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2. Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients

Author

Gutierrez-Gutierrez, B., Perez-Nadales, E., Perez-Galera, S., Fernandez-Ruiz, M., Carratala, J., Oriol, I., Cordero, E., Lepe, J. A., Tan, B. H., Corbella, L., Paul, M., Natera, A. M., David, M. D., Montejo, M., Iyer, R. N., Pierrotti, L. C., Merino, E., Steinke, S. M., Rana, M. M., Munoz, P., Mularoni, A., van Delden, C., Grossi, P. A., Seminari, E. M., Gunseren, F., Lease, E. D., Roilides, E., Fortun, J., Arslan, H., Coussement, J., Tufan, Z. K., Pilmis, B., Rizzi, M., Loeches, B., Eriksson, B. M., Abdala, E., Soldani, F., Lowman, W., Clemente, W. T., Bodro, M., Farinas, M. C., Kazak, E., Martinez-Martinez, L., Aguado, J. M., Torre-Cisneros, J., Pascual, A., Rodriguez-Bano, J., Sabe, N., Camoez, M., Martin-Gandul, C., Bernal, G., Kee, T. Y. S., Lopez-Medrano, F., Juan, R. S., Koppel, F., Bar-Sinai, N., Caston, J. J., Cano, A., Gracia-Ahufinger, I., Rodriguez, R., Lopez-Soria, L., Azurmendi, M., Pinheiro, M., Freire, M., Banks, I., Lopes, F., David-Neto, E., Balibrea, N., Franco, A., Avery, R., Ostrander, D., Minero, M. V., Carrillo, C. S., Rodriguez-Ferrero, M. L., Monaco, F., Campanella, M., Mueller, N. J., Manuel, O., Khanna, N., Rovelli, C., Balsamo, M. L., Colombo, A., Leoni, C., Pyrpasopoulou, A., Mouloudi, E., Iosifidis, E., Martin-Davila, P., Gioia, F., Escudero, R., Demirkaya, M. H., Dewispelaere, L., Kalem, A. K., Hasanoglu, I., Guner, R., Lortholary, O., Scemla, A., Calvi, E. G., Gervasi, E., Binda, F., Oliva, M. L., Dimopoulos, N., Magalhaes, M. R., Song, A. T. W., D'Albuquerque, L. A. C., Chiesi, S., Salerno, N. D., Mourao, P. H. O., Moreno, A., Linares, L., Almela, M., Rico, C. G., Rodrigo, E., Martinez, M. F., Falcone, M., Tumbarello, M., Strabelli, T. M. V., Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, European Commission, Sociedad Andaluza de Trasplante de Órganos y Tejidos, and Ministerio de Ciencia e Innovación (España)

Subjects
Ertapenem, medicine.medical_specialty, Urinary system, UTI, Bacteremia, Bloodstream infection, BSI, Logistic regression, Extended-spectrum-b-lactamase-producing Enterobacterales, Meropenem, beta-Lactamases, Cohort Studies, chemistry.chemical_compound, Internal medicine, polycyclic compounds, medicine, Humans, Pharmacology (medical), Propensity Score, Kidney transplant, Retrospective Studies, Pharmacology, Urinary tract infection, business.industry, ESBL-E, Anti-Bacterial Agents, Kidney Transplantation, Urinary Tract Infections, bacterial infections and mycoses, medicine.disease, Infectious Diseases, chemistry, Propensity score matching, Cohort, business, medicine.drug, Cohort study
Abstract

REIPI/ESGICH/ESGBIS/INCREMENT-SOT Group., There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages., This work was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0008; RD16/0016/00010) and was cofinanced by the European Development Regional Fund “A way to achieve Europe,” Operative program Intelligent Growth 2014‐2020; ESCMID Study Group for Infections in Compromised Hosts (ESGICH grant to J.M.A.); Sociedad Andaluza de Trasplante de Órgano Sólido (SATOT grant to L.M.-M.); ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS); and ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS). B.G.-G. (PI 18/01849) and E.P.-N. (PI 16/01631) have received research funds from the Spanish Ministry of Science and Innovation, ISCIII; M.F.-R. holds a research contract “Miguel Servet” (CP 18/00073) from the Spanish Ministry of Science and Innovation, ISCIII.

