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69 results on '"Strasfeld, Lynne"'

55. Impact of a Clostridioides DifficileTesting Computerized Clinical Decision Support Tool on an Adult Stem Cell Transplantation and Hematologic Malignancies Unit

Author

Nix, Chad D., Messer, William B., Hale, Molly L., Lewis, James S., and Strasfeld, Lynne M.

Abstract

•C difficile infection rates in hospitalized hematopoietic stem cell transplant (HSCT) recipients and paitents with hematologic malignancy (HM) are higher than in the general population.•Following implementation of a C difficile testing algorithm with computerized decision support tool on our HSCT/HM unit we observed a >2-fold decrease in C difficile incidence and oral vancomycin use.•Along wiht this decrease in oral vancomycin use we noted a corresponding decline in the incidence of vancomycin-resistant Enterococcus (VRE) colonization and VRE bloodstream infection.

Published
2024
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64. Maribavir prophylaxis for prevention of cytomegalovirus disease in recipients of allogeneic stem-cell transplants: A phase 3, double-blind, placebo-controlled, randomised trial

Author

UCL - (SLuc) Service d'hématologie, Marty, Francisco M, Ljungman, Per, Papanicolaou, Genovefa A, Winston, Drew J, Chemaly, Roy F, Strasfeld, Lynne, Young, Jo-Anne H, Rodriguez, Tulio, Maertens, Johan, Schmitt, Michael, Einsele, Hermann, Ferrant, Augustin, Lipton, Jeffrey H, Villano, Stephen A, Chen, Hongzi, Boeckh, Michael, UCL - (SLuc) Service d'hématologie, Marty, Francisco M, Ljungman, Per, Papanicolaou, Genovefa A, Winston, Drew J, Chemaly, Roy F, Strasfeld, Lynne, Young, Jo-Anne H, Rodriguez, Tulio, Maertens, Johan, Schmitt, Michael, Einsele, Hermann, Ferrant, Augustin, Lipton, Jeffrey H, Villano, Stephen A, Chen, Hongzi, and Boeckh, Michael

Abstract

Background: Available drugs against cytomegalovirus have adverse effects that compromise their prophylactic use in recipients of allogeneic stem-cell transplants. We assessed the safety, tolerability, and antiviral activity of oral maribavir in such patients. Methods: In this placebo-controlled, randomised, double-blind, multicentre phase 3 study, we enrolled adult patients recipient-seropositive or donor-seropositive for cytomegalovirus who had undergone allogeneic stem-cell transplantation. Patients were recruited from 90 centres in Canada, Europe, and the USA. After engraftment, patients were stratified by recipient cytomegalovirus serostatus and conditioning regimen (myeloablative or reduced-intensity) and assigned (2:1) by masked computer-generated randomisation sequence to receive maribavir 100 mg twice daily or placebo for up to 12 weeks, with weekly blood cytomegalovirus surveillance. If the virus was detected, administration of study drug was stopped and pre-emptive anticytomegalovirus treatment started. The primary endpoint was cytomegalovirus disease within 6 months of transplantation. Analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, NCT00411645. Findings: Between December, 2006, and May, 2008, 681 patients were enrolled and assigned to receive maribavir (454) or placebo (227). The incidence of cytomegalovirus disease within 6 months was 20 of 454 (4%) for the maribavir group and 11 of 227 (5%) for the placebo group (OR 0·90; 95% CI 0·42-1·92). During the 100 days following transplantation, cytomegalovirus infection rates as measured by pp65 antigenaemia were lower in the maribavir group (26·4%) than in the placebo group (34·8%; OR 0·67; 0·47-0·95), but not when measured by plasma cytomegalovirus DNA PCR (27·8% vs 30·4%; OR 0·88; 0·62-1·25), nor by initiation of treatment against cytomegalovirus (30·6% vs 37·4%; OR 0·73, 0·52-1·03). Maribavir was well tolerated: most adverse events, including incident acute graft-versu

Published
2011

69. The impact of an intervention to reduce dispersal from wastewater drain sites on carbapenem-resistant Pseudomonas aeruginosa colonization and bloodstream infection on a hematopoietic cell transplant and hematologic malignancy unit.

Author

Fontana L, Hakki M, Ozer EA, Laird A, and Strasfeld L

Subjects
Humans, Retrospective Studies, Carbapenems pharmacology, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Bacteremia prevention & control, Bacteremia microbiology, Bacteremia epidemiology, Cross Infection prevention & control, Cross Infection microbiology, Cross Infection epidemiology, Male, Female, Middle Aged, Adult, Quality Improvement, Meropenem pharmacology, Meropenem therapeutic use, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa isolation & purification, Hematopoietic Stem Cell Transplantation adverse effects, Pseudomonas Infections prevention & control, Pseudomonas Infections epidemiology, Wastewater microbiology, Hematologic Neoplasms
Abstract

Objective: To evaluate the impact of an intervention to limit dispersal from wastewater drain (WWD) sites on meropenem-nonsusceptible Pseudomonas aeruginosa patient and environmental colonization and bloodstream infection (BSI) on a hematopoietic cell transplant (HCT) and hematologic malignancy (HM) unit., Design: This quasi-experimental study included pre/postintervention point-prevalence surveys in July 2019 and June 2020, respectively. The retrospective cohort included HCT/HM patients with P. aeruginosa BSI between 2012 and 2022., Setting: Adult HCT/HM unit at an academic center., Participants: This study included consenting HCT/HM patients on the unit at the time of the point-prevalence surveys. HCT/HM patients with P. aeruginosa BSI between 2012 and 2022., Methods: A quality improvement intervention targeting WWD sites was conceived and implemented on a HCT/HM unit. Pre and postintervention colonization samples were obtained from patients and environmental sites, cultivated on selective media, then characterized by susceptibility testing. Whole-genome sequencing and phylogenetic analysis were performed on select isolates. The impact of the intervention on colonization and BSI was evaluated, as was relatedness among isolates., Results: Although colonization of WWD sites with meropenem-nonsusceptible P. aeruginosa was widespread before and after this intervention, we observed a substantial decline in patient colonization (prevalence rate ratio, 0.35; 95% confidence interval [CI], 0.04-3.12) and BSI (incidence rate ratio, 0.67; 95% CI, 0.31-1.42) after the intervention. Among 3 predominant sequence types (ST-111, ST-446, and ST-308), there was striking genetic conservation within groups and among environmental colonization, patient colonization, and BSI isolates., Conclusions: An intervention targeting WWD sites on a HCT/HM unit had a meaningful impact on meropenem-nonsusceptible P. aeruginosa patient colonization and BSI.

Published
2024
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