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152. Screening for Asymptomatic Clostridioides difficileCarriage Among Hospitalized Patients: A Narrative Review

Author

Gilboa, Mayan, Baharav, Nadav, Melzer, Eyal, Regev-Yochay, Gili, and Yahav, Dafna

Abstract

Clostridioides difficileinfection (CDI) has become the most common healthcare-associated infection in the United States, with considerable morbidity, mortality, and healthcare costs. Assessing new preventive strategies is vital. We present a literature review of studies evaluating a strategy of screening and isolation of asymptomatic carriers in hospital settings. Asymptomatic detection of C. difficileis reported in ~ 10–20% of admitted patients. Risk factors for carriage include recent hospitalization, previous antibiotics, older age, lower functional capacity, immunosuppression, and others. Asymptomatic C. difficilecarriers of toxigenic strains are at higher risk for progression to CDI. They are also shedders of C. difficilespores and may contribute to the persistence and transmission of this bacterium. Screening for asymptomatic carriers at hospital admission can theoretically reduce CDI by isolating carriers to reduce transmission, and implementing antibiotic stewardship measures targeting carriers to prevent progression to clinical illness. Several observational studies, summarized in this review, have reported implementing screening and isolation strategies, and found a reduction in CDI rates. Nevertheless, the data are still limited to a few observational studies, and this strategy is not commonly practiced. Studies supporting screening were performed in North America, coinciding with the period of dominance of the 027/BI/NAP1 strain. Additional studies evaluating screening, followed by infection control and antibiotic stewardship measures, are needed.

Published
2023
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156. Effectiveness and safety of colistin among older adults: a systematic review and meta-analysis.

Author

Margalit, Ili, Prendki, Virginie, Tishler, Ori, Falcone, Marco, Tiseo, Giusy, Leibovici-Weissman, Yaara, Paul, Mical, Yahav, Dafna, (ESGIE), ESCMID Study Group for Infections in the Elderly, and ESCMID Study Group for Infections in the Elderly (ESGIE)

Subjects
COLISTIN, META-analysis, SYSTEMATIC reviews, ACUTE kidney failure
Abstract

Objectives: Limited data are available to guide colistin use in older adults (>65 years old). We aimed to assess the effectiveness and safety of colistin in this population.Methods: Systematic review and meta-analysis of original data from randomized control trials, cohort studies and case-control studies assessing colistin regimens with various comparisons for any infection. Original data were obtained from corresponding authors of original studies. The primary outcome was all-cause 1 month mortality; secondary outcomes included clinical and microbiological outcomes and adverse events, including acute kidney injury. Two independent reviewers screened citations, extracted data and assessed risk of bias. ORs with 95% CIs were pooled.Results: We included 38 publications (41 comparisons) reporting 2857 elderly individuals: 29 studies compared a colistin-based regimen versus another regimen (comparison 1) and 10 compared colistin monotherapy versus colistin combination (comparison 2). No significant difference in 1 month mortality was demonstrated between colistin and comparator (comparison 1, OR 1.13, 95% CI 0.80-1.60; comparison 2, OR 0.99, 95% CI 0.78-1.27). Clinical failure was significantly more likely with colistin-based therapy versus comparator (OR 1.52, 95% CI 1.13-2.06). Acute kidney injury was also significantly more common with colistin-based combinations versus other drugs (OR 3.81, 95% CI 2.14-6.77).Conclusions: For older adults, colistin-based therapy resulted in no mortality difference, compared with other regimens, for any infection. Clinical failure and acute kidney injury were significantly more common with colistin-based regimens. Close renal function monitoring is needed while using colistin in older adults. [ABSTRACT FROM AUTHOR]

Published
2022
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157. The clinical value of the endocarditis team: insights from before and after guidelines implementation strategy

Author

Elad, Boaz, primary, Perl, Leor, additional, Hamdan, Ashraf, additional, Yahav, Dafna, additional, Atamna, Alaa, additional, Shaked, Hila, additional, Rubchevsky, Victor, additional, Sharony, Ram, additional, Bernstine, Hanna, additional, Shapira, Yaron, additional, Vaturi, Mordehay, additional, Ofek, Hadas, additional, Sagie, Alexander, additional, Kornowski, Ran, additional, and Orvin, Katia, additional