Published
2021

3. Changing trends in mortality among solid organ transplant recipients hospitalized for COVID‐19 during the course of the pandemic

Author

Heldman, M. R., Kates, O. S., Safa, K., Kotton, C. N., Georgia, S. J., Steinbrink, J. M., Alexander, B. D., Hemmersbach-Miller, M., Blumberg, E. A., Multani, A., Haydel, B., La Hoz, R. M., Moni, L., Condor, Y., Flores, S., Munoz, C. G., Guitierrez, J., Diaz, E. I., Diaz, D., Vianna, R., Guerra, G., Loebe, M., Rakita, R. M., Malinis, M., Azar, M. M., Hemmige, V., Mccort, M. E., Chaudhry, Z. S., Singh, P. P., Hughes Kramer, K., Velioglu, A., Yabu, J. M., Morillis, J. A., Mehta, S. A., Tanna, S. D., Ison, M. G., Derenge, A. C., van Duin, D., Maximin, A., Gilbert, C., Goldman, J. D., Lease, E. D., Fisher, C. E., Limaye, A. P., De la Cruz, O., Besharatian, B. D., Crespo, M., Tomic, R., Sehgal, S., Weisshaar, D., Girgis, R., Lawrence, C., Nelson, J., Bennett, W., Leandro, J., Sait, A., Rumore, A., West, P., Jeng, A., Bajrovic, V., Bilgili, E. P., Anderson-Haag, T., Nastase, A., Badami, A., Alvarez-Garcia, J., Bowman-Anger, L., Julien, L., Ortiz-Bautista, C., Friedman-Morocco, R., Gajurel, K., Cahuayme-Zuniga, L., Wakefield, M., Fung, M., Theodoropoulos, N., Chuang, S. T., Bhandaram, S., Veroux, M., Chopra, B., Florescu, D., Witteck, D., Ripley, K., Saharia, K., Akkina, S., Mccarty, T. P., Webb, A., Arya, A., Vedula, G., El-Amm, J. -M., Katherine Dokus, M., Narayanan, A., Cilene Leon Bueno de Camargo, P., Ouseph, R., Breuckner, A., Luk, A., Aujayeb, A., Ganger, D., Keith, D. S., Meloni, F., Haidar, G., Zapernick, L., Moraels, M., Goyal, N., Sharma, T., Malhotra, U., Kuo, A., Rossi, A. P., Edwards, A., Keller, B., Beneri, C., Derringer, D., Dominguez, E., Carlson, E., Hashim, F., Murad, H., Wilkens, H., Neumann, H., Gani, I., Kahwaji, J., Popoola, J., Michaels, M., Jakharia, N., Puing, A., Motallebzadeh, R., Velagapudi, R., Kapoor, R., Allam, S., Silveira, F., Vora, S., Kelly, U. M., Reddy, U., Dharnidharka, V., Wadei, H., Zurabi, L., 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., Multani, Ashrit, 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 P., Hughes Kramer, Kailey, Velioglu, Arzu, Yabu, Julie M., Morillis, Jose A., Mehta, Sapna A., Tanna, Sajal D., Ison, Michael G., Derenge, Ariella C., van Duin, David, Maximin, Adrienne, Gilbert, Carlene, Goldman, Jason D., Lease, Erika D., Fisher, Cynthia E., and Limaye, Ajit P.

