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2. Seroprevalence du SRAS-CoV-2 chez les travailleurs de la sante de 10 hopitaux du Quebec, au Canada : etude transversale

Author

Brousseau, Nicholas, Morin, Laurianne, Ouakki, Manale, Savard, Patrice, Quach, Caroline, Longtin, Yves, Cheng, Matthew P., Carignan, Alex, Dufresne, Simon F., Leduc, Jean-Michel, Lavallee, Christian, Gauthier, Nicolas, Bestman-Smith, Julie, Arrieta, Maria-Jesus, Ishak, Magued, Levesque, Simon, Martin, Philippe, and De Serres, Gaston

Subjects
Health
Abstract

Contexte : La pandemie de COVID-19 a affecte de maniere disproportionnee les travailleurs de la sante. Nous avons voulu mesurer la seroprevalence du SRAS-CoV-2 chez les travailleurs de la sante dans les hopitaux du Quebec, au Canada, apres la premiere vague de la pandemie, afin d'explorer les facteurs associes a la SRAS-CoV-2-seropositivite. Methodes : Entre le 6 juillet et le 24 septembre 2020, nous avons recrute des travailleurs de la sante de 10 hopitaux, dont 8 d'une region ou l'incidence de la COVID-19 etait elevee (region de Montreal) et 2 de regions du Quebec ou l'incidence etait faible. Les travailleurs de la sante admissibles etaient des medecins, des infirmieres, des preposees aux beneficiaires et des proposes a l'entretien menager travaillant dans 4 types d'unite de soins (urgences, soins intensifs, unite hospitaliere COVID-19 et unite hospitaliere non-COVID-19). Les participants ont repondu a un questionnaire et subi un depistage serologique du SRAS-CoV-2. Nous avons identifie les facteurs ayant un lien independant avec une seroprevalence plus elevee. Resultats : Parmi les 2056 travailleurs de la sante recrutes, 241 (11,7%) se sont reveles SRAS-CoV-2-positifs. Parmi eux, 171 (71,0%) avaient deja requ un diagnostic de COVID-19. La seroprevalence a varie d'un hopital a l'autre, de 2,4%-3,7% dans les regions ou l'incidence etait faible, a 17,9%-32,0% dans les hopitaux ayant connu des eclosions touchant 5 travailleurs de la sante ou plus. La seroprevalence plus elevee a ete associee au fait de travailler dans un hopital ou des eclosions sont survenues (rapport de prevalence ajuste 4,16, intervalle de confiance [IC] a 95% 2,63-6,57), au fait d'etre infirmiere ou auxiliaire (rapport de prevalence ajuste 1,34, IC a 95% 1,03-1,74), preposee aux beneficiaires (rapport de prevalence ajuste 1,49, IC a 95% 1,12-1,97) et d'ethnicite noire ou hispanique (rapport de prevalence ajuste 1,41, IC a 95% 1,131,76). La seroprevalence moindre a ete associee au fait de travailler dans une unite de soins intensifs (rapport de prevalence ajuste 0,47, IC a 95% 0,30-0,71) ou aux urgences (rapport de prevalence ajuste 0,61, IC a 95% 0,39-0,98). Interpretation : Les travailleurs de la sante des hopitaux du Quebec ont ete exposes a un risque eleve d'infection par le SRAS-CoV-2, particulierement lors des eclosions. Il faudra travailler a mieux comprendre la dynamique de la transmission du SRAS-CoV-2 dans les milieux de soins., La pandemie de COVID-19 a affecte de maniere disproportionnee les travailleurs de la sante. En France, en Espagne, en Italie, en Allemagne et aux Etats-Unis, au moins 10% des cas [...]

Published
2022
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3. Breakthrough Invasive Fungal Infections in Patients With High-Risk Hematological Disorders Receiving Voriconazole and Posaconazole Prophylaxis: A Systematic Review.