Published
2021
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160. Combination versus monotherapy as definitive treatment for Pseudomonas aeruginosa bacteraemia: a multicentre retrospective observational cohort study

Author

Babich, Tanya, primary, Naucler, Pontus, additional, Valik, John Karlsson, additional, Giske, Christian G, additional, Benito, Natividad, additional, Cardona, Ruben, additional, Rivera, Alba, additional, Pulcini, Celine, additional, Abdel Fattah, Manal, additional, Haquin, Justine, additional, MacGowan, Alasdair, additional, Grier, Sally, additional, Gibbs, Julie, additional, Chazan, Bibiana, additional, Yanovskay, Anna, additional, Ami, Ronen Ben, additional, Landes, Michal, additional, Nesher, Lior, additional, Zaidman-Shimshovitz, Adi, additional, McCarthy, Kate, additional, Paterson, David L, additional, Tacconelli, Evelina, additional, Buhl, Michael, additional, Mauer, Susanna, additional, Rodriguez-Bano, Jesus, additional, Morales, Isabel, additional, Oliver, Antonio, additional, Ruiz de Gopegui, Enrique, additional, Cano, Angela, additional, Machuca, Isabel, additional, Gozalo-Marguello, Monica, additional, Martinez, Luis Martinez, additional, Gonzalez-Barbera, Eva M, additional, Alfaro, Iris Gomez, additional, Salavert, Miguel, additional, Beovic, Bojana, additional, Saje, Andreja, additional, Mueller-Premru, Manica, additional, Pagani, Leonardo, additional, Vitrat, Virginie, additional, Kofteridis, Diamantis, additional, Zacharioudaki, Maria, additional, Maraki, Sofia, additional, Weissman, Yulia, additional, Paul, Mical, additional, Dickstein, Yaakov, additional, Leibovici, Leonard, additional, and Yahav, Dafna, additional

Published
2021
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163. Desirability of Outcome Ranking Analysis of a Randomized Clinical Trial Comparing Seven Versus Fourteen Days of Antibiotics for Uncomplicated Gram-Negative Bloodstream Infection.

Author

Howard-Anderson, Jessica, Dai, Weixiao, Yahav, Dafna, Hamasaki, Toshimitsu, Turjeman, Adi, Koppel, Fidi, Franceschini, Erica, Hill, Carol, Sund, Zoë, Chambers, Henry F, Fowler, Vance G, Boucher, Helen W, Evans, Scott R, Paul, Mical, Holland, Thomas L, and Doernberg, Sarah B

Subjects
CLINICAL trials, GRAM-negative bacteria, GRAM-negative bacterial diseases, ANTIBIOTIC prophylaxis, CREDIT analysis, ANTIBIOTICS
Abstract

Background Although a short course (7 days) of antibiotics has been demonstrated to be noninferior to a conventional course (14 days) in terms of mortality and infectious complications for patients with a Gram-negative bacterial bloodstream infection (GNB), it is unknown whether a shorter treatment duration can provide a better overall clinical outcome. Methods We applied a bloodstream infection-specific desirability of outcome ranking (DOOR) analysis to the results of a previously completed, randomized controlled trial comparing short versus conventional course antibiotic therapy for hospitalized patients with uncomplicated GNB. We determined the probability that a randomly selected participant in the short course group would have a more desirable overall outcome than a participant in the conventional duration group. We performed (1) partial credit analyses allowing for calculated and variable weighting of DOOR ranks and (2) subgroup analyses to elucidate which patients may benefit the most from short durations of therapy. Results For the 604 patients included in the original study (306 short course, 298 conventional course), the probability of having a more desirable outcome with a short course of antibiotics compared with a conventional course was 51.1% (95% confidence interval, 46.7% to 55.4%), indicating no significant difference. Partial credit analyses indicated that the DOOR results were similar across different patient preferences. Prespecified subgroup analyses using DOOR did not reveal significant differences between short and conventional courses of therapy. Conclusions Both short and conventional durations of antibiotic therapy provide comparable clinical outcomes when using DOOR to consider benefits and risks of treatment options for GNB. [ABSTRACT FROM AUTHOR]

Published
2022
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167. Relevance of intra-hospital patient movements for the spread of healthcare-associated infections within hospitals - a mathematical modeling study