Subjects
medicine.medical_specialty, infection and infectious agents, infection and infectious agents - viral, Coronavirus disease 2019 (COVID-19), infectious disease, Population, Logistic regression, Brief Communication, clinical research/practice, Medical and Health Sciences, Article, infection and infectious agents ‐ viral, quality of care, Internal medicine, Pandemic, quality of care/care delivery, care delivery, Immunology and Allergy, Medicine, Humans, Pharmacology (medical), organ transplantation in general, Mortality trends, education, Pandemics, Dexamethasone, UW COVID-19 SOT Study Team, education.field_of_study, Transplantation, business.industry, SARS-CoV-2, COVID-19, Hydroxychloroquine, Organ Transplantation, Transplant Recipients, practice, Good Health and Well Being, clinical research, Surgery, business, Solid organ transplantation, Brief Communications, medicine.drug, viral
Abstract

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020-June 19, 2020) and late 2020 (June 20, 2020-December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p&nbsp

Published
2021

5. Solid Organ Transplantation From Hepatitis B Virus–Positive Donors: Consensus Guidelines for Recipient Management†

Author

Huprikar, S., Danziger-Isakov, L., Ahn, J., Naugler, S., Blumberg, E., Avery, R. K., Koval, C., Lease, E. D., Pillai, A., Doucette, K. E., Levitsky, J., Morris, M. I., Lu, K., McDermott, J. K., Mone, T., Orlowski, J. P., Dadhania, D. M., Abbott, K., Horslen, S., Laskin, B. L., Mougdil, A., Venkat, V. L., Korenblat, K., Kumar, V., Grossi, P., Bloom, R. D., Brown, K., Kotton, C. N., and Kumar, D.

Published
2015
Full Text
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6. Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients

Author

Gutierrez-Gutierrez B, Perez-Nadales E, Perez-Galera S, Fernandez-Ruiz M, Carratala J, Oriol I, Cordero E, Lepe J, Tan B, Corbella L, Paul M, Natera A, David M, Montejo M, Iyer R, Pierrotti L, Merino E, Steinke S, Rana M, Munoz P, Mularoni A, van Delden C, Grossi P, Seminari E, Gunseren F, Lease E, Roilides E, Fortun J, Arslan H, Coussement J, Tufan Z, Pilmis B, Rizzi M, Loeches B, Eriksson B, Abdala E, Soldani F, Lowman W, Clemente W, Bodro M, Farinas M, Kazak E, Martinez-Martinez L, Aguado J, Torre-Cisneros J, Pascual A, Rodriguez-Bano J, and Investigators REIPI ESGICH ESGBIS

Subjects
kidney transplant, ertapenem, UTI, bloodstream infection, BSI, urinary tract infection, extended-spectrum-beta-lactamase-producing Enterobacterales, ESBL-E
Abstract

There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.

Published
2021

7. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Author

Perez-Nadales, E., Gutierrez-Gutierrez, B., Natera, A. M., Abdala, E., Reina Magalhaes, M., Mularoni, A., Monaco, F., Camera Pierrotti, L., Pinheiro Freire, M., Iyer, R. N., Mehta Steinke, S., Grazia Calvi, E., Tumbarello, M., Falcone, M., Fernandez-Ruiz, M., Costa-Mateo, J. M., Rana, M. M., Mara Varejao Strabelli, T., Paul, M., Carmen Farinas, M., Clemente, W. T., Roilides, E., Munoz, P., Dewispelaere, L., Loeches, B., Lowman, W., Hock Tan, B., Escudero-Sanchez, R., Bodro, M., Antonio Grossi, P., Soldani, F., Gunseren, F., Nestorova, N., Pascual, A., Martinez-Martinez, L., Aguado, J., Rodriguez-Bano, J., Torre-Cisneros, J., Wan Song, A. T., Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., Jota de Paula, F., Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I., Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. V., Bar-Sinai, N., Koppel, F., Arnaiz de las Revillas Almajano, F., Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I., Minero, M. V., Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, B. M., van Delden, C., Manuel, O., Arslan, H., Kocak Tufan, Z., Kazak, E., David, M., Lease, E., Cornaglia, G., Akova, M., European Commission, Ministerio de Ciencia, Innovación y Universidades (España), Instituto de Salud Carlos III, and Universidad de Cantabria