Author

Boutin, Catherine-Audrey, Durocher, Florence, Beauchemin, Stéphanie, Ziegler, Daniela, Chakra, Claire Nour Abou, and Dufresne, Simon Frédéric

Subjects
MYCOSES, ANTIFUNGAL agents, MEDICAL information storage & retrieval systems, GREY literature, CANDIDA, RESEARCH funding, DRUG resistance in microorganisms, CINAHL database, FUNGI, SYSTEMATIC reviews, MEDLINE, ASPERGILLUS, BLOOD diseases, VORICONAZOLE, TREATMENT failure, DISEASE risk factors
Abstract

Background Primary antifungal prophylaxis with mold-active azoles is used to prevent invasive fungal infections in patients with high-risk hematological disorders; however, breakthrough infections occur, and the reasons for treatment failure are still not fully understood. To help inform clinical decisions, we sought to define microbiological, clinical, and pharmacological characteristics of proven and probable breakthrough invasive fungal infections (bIFIs) in patients with high-risk hematological disorders receiving voriconazole or posaconazole prophylaxis. Methods We performed a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy was last conducted on 19 April 2023. Results We assessed 5293 studies for eligibility, and 300 were selected for data extraction. These studies described 1076 cases of bIFIs occurring under voriconazole (42.5%) or posaconazole (57.5%). The most commonly found pathogens were Aspergillus (40%), Mucorales (20%), Candida (18%), and Fusarium (9%) species. Mucorales were more frequent among voriconazole-emerging cases, whereas Aspergillus and Fusarium were more prevalent among posaconazole-emerging cases. Definitive, putative, or probable antifungal resistance was found in 31% of cases. Therapeutic drug monitoring showed subtherapeutic azole concentration in 32 of 90 (36%) cases. Infection-related mortality was reported in 117 cases and reached 35%. Conclusions In our systemic review, the most common bIFIs were aspergillosis, mucormycosis, candidiasis, and fusariosis. Antifungal resistance explains only a minority of cases. Subtherapeutic prophylaxis was frequent but rarely reported. Prospective studies are needed to better understand these infections and to establish optimal management. [ABSTRACT FROM AUTHOR]

Published
2024
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5. SARS-CoV-2 seroprevalence in health care workers from 10 hospitals in Quebec, Canada: a cross-sectional study

Author

Brousseau, Nicholas, Morin, Laurianne, Ouakki, Manale, Savard, Patrice, Quach, Caroline, Longtin, Yves, Cheng, Matthew P., Carignan, Alex, Dufresne, Simon F., Leduc, Jean-Michel, Lavallee, Christian, Gauthier, Nicolas, Bestman-Smith, Julie, Arrieta, Maria-Jesus, Ishak, Magued, Levesque, Simon, Martin, Philippe, and De Serres, Gaston

Subjects
Quebec -- Health aspects, Epidemics -- Statistics -- Risk factors -- Canada, Medical personnel -- Statistics -- Health aspects, Health
Abstract

Background: The COVID-19 pandemic has disproportionately affected health care workers. We sought to estimate SARS-CoV-2 seroprevalence among hospital health care workers in Quebec, Canada, after the first wave of the pandemic and to explore factors associated with SARS-CoV-2 seropositivity. Methods: Between July 6 and Sept. 24, 2020, we enrolled health care workers from 10 hospitals, including 8 from a region with a high incidence of COVID-19 (the Montreal area) and 2 from low-incidence regions of Quebec. Eligible health care workers were physicians, nurses, orderlies and cleaning staff working in 4 types of care units (emergency department, intensive care unit, COVID-19 inpatient unit and non-COVID-19 inpatient unit). Participants completed a questionnaire and underwent SARS-CoV-2 serology testing. We identified factors independently associated with higher seroprevalence. Results: Among 2056 enrolled health care workers, 241 (11.7%) had positive SARS-CoV-2 serology. Of these, 171 (71.0%) had been previously diagnosed with COVID-19. Seroprevalence varied among hospitals, from 2.4% to 3.7% in low-incidence regions to 17.9% to 32.0% in hospitals with outbreaks involving 5 or more health care workers. Higher seroprevalence was associated with working in a hospital where outbreaks occurred (adjusted prevalence ratio 4.16, 95% confidence interval [CI] 2.63-6.57), being a nurse or nursing assistant (adjusted prevalence ratio 1.34, 95% CI 1.03-1.74) or an orderly (adjusted prevalence ratio 1.49, 95% CI 1.12-1.97), and Black or Hispanic ethnicity (adjusted prevalence ratio 1.41, 95% CI 1.13-1.76). Lower seroprevalence was associated with working in the intensive care unit (adjusted prevalence ratio 0.47, 95% CI 0.30-0.71) or the emergency department (adjusted prevalence ratio 0.61, 95% CI 0.39-0.98). Interpretation: Health care workers in Quebec hospitals were at high risk of SARS-CoV-2 infection, particularly in outbreak settings. More work is needed to better understand SARS-CoV-2 transmission dynamics in health care settings., The COVID-19 pandemic has disproportionately affected health care workers. In France, Spain, Italy, Germany and the United States, at least 10% of cases reported in spring 2020 were in health [...]