Author

Tahir, Hannan, primary, López-Cortés, Luis Eduardo, additional, Kola, Axel, additional, Yahav, Dafna, additional, Karch, André, additional, Xia, Hanjue, additional, Horn, Johannes, additional, Sakowski, Konrad, additional, Piotrowska, Monika J., additional, Leibovici, Leonard, additional, Mikolajczyk, Rafael T., additional, and Kretzschmar, Mirjam E., additional

Published
2021
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169. Piperacillin–tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen)

Author

Bitterman, Roni, primary, Koppel, Fidi, additional, Mussini, Cristina, additional, Geffen, Yuval, additional, Chowers, Michal, additional, Rahav, Galia, additional, Nesher, Lior, additional, Ben-Ami, Ronen, additional, Turjeman, Adi, additional, Huberman Samuel, Maayan, additional, Cheng, Matthew P, additional, Lee, Todd C, additional, Leibovici, Leonard, additional, Yahav, Dafna, additional, and Paul, Mical, additional

Published
2021
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175. Prediction of bacteremia using TREAT, a computerized decision-support system

Author

Paul, Mical, Andreassen, Steen, Nielsen, Anders D., Tacconelli, Evelina, Almanasreh, Nadja, Fraser, Abigail, Yahav, Dafna, Ram, Ron, and Leibovici, Leonard

Subjects
Bacteremia -- Diagnosis, Bacteremia -- Risk factors, Bacteremia -- Economic aspects, Medical protocols -- Usage, Medical protocols -- Technology application, Decision support systems -- Usage, Decision support systems -- Research, Decision support software, Technology application, Health, Health care industry
Published
2006

183. Colistin plus meropenem for carbapenem-resistant Gram-negative infections: in vitro synergism is not associated with better clinical outcomes

Author

Nutman, Amir, primary, Lellouche, Jonathan, additional, Temkin, Elizabeth, additional, Daikos, George, additional, Skiada, Anna, additional, Durante-Mangoni, Emanuele, additional, Dishon-Benattar, Yael, additional, Bitterman, Roni, additional, Yahav, Dafna, additional, Daitch, Vered, additional, Bernardo, Mariano, additional, Iossa, Domenico, additional, Zusman, Oren, additional, Friberg, Lena E., additional, Mouton, Johan W., additional, Theuretzbacher, Ursula, additional, Leibovici, Leonard, additional, Paul, Mical, additional, Carmeli, Yehuda, additional, Benattar, Yael Dishon, additional, Dickstein, Yaakov, additional, Zayyad, Hiba, additional, Koppel, Fidi, additional, Zak-Doron, Yael, additional, Altunin, Sergey, additional, Andria, Nizar, additional, Neuberger, Ami, additional, Stern, Anat, additional, Petersiel, Neta, additional, Raines, Marina, additional, Karban, Amir, additional, Eliakim-Raz, Noa, additional, Elbaz, Michal, additional, Atamna, Heyam, additional, Babich, Tanya, additional, Nutman, Amir, additional, Adler, Amos, additional, Levi, Inbar, additional, Daikos, George L., additional, Pavleas, Ioannis, additional, Antoniadou, Anastasia, additional, Kotsaki, Antigoni, additional, Andini, Roberto, additional, Cavezza, Giusi, additional, Bertolino, Lorenzo, additional, Giuffre, Giuseppe, additional, Giurazza, Roberto, additional, Cuccurullo, Susanna, additional, Galdo, Maria, additional, Murino, Patrizia, additional, Cristinziano, Adriano, additional, Corcione, Antonio, additional, Zampino, Rosa, additional, Pafundi, Pia Clara, additional, Mouton, Johan, additional, Friberg, Lena, additional, and Kristoffersson, Anders, additional

Published
2020
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188. Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study