Subjects
medicine.medical_specialty, Combination therapy, infectious disease, 030230 surgery, Settore MED/17 - MALATTIE INFETTIVE, Logistic regression, clinical research/practice, 03 medical and health sciences, 0302 clinical medicine, infection and infectious agents - bacterial, Internal medicine, medicine, Immunology and Allergy, Pharmacology (medical), organ transplantation in general, Infection and infectious agents - bacterial, Transplantation, Infectious disease, Receiver operating characteristic, business.industry, Hazard ratio, Confidence interval, Organ transplantation in general, antibiotic drug resistance, Cohort, Clinical research/practice, Antibiotic drug resistance, business, Cohort study
Abstract

Treatment of carbapenemase‐producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase‐producing Enterobacterales bloodstream infections. A multinational, retrospective (2004‐2016) cohort study (INCREMENT‐SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30‐day all‐cause mortality. The INCREMENT‐SOT‐CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT‐CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT‐CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76‐0.88) and classified patients into 3 strata: 0‐7 (low mortality), 8‐11 (high mortality), and 12‐17 (very‐high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very‐high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13‐7.06, P = .03) and high (HR 9.93, 95% CI 2.08‐47.40, P = .004) mortality risk strata. A score‐based algorithm is provided for therapy guidance., This work was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0008; RD16/0016/0001, RD16/0016/0002, RD16/0016/00010] ‐ co‐financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014‐2020; ESCMID Study Group for Infections in Compromised Hosts [ESGICH grant to JMA]; Sociedad Andaluza de Trasplante de Órgano Sólido [SATOT grant to LMM]; ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS); and ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS).

Published
2020

8. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Author

Perez-Nadales E, Gutierrez-Gutierrez B, Natera A, Abdala E, Magalhaes M, Mularoni A, Monaco F, Pierrotti L, Freire M, Iyer R, Steinke S, Calvi E, Tumbarello M, Falcone M, Fernandez-Ruiz M, Costa-Mateo J, Rana M, Strabelli T, Paul M, Farinas M, Clemente W, Roilides E, Munoz P, Dewispelaere L, Loeches B, Lowman W, Tan B, Escudero-Sanchez R, Bodro M, Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual A, Martinez-Martinez L, Aguado J, Rodriguez-Bano J, Torre-Cisneros J, Song A, Andraus W, D'Albuquerque L, David-Neto E, de Paula F, Rossi F, Ostrander D, Avery R, Rizzi M, Losito A, Raffaelli F, Del Giacomo P, Tiseo G, Lora-Tamayo J, San-Juan R, Gracia-Ahufinger I, Caston J, Ruiz Y, Altman D, Campos S, Bar-Sinai N, Koppel F, Almajano F, Rico C, Martinez M, Mourao P, Neves F, Ferreira J, Pyrpasopoulou A, Iosifidis E, Romiopoulos I, Minero M, Sanchez-Carrillo C, Lardo S, Coussement J, Dodemont M, Jiayun K, Martin-Davila P, Fortun J, Almela M, Moreno A, Linares L, Gasperina D, Balsamo M, Rovelli C, Concia E, Chiesi S, Salerno D, Ogunc D, Pilmis B, Seminari E, Carratala J, Dominguez A, Cordero E, Lepe J, Montejo M, de Lucas E, Eriksson B, van Delden C, Manuel O, Arslan H, Tufan Z, Kazak E, David M, Lease E, Cornaglia G, Akova M, REIPI INCREMENT-SOT Investigators, Swiss Transplant Cohort Study, and ESGARS-ESCMID Study Grp Antimicrob

Subjects
infection and infectious agents - bacterial, clinical research, infectious disease, antibiotic drug resistance, organ transplantation in general, practice
Abstract

Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.

