analyzed. Long-term survival was also recorded. Patients’ mean age was 68.7 years (SD ± 14.9); 104 were men (64.2%) and 58 were women (35.8%). Hartmann’s operation mortality was 20.4%. Forty-two colonic continuity restorations were performed (25.9%). Mean time until reconstruction procedure was 13.3 months. There were no deaths (mortality 0%), but 23 cases suffered complications (54.8%). No suture dehiscence was observed. Estimated probability of being alive 1, 3, and 5 years after the initial operation was 64.1, 50.4, and 44.3%, respectively. Significant univariate predictors of reversal were male sex (p = 0.003), non-neoplastic disorder (p = 0.004), younger age (p = 0.001) and lower anesthetic risk (p = 0.009). In the multivariate analysis, independent predictive factors were age (OR: 0.94; 95% CI: 0.91–0.98), non-neoplastic disorder (OR: 0.16; 95% CI: 0.05–0.45), and lower anesthetic risk (OR: 0.22; 95% CI: 0.08–0.58). Hartmann’s procedure implies a high mortality and a low percentage of restoration of intestinal continuity. In selected patients, closure of Hartmann’s colostomy is a safe procedure, but has a significant morbidity. more...
- Published
- 2007
48. Spontaneous retroperitoneal hematomas in elderly patients treated with low-molecular-weight heparins
- Author
-
Alicia, Conde-Martel, Sofia, Perez-Correa, Marion, Hemmersbach-Miller, Pedro, Betanocor-Leon, and Joaquin, Marchena-Gomez
- Subjects
Aged, 80 and over ,Male ,Hematoma ,Spain ,Anticoagulants ,Humans ,Female ,Retroperitoneal Space ,Heparin, Low-Molecular-Weight ,Platelet Aggregation Inhibitors ,Aged - Published
- 2005
49. Pseudo-tumor of the lung, a rare clinical presentation of dirofilariasis
- Author
-
Marion Hemmersbach-Miller, C. Hours, J. Delmont, and Philippe Brouqui
- Subjects
Pathology ,medicine.medical_specialty ,Chest Pain ,Endemic Diseases ,Lung Diseases, Parasitic ,medicine.medical_treatment ,Asymptomatic ,Diagnosis, Differential ,Pneumonectomy ,Dogs ,Rare Diseases ,Dirofilariasis ,Zoonoses ,Bronchoscopy ,medicine ,Prevalence ,Animals ,Humans ,Dog Diseases ,Dirofilaria ,Aged ,Solitary pulmonary nodule ,Lung ,biology ,business.industry ,Incidence ,Respiratory disease ,Solitary Pulmonary Nodule ,General Medicine ,medicine.disease ,biology.organism_classification ,medicine.anatomical_structure ,Dyspnea ,Female ,France ,Differential diagnosis ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Immunocompetence - Abstract
Summary Introduction Pulmonary dirofilariasis is an uncommon entity. Known as a zoonotic disease it can affect humans as a secondary host. A pseudo-tumor of the lung called “coin” lesion is usually detected while performing a chest X-ray for another reason. Observation We present a case of pulmonary dirofilariasis due to Dirofilaria sp. in a 72 year old immunocompetent patient who underwent surgery for suspicion of a neoplasm. Discussion Human pulmonary dirofilariasis should be evoked in asymptomatic patient from endemic area of canine dirofilariasis presenting with a pseudo tumor of the lung. more...
- Published
- 2005
50. Nocardiosis in a tertiary care hospital on the island of Gran Canaria
- Author
-
Alicia Conde-Martel, Pedro Betancor-León, Marion Hemmersbach-Miller, and A. Bordes-Benı́tez
- Subjects
medicine.medical_specialty ,biology ,business.industry ,medicine.medical_treatment ,Mortality rate ,Nocardiosis ,Immunosuppression ,Nocardia ,medicine.disease ,biology.organism_classification ,Trimethoprim ,Surgery ,Internal medicine ,Epidemiology ,Internal Medicine ,medicine ,Differential diagnosis ,business ,Brain abscess ,medicine.drug - Abstract
Background: Nocardiosis is an uncommon but serious infection increasingly found in immunosuppressed persons. We describe 14 cases of nocardial infection seen at a tertiary hospital. Methods: All positive Nocardia cultures isolated from 1991 to 2002 were included. We analyzed predisposing factors, epidemiological and clinical features, laboratory and radiological findings, site(s) of infection, antimicrobial susceptibility pattern, treatment, and outcome. Factors related to mortality were analyzed. Results: Nineteen patients with a Nocardia isolate were identified and 14 were finally included. The most common predisposing factors included pulmonary diseases (71.4%), diabetes mellitus (35.7%), systemic diseases (28.6%) and immunosuppressive therapy (28.6%). The site of infection was pulmonary in 12 cases (85.71%), cutaneous or subcutaneous in one case (7.1%), and disseminated in another case (7.1%). The predominant clinical symptom was purulent expectoration (71.4%) while the predominant radiological pattern was a reticulonodular infiltrate (6/12, 50%). Relapse was observed in one case (7.7%) and death in three cases (23.1%). Diabetes mellitus was associated with the mortality rate (p=0.035). Treatment was highly individualized, but trimethoprim (TMP)–sulfamethoxazole (SMX) was the combination most often used. Conclusions: Nocardiosis should be part of the differential diagnosis for patients presenting with pulmonary symptoms, soft tissue infection, or brain abscess. more...
- Published
- 2003
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.