Author

Babich, Tanya, primary, Naucler, Pontus, additional, Valik, John Karlsson, additional, Giske, Christian G., additional, Benito, Natividad, additional, Cardona, Ruben, additional, Rivera, Alba, additional, Pulcini, Celine, additional, Fattah, Manal Abdel, additional, Haquin, Justine, additional, MacGowan, Alasdair, additional, Grier, Sally, additional, Chazan, Bibiana, additional, Yanovskay, Anna, additional, Ami, Ronen Ben, additional, Landes, Michal, additional, Nesher, Lior, additional, Zaidman-Shimshovitz, Adi, additional, McCarthy, Kate, additional, Paterson, David L., additional, Tacconelli, Evelina, additional, Buhl, Michael, additional, Maurer, Susanna, additional, Rodriguez-Bano, Jesus, additional, Morales, Isabel, additional, Oliver, Antonio, additional, de Gopegui, Enrique Ruiz, additional, Cano, Angela, additional, Machuca, Isabel, additional, Gozalo-Marguello, Monica, additional, Martinez-Martinez, Luis, additional, Gonzalez-Barbera, Eva M., additional, Alfaro, Iris Gomez, additional, Salavert, Miguel, additional, Beovic, Bojana, additional, Saje, Andreja, additional, Mueller-Premru, Manica, additional, Pagani, Leonardo, additional, Vitrat, Virginie, additional, Kofteridis, Diamantis, additional, Zacharioudaki, Maria, additional, Maraki, Sofia, additional, Weissman, Yulia, additional, Paul, Mical, additional, Dickstein, Yaakov, additional, Leibovici, Leonard, additional, and Yahav, Dafna, additional

Published
2020
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193. Flavobacteriaceae Bacteremia in Children

Author

Cooper, Shiri, primary, Levy, Itzhak, additional, Ben-Zvi, Haim, additional, Ashkenazi-Hoffnung, Liat, additional, Ben-Shimol, Shalom, additional, Shachor-Meyouhas, Yael, additional, Grisaru-Soen, Galia, additional, Kriger, Or, additional, Yahav, Dafna, additional, and Scheuerman, Oded, additional

Published
2019
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196. Cochrane Column

Author

Ojukwu, Juliana U, Okebe, Joseph U, Yahav, Dafna, and Paul, Mical

Published
2010

200. Good Studies Evaluate the Disease While Great Studies Evaluate the Patient: Development and Application of a Desirability of Outcome Ranking Endpoint for Staphylococcus aureus Bloodstream Infection

Author

Doernberg, Sarah B, Tran, Thuy Tien Tram, Tong, Steven YC, Paul, Mical, Yahav, Dafna, Davis, Joshua S, Leibovici, Leonard, Boucher, Helen W, Corey, G Ralph, Cosgrove, Sara E, Chambers, Henry F, Fowler, Vance G, Evans, Scott R, Holland, Thomas L, and Antibacterial Resistance Leadership Group

Subjects
Adult, Methicillin-Resistant Staphylococcus aureus, Staphylococcus aureus, Clinical Trials and Supportive Activities, Antibacterial Resistance Leadership Group, Bacteremia, bloodstream infection, clinical trial, Staphylococcal Infections, Biological Sciences, Survival Analysis, Medical and Health Sciences, Microbiology, Anti-Bacterial Agents, Emerging Infectious Diseases, Infectious Diseases, Good Health and Well Being, Risk Factors, Clinical Research, Surveys and Questionnaires, Humans, Multicenter Studies as Topic, Infection, Randomized Controlled Trials as Topic
Abstract

BackgroundDesirability of outcome ranking (DOOR) is an innovative approach in clinical trials to evaluate the global benefits and risks of an intervention. We developed and validated a DOOR endpoint for Staphylococcus aureus bloodstream infection (BSI) through a survey to infectious diseases clinicians and secondary analysis of trial data.MethodsWe administered a survey of 20 cases of S. aureus BSI, asking respondents to rank outcomes by global desirability. Correlations and percentage of pairwise agreement among rankings were estimated to inform development of a DOOR endpoint, which was applied to 2 prior S. aureus BSI trials. The probability that a patient randomly assigned to experimental treatment would have a better DOOR ranking than if assigned to control was estimated. Results were also analyzed using partial credit, which is analogous to scoring an academic test, assigning 100% to the most desirable outcome, 0% to the least, and "partial credit" to intermediate ranks.ResultsForty-two recipients (97%) completed the survey. The DOOR endpoint fitting these rankings (r = 0.89; 95% confidence interval, 0.67 to 0.94) incorporated survival plus cumulative occurrence of adverse events, cure, infectious complications, and ongoing symptoms. Tailored versions of this endpoint were applied to 2 S. aureus BSI trials, and both demonstrated no benefit of the experimental treatment using DOOR and partial credit analysis.ConclusionsUsing S. aureus BSI as an exemplar, we developed a DOOR endpoint that can be used as a template for development of DOOR endpoints for other diseases. Future trials can incorporate DOOR to allow for global assessment of patient experience.

Published
2019

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