Published
2020

9. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales : The impact of cytomegalovirus disease and lymphopenia

Author

Perez-Nadales, Elena, Gutierrez-Gutierrez, Belen, Natera, Alejandra M., Abdala, Edson, Magalhaes, Maira Reina, Mularoni, Alessandra, Monaco, Francesco, Pierrotti, Ligia Camera, Freire, Maristela Pinheiro, Iyer, Ranganathan N., Steinke, Seema Mehta, Calvi, Elisa Grazia, Tumbarello, Mario, Falcone, Marco, Fernandez-Ruiz, Mario, Maria Costa-Mateo, Jose, Rana, Meenakshi M., Varejao Strabelli, Tania Mara, Paul, Mical, Carmen Farinas, Maria, Clemente, Wanessa Trindade, Roilides, Emmanuel, Munoz, Patricia, Dewispelaere, Laurent, Loeches, Belen, Lowman, Warren, Tan, Ban Hock, Escudero-Sanchez, Rosa, Bodro, Marta, Grossi, Paolo Antonio, Soldani, Fabio, Gunseren, Filiz, Nestorova, Nina, Pascual, Alvaro, Martinez-Martinez, Luis, Maria Aguado, Jose, Rodriguez-Bano, Jesus, Torre-Cisneros, Julian, Song, A. T. Wan, Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., de Paula, F. Jota, Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I, Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. , V, Bar-Sinai, N., Koppel, F., de las Revillas Almajano, F. Arnaiz, Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I, Minero, M. , V, Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, Britt-Marie, van Delden, C., Manuel, O., Arslan, H., Tufan, Z. Kocak, Kazak, E., David, M., Lease, E., Cornaglia, G., Akova, M., Perez-Nadales, Elena, Gutierrez-Gutierrez, Belen, Natera, Alejandra M., Abdala, Edson, Magalhaes, Maira Reina, Mularoni, Alessandra, Monaco, Francesco, Pierrotti, Ligia Camera, Freire, Maristela Pinheiro, Iyer, Ranganathan N., Steinke, Seema Mehta, Calvi, Elisa Grazia, Tumbarello, Mario, Falcone, Marco, Fernandez-Ruiz, Mario, Maria Costa-Mateo, Jose, Rana, Meenakshi M., Varejao Strabelli, Tania Mara, Paul, Mical, Carmen Farinas, Maria, Clemente, Wanessa Trindade, Roilides, Emmanuel, Munoz, Patricia, Dewispelaere, Laurent, Loeches, Belen, Lowman, Warren, Tan, Ban Hock, Escudero-Sanchez, Rosa, Bodro, Marta, Grossi, Paolo Antonio, Soldani, Fabio, Gunseren, Filiz, Nestorova, Nina, Pascual, Alvaro, Martinez-Martinez, Luis, Maria Aguado, Jose, Rodriguez-Bano, Jesus, Torre-Cisneros, Julian, Song, A. T. Wan, Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., de Paula, F. Jota, Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I, Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. , V, Bar-Sinai, N., Koppel, F., de las Revillas Almajano, F. Arnaiz, Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I, Minero, M. , V, Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, Britt-Marie, van Delden, C., Manuel, O., Arslan, H., Tufan, Z. Kocak, Kazak, E., David, M., Lease, E., Cornaglia, G., and Akova, M.

Abstract

Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.

Published
2020
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16. Proteins of Bovine Serum

Author

Ledesma, R. E., Lease, E. J., and Dudley, B. W.

Abstract

The protein composition of the blood from 97 heifers challenged with virulent Brucella abortusstrain 2308 was studied using paper electrophoresis separation techniques. The average values for the protein components of the serum for heifers which were not infected or vaccinated were albumin 54%, alpha globulin 11%, beta globulin 12%, and gamma globulin 23%. Only minor changes in this distribution were noted during the early phases of the infection with Brucella abortus.About 20 days before the end of gestation, the gamma globulin and total protein content of the serum of both infected and noninfected animals decreased briefly while a corresponding increase in the albumin fraction occurred. Decreases in the alpha and beta globulins were less consistent during this period, but were observed with more frequency in non-infected animals.During a more extended period of time which began about 10 days before the end of gestation, a marked increase in gamma globulin was observed. This high gamma globulin content persisted until after abortion or parturition. The increase in gamma globulin was accompanied by a marked decrease in the albumin fraction. Changes in the alpha and beta fractions were not consistent.Basic changes in the electrophoretic pattern of both infected and noninfected heifers appear to be related to the physiologic stage of gestation. Infected heifers exhibited more pronounced changes; however, the basic pattern remains the same in both infected and noninfected animals.