Published
2021
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6. UM171-Expanded Cord Blood Transplants Support Robust T Cell Reconstitution with Low Rates of Severe Infections

Author

Dumont-Lagacé, Maude, Li, Qi, Tanguay, Mégane, Chagraoui, Jalila, Kientega, Tibila, Cardin, Guillaume B., Brasey, Ann, Trofimov, Assya, Carli, Cédric, Ahmad, Imran, Bambace, Nadia M., Bernard, Léa, Kiss, Thomas L., Roy, Jean, Roy, Denis-Claude, Lemieux, Sébastien, Perreault, Claude, Rodier, Francis, Dufresne, Simon Frédéric, Busque, Lambert, Lachance, Silvy, Sauvageau, Guy, Cohen, Sandra, and Delisle, Jean-Sébastien

Published
2020
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7. Epstein–Barr Virus Monitoring after an Allogeneic Hematopoietic Stem Cell Transplant: Review of the Recent Data and Current Practices in Canada.

Author

Ratiu, Claire, Dufresne, Simon F., Thiant, Stéphanie, and Roy, Jean

Subjects
*STEM cell transplantation, *HEMATOPOIETIC stem cells, *EPSTEIN-Barr virus, *HEMATOPOIETIC stem cell transplantation, *LITERATURE reviews, *LYMPHOPROLIFERATIVE disorders
Abstract

Epstein–Barr virus-related post-transplantation lymphoproliferative disorder (EBV-PTLD) is a serious complication following hematopoietic stem cell transplantation (HSCT). A pre-emptive strategy using rituximab, which aims to manage patients early at the time of EBV reactivation to avoid PTLD, has been recommended by the most recent ECIL-6 guidelines in 2016. However, there is still a great heterogeneity of viral-load monitoring protocols, targeted patient populations, and pre-emptive treatment characteristics between centers, making precise EBV monitoring recommendations difficult. We conducted a literature review from the most recent publications between 1 January 2015 and 1 August 2023, to summarize the emerging data on EBV-PTLD prevention strategies in HSCT recipients, including the EBV-DNA threshold and use of rituximab. We also present the results of a survey of current practices carried out in 12 of the main HSCT centers across Canada. We confirm that pre-emptive rituximab remains an efficient strategy for EBV-PTLD prevention. However, there is an urgent need to perform prospective, randomized, multicentric trials with larger numbers of patients reflecting current practices to determine the best clinical conduct with regards to rituximab dosing, timing of treatment, and criteria to initiate treatments. Longer follow-ups will also be necessary to assess patients' long-term outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Real-life comparison of posaconazole versus fluconazole for primary antifungal prophylaxis during remission-induction chemotherapy for acute leukemia

Author

Dufresne, Simon F, Bergeron, Julie, Beauchemin, Stéphanie, Abou Chakra, Claire Nour, Vadnais, Barbara, Bouchard, Philippe, Labbé, Annie-Claude, and Laverdière, Michel