Published
1968
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24. International Society for Heart and Lung Transplantation consensus statement for the standardization of bronchoalveolar lavage in lung transplantation

Author

Tereza Martinu, Angela Koutsokera, Christian Benden, Edward Cantu, Daniel Chambers, Marcelo Cypel, Jeffrey Edelman, Amir Emtiazjoo, Andrew J. Fisher, John R. Greenland, Don Hayes, David Hwang, Brian C. Keller, Erika D. Lease, Michael Perch, Masaaki Sato, Jamie L. Todd, Stijn Verleden, Jan von der Thüsen, S. Samuel Weigt, Shaf Keshavjee, Cecilia Chaparro, David Wilson Roe, Frank D'Ovidio, George Chaux, Greg Snell, Laurent Godinas, Mohamed Al-Aloul, Steven Hays, Jamie Todd, Amy Rigby, Louis Clauden, Matthew Morrell, Puneet Garcha, Sanjeev Raman, Soma Jyothula, Michael Trotter, Erika Lease, Cassie Kennedy, Chadi A Hage, Saima Aslam, Shahid Husain, Katharina Wassilew, Reinaldo Rampolla-Selles, Siddhartha G Kapnadak, Umesh Goswami, John Greenland, Aric Gregson, Bart Vanaudenaerde, Tji Gan, Brian Keller, Laura K Frye, Margaret Hannan, Harish Seethamraju, Rade Tomic, Remzi Bag, Alicia Mitchell, Jorge Mallea, Maria Crespo, Sangeeta Bhorade, Cantu Edward, Cypel Marcelo, Gundeep Dhillon, Jason Christie, Jessica GY Luc, Keith M Wille, Olufemi Akindipe, Omar Mohamedaly, Christopher Wigfield, Ernestina Melicoff-Portillo, Marc Schecter, Shailendra Das, Ani Orchanian-Cheff, George Tomlinson, Pathology, bronchoalveolar lavage standardization workgroup, Martinu, T., Koutsokera, A., Keshavjee, S., Weigt, S.S., Sato, M., Chaparro, C., Roe, D.W., D'Ovidio, F., Chaux, G., Snell, G., Godinas, L., Al-Aloul, M., Hays, S., Todd, J., Perch, M., Rigby, A., Clauden, L., Morrell, M., Garcha, P., Raman, S., Jyothula, S., Trotter, M., Lease, E., Edelman, J., Kennedy, C., Hage, C.A., Aslam, S., Husain, S., von der Thüsen, J., Fisher, A.J., Wassilew, K., Rampolla-Selles, R., Kapnadak, S.G., Goswami, U., Greenland, J., Emtiazjoo, A., Gregson, A., Vanaudenaerde, B., Gan, T., Hwang, D., Keller, B., Frye, L.K., Hannan, M., Seethamraju, H., Tomic, R., Bag, R., Mitchell, A., Verleden, S., Chambers, D., Mallea, J., Crespo, M., Bhorade, S., Edward, C., Marcelo, C., Dhillon, G., Christie, J., Luc, J.G., Wille, K.M., Akindipe, O., Mohamedaly, O., Wigfield, C., Hayes, D., Benden, C., Melicoff-Portillo, E., Schecter, M., Das, S., Orchanian-Cheff, A., Tomlinson, G., and Bronchoalveolar Lavage Standardiza