Subjects
Microbiology (medical), Infectious Diseases, Original Research
Abstract

Background: Patients undergoing remission-induction intensive chemotherapy for acute leukemia are at high risk for life-threatening invasive fungal infections (IFIs). Primary antifungal prophylaxis with posaconazole has been shown to reduce the incidence of IFI compared to fluconazole, but real-life data are limited and the effect on mortality remains unclear. Methods: This retrospective cohort study compared fluconazole and posaconazole as primary prophylaxis in real-life practice over a 10-year period, in a Canadian hospital. Results: A total of 299 episodes were included (fluconazole, n = 98; posaconazole, n = 201), of which 68% were first inductions. The underlying hematologic malignancy was acute myeloid leukemia or myelodysplastic syndrome in 88% of episodes and acute lymphoblastic leukemia in 9%. Overall, 20 cases of IFI occurred (aspergillosis, n = 17; candidiasis, n = 3) and 14 were considered as breakthrough IFI. IFI incidence was significantly lower in the posaconazole group (3.5% versus 13.2%; p = 0.001). Empirical or targeted antifungal therapy was also reduced in the posaconazole cohort. Mortality was similar in both groups. Conclusions: In a real-life setting in Canada, primary posaconazole prophylaxis reduces the incidence of IFI during remission-induction chemotherapy, compared to fluconazole.

Published
2023
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14. Epidemiology and Disease Burden of Mucormycosis in Canada: Canmus Registry

Author

Haider, Shariq, primary, Mah, Allison, additional, Buchan, C.Arianne, additional, Vinh, Donald, additional, Bai, Tony D, additional, Bow, Eric, additional, Cheng, Matthew P, additional, Dufresne, Phillipe, additional, Dufresne, Simon Frédéric, additional, Faulkner, Jodi, additional, Husain, Shahid, additional, Luong, Me-Linh, additional, Robinson, Stephen, additional, Sanche, Stephen, additional, Schwartz, Ilan, additional, Shalhoub, Sarah, additional, Vanniyasingam, Thuva, additional, and Rotstein, Coleman, additional

Published
2022
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17. Multicenter Evaluation of Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) Spectroscopy-Based Method for Rapid Identification of Clinically Relevant Yeasts

Author

Lam, Lisa M. T., primary, Ismail, Ashraf A., additional, Lévesque, Simon, additional, Dufresne, Simon F., additional, Cheng, Mathew P., additional, Vallières, Émilie, additional, Luong, Me-Linh, additional, Sedman, Jacqueline, additional, and Dufresne, Philippe J., additional

Published
2022
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18. Face Transplant: Current Update and First Canadian Experience: Correction

Author

Govshievich, Alexander, primary, Saleh, Eli, additional, Boghossian, Elie, additional, Collette, Suzon, additional, Desy, Delphine, additional, Dufresne, Simon, additional, St-Jacques, Helen, additional, Chollet, Andre, additional, Tremblay, Dominique, additional, Guertin, Charles, additional, Tardif, Michele, additional, Poirier, Jean, additional, Ayad, Tareck, additional, Rahal, Akram, additional, Lin, Jenny C., additional, and Borsuk, Daniel E., additional

Published
2021
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21. UM171-Expanded Cord Blood Transplants Support Robust T Cell Reconstitution with Low Rates of Severe Infections

Author

Dumont-Lagacé, Maude, primary, Li, Qi, additional, Tanguay, Mégane, additional, Chagraoui, Jalila, additional, Kientega, Tibila, additional, Cardin, Guillaume B., additional, Brasey, Ann, additional, Trofimov, Assya, additional, Carli, Cédric, additional, Ahmad, Imran, additional, Bambace, Nadia M., additional, Bernard, Léa, additional, Kiss, Thomas L., additional, Roy, Jean, additional, Roy, Denis-Claude, additional, Lemieux, Sébastien, additional, Perreault, Claude, additional, Rodier, Francis, additional, Dufresne, Simon Frédéric, additional, Busque, Lambert, additional, Lachance, Silvy, additional, Sauvageau, Guy, additional, Cohen, Sandra, additional, and Delisle, Jean-Sébastien, additional

Published
2021
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25. Single UM171‐Expanded Cord Blood Transplants Support Robust T‐Cell Reconstitution with Low Rates of Severe Infections

Author

Dumont‐Lagacé, Maude, primary, Li, Qi, additional, Tanguay, Mégane, additional, Chagraoui, Jalila, additional, Kientega, Tibila, additional, Cardin, Guillaume B., additional, Brasey, Ann, additional, Trofimov, Assya, additional, Carli, Cédric, additional, Ahmad, Imran, additional, Bambace, Nadia, additional, Bernard, Léa, additional, Kiss, Thomas L., additional, Roy, Jean, additional, Roy, Denis‐Claude, additional, Lemieux, Sébastien, additional, Perreault, Claude, additional, Rodier, Francis, additional, Dufresne, Simon Frédéric, additional, Busque, Lambert, additional, Lachance, Silvy, additional, Sauvageau, Guy, additional, Cohen, Sandra, additional, and Delisle, Jean‐Sébastien, additional

Published
2020
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32. Prevalence and mechanisms of azole resistance in clinical isolates of Aspergillus section Fumigati species in a Canadian tertiary care centre, 2000 to 2013.

Author

Parent-Michaud, Maxime, Dufresne, Philippe J, Fournier, Eric, Folch, Benjamin, Martineau, Christine, Moreira, Sandrine, Doucet, Nicolas, Repentigny, Louis De, Dufresne, Simon F, and De Repentigny, Louis

Subjects
PULMONARY aspergillosis, ASPERGILLUS, TERTIARY care, ASPERGILLUS fumigatus, FUNGICIDE resistance, SPECIES, ANTIFUNGAL agents, PROTEINS, RESEARCH, SPECIALTY hospitals, HETEROCYCLIC compounds, RESEARCH methodology, MEDICAL cooperation, EVALUATION research, COMPARATIVE studies, DISEASE prevalence, RESEARCH funding, DRUG resistance in microorganisms, MICROBIAL sensitivity tests, PHARMACODYNAMICS
Abstract

Objectives: Azole resistance among Aspergillus fumigatus isolates is a growing concern worldwide. Induction of mutations during azole therapy, environment-acquired mutations caused by azole fungicides and intrinsic resistance of cryptic Fumigati species all contribute to the burden of resistance. However, there is a lack of data in Canada on this emerging threat.Methods: To gain insights into the magnitude and mechanisms of resistance, a 14 year collection of Aspergillus section Fumigati comprising 999 isolates from 807 patients at a Montreal hospital was screened for azole resistance, and resistance mechanisms were investigated with the combined use of genome sequencing, 3D modelling and phenotypic efflux pump assays.Results: Overall azole resistance was low (4/807 patients; 0.5%). A single azole-resistant A. fumigatus sensu stricto strain, isolated from a patient with pulmonary aspergillosis, displayed efflux-pump-mediated resistance. Three patients were colonized or infected with azole-resistant cryptic Fumigati species (one Aspergillus thermomutatus, one Aspergillus lentulus and one Aspergillus turcosus). Evidence is presented that azole resistance is efflux-pump-mediated in the A. turcosus isolate, but not in the A. lentulus and A. thermomutatus isolates.Conclusions: Azole resistance is rare in our geographic area and currently driven by cryptic Fumigati species. Continued surveillance of emergence of resistance is warranted. [ABSTRACT FROM AUTHOR]

Published
2020
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37. UM171-Expanded Cord Blood Transplants Support Robust T Cell Reconstitution with Low Rates of Severe Infections

Author

Dumont-Lagacé, Maude, Li, Qi, Tanguay, Mégane, Chagraoui, Jalila, Kientega, Tibila, Cardin, Guillaume B., Brasey, Ann, Trofimov, Assya, Carli, Cédric, Ahmad, Imran, Bambace, Nadia M., Bernard, Léa, Kiss, Thomas L., Roy, Jean, Roy, Denis-Claude, Lemieux, Sébastien, Perreault, Claude, Rodier, Francis, Dufresne, Simon Frédéric, Busque, Lambert, Lachance, Silvy, Sauvageau, Guy, Cohen, Sandra, and Delisle, Jean-Sébastien

Abstract

•Recipients of UM171-expanded cord blood show robust T cell reconstitution.•Recipients of UM171 grafts show high T cell receptor repertoire diversity post-transplant.•UM171 expansion increases the frequency and potency of common lymphoid progenitors.•UM171 grafts are associated with low rate of severe infections post-transplant.

Published
2024
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41. Isolated muscular cystic echinococcosis mimicking neoplasia.

Author

Lapierre, Simon Grandjean, Barkati, Sapha, Desjardins, Michael, Ndao, Momar, Libman, Michael, Poirier, Louise, Mottard, Sophie, Désy, Delphine, Dufresne, Simon-Frédéric, and Grandjean Lapierre, Simon

Subjects
ECHINOCOCCOSIS
Abstract

Musculoskeletal cystic echinococcosis can present as an isolated disease mimicking neoplasia. Along with albendazole therapy, complete excision avoiding cyst rupture is essential to prevent disease dissemination and hypersensitivity reactions. Conventional epidemiology and molecular typing can help differentiate between domestic and sylvatic strains of echinococcosis in the traveler and migrant population. [ABSTRACT FROM AUTHOR]

Published
2020
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44. High frequency of pathogenic Aspergillus species among nonsporulating moulds from respiratory tract samples.

Author

Dufresne, Philippe J., Moonjely, Soumya S., Ozaki, Koyomi, Tremblay, Cecile, Laverdière, Michel, and Dufresne, Simon F.

Abstract

Nonsporulating moulds (NSM) represent an identification challenge for clinical laboratories. Data on the prevalence of pathogenic species among NSM are lacking. We prospectively investigated consecutive thermotolerant (36°C) clinical NSM isolates from respiratory tract samples. A total of 123 isolates were identified by DNA sequencing and phenotypically characterized. Of those, 13 (11%) were pathogenic species (Aspergillus fumigatus, n = 10; A flavus, n = 1; A hiratsukae, n = 1; Schizophyllum commune, n = 1). Presumptive identification of Aspergillus species among NSM can be achieved by simple phenotypic testing. [ABSTRACT FROM AUTHOR]

Published
2017
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50. Incidence of invasive aspergillosis following remission--induction chemotherapy for acute leukemia: a retrospective cohort study in a single Canadian tertiary care centre.

Author

Barkati, Sapha, Dufresne, Simon F., Bélanger, Sylvie, Vadnais, Barbara, Bergeron, Julie, Labbé, Annie Claude, and Laverdière, Michel

Subjects
*ASPERGILLOSIS treatment, *ACUTE leukemia, *DISEASE remission, *TERTIARY care, *DRUG therapy, *REMISSION induction
Abstract

Background: The decision to use universal primary antimould prophylaxis to prevent invasive aspergillosis in patients with acute leukemia depends on the incidence of infection at individual centres. We determined our institution's incidence of invasive aspergillosis among patients who received remission--induction chemotherapy for acute leukemia to evaluate the potential benefits of primary antimould prophylaxis. Methods: We conducted this retrospective cohort study at a Canadian tertiary care centre. From the central pharmacy registries, we retrieved records for all adult patients for whom remission--induction chemotherapy for acute leukemia was prescribed between 2008 and 2010. We retrieved clinical, microbiologic, pathologic and radiologic data from the patients' medical charts. The primary outcome was a diagnosis of probable or proven invasive aspergillosis up to 180 days after resolution of aplasia. Results: We retrieved records for 123 patients with acute leukemia. Twenty-two of these patients did not receive the prescribed chemotherapy and were excluded from the analysis. Of the 101 patients included, 77 (76.2%) had acute myeloid leukemia. Overall, 136 courses of chemotherapy were administered, with more than 1 course administered to 26 (25.7%) of the 101 patients. In 9 of the patients (8.9%; 95% confidence interval 4.2%-16.2%), invasive aspergillosis was diagnosed (3 proven and 6 probable cases) a median of 19 (range 11-34) days after initiation of chemotherapy. In 7 (78%) of these 9 patients, invasive aspergillosis occurred during the first course of chemotherapy. Three patients died within the first year after diagnosis of invasive aspergillosis. Interpretation: We found a high incidence (8.9%) of invasive aspergillosis at our centre. This finding triggered the introduction of targeted antimould prophylaxis for patients with acute leukemia who were undergoing remission--induction chemotherapy. [ABSTRACT FROM AUTHOR]

Published
2014
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