Subjects
RCF, relative centrifugal force, Standardization, medicine.medical_treatment, Sample processing, IDSA, Infectious Disease Society of America, Cardiorespiratory Medicine and Haematology, ATS, American Thoracic Society, 030230 surgery, Bronchoalveolar Lavage, PCR, polymerase chain reaction, 0302 clinical medicine, Bronchoscopy, bronchoalveolar lavage standardization workgroup, Medicine, bronchoalveolar lavage, Lung, EVLP, ex-vivo lung perfusion, Sample handling, medicine.diagnostic_test, VZV, varicella zoster virus (VZV), methodology, LTx, lung transplantation, respiratory system, ERS, European Respiratory Society, Bronchoalveolar Lavage/standards, Consensus, Heart Transplantation/standards, Humans, Lung Transplantation/standards, bronchial wash, donor bronchoscopy, lung transplantation, pediatric bronchoscopy, standardization, BAL, bronchoalveolar lavage, Cardiology and Cardiovascular Medicine, Lung Transplantation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), AMR, antibody-mediated rejection, CLAD, chronic lung allograft dysfunction, Article, RPM, revolutions per minute, 03 medical and health sciences, Clinical Research, Abbreviations: AFB, acid-fast bacilli, Lung transplantation, AR, acute rejection, PJP, Pneumocystis jiroveci pneumonia, Intensive care medicine, CF, cystic fibrosis, Transplantation, business.industry, Organ Transplantation, CMV, cytomegalovirus, respiratory tract diseases, ISHLT, International Society for Heart and Lung Transplantation, Bronchoalveolar lavage, 030228 respiratory system, ML, middle lobe, HSV, herpes simplex virus, Heart Transplantation, ASM, American Society for Microbiology, Surgery, Human medicine, RSV, respiratory syncytial virus, business, BW, bronchial wash
Abstract

Bronchoalveolar lavage (BAL) is a key clinical and research tool in lung transplantation (LTx). However, BAL collection and processing are not standardized across LTx centers. This International Society for Heart and Lung Transplantation-supported consensus document on BAL standardization aims to clarify definitions and propose common approaches to improve clinical and research practice standards. The following 9 areas are covered: (1) bronchoscopy procedure and BAL collection, (2) sample handling, (3) sample processing for microbiology, (4) cytology, (5) research, (6) microbiome, (7) sample inventory/tracking, (8) donor bronchoscopy, and (9) pediatric considerations. This consensus document aims to harmonize clinical and research practices for BAL collection and processing in LTx. The overarching goal is to enhance standardization and multicenter collaboration within the international LTx community and enable improvement and development of new BAL-based diagnostics. ispartof: JOURNAL OF HEART AND LUNG TRANSPLANTATION vol:39 issue:11 pages:1171-1190 ispartof: location:United States status: published

Published
2020

25. Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients.

Author

Shah P, Lowery E, Chaparro C, Visner G, Hempstead SE, Abraham J, Bhakta Z, Carroll M, Christon L, Danziger-Isakov L, Diamond JM, Lease E, Leonard J, Litvin M, Poole R, Vlahos F, Werchan C, Murray MA, Tallarico E, Faro A, Pilewski JM, and Hachem RR

Subjects
Humans, Consensus, Cystic Fibrosis surgery, Lung Transplantation standards, Societies, Medical, Transplant Recipients
Abstract

Cystic fibrosis (CF) is the indication for transplantation in approximately 15% of recipients worldwide, and Cystic Fibrosis Lung Transplant Recipients (CFLTRs) have excellent long-term outcomes. Yet, CFLTRs have unique comorbidities that require specialized care. The objective of this document is to provide recommendations to CF and lung transplant clinicians for the management of perioperative and underlying comorbidities of CFLTRs and the impact of transplantation on these comorbidities. The Cystic Fibrosis Foundation (CFF) organized a multidisciplinary committee to develop CF Lung Transplant Clinical Care Recommendations. Three workgroups were formed to develop focused questions. Following a literature search, consensus recommendations were developed by the committee members based on literature review, committee experience and iterative revisions, and in response to public comment. The committee formulated 32 recommendation statements in the topics related to infectious disease, endocrine, gastroenterology, pharmacology, mental health and family planning. Broadly, the committee recommends close coordination of care between the lung transplant team, the cystic fibrosis care center, and specialists in other disciplines with experience in the care of CF and lung transplant recipients. These consensus statements will help lung transplant providers care for CFLTRs in order to improve post-transplant outcomes in this population., (Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Published
2021
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26. Lung Transplant Pulmonologists' Views of Specialty Palliative Care for Lung Transplant Recipients.

Author

Nolley E, Fleck J, Kavalieratos D, Dew MA, Dilling D, Colman R, Crespo MM, Goldberg H, Hays S, Hachem R, Lease E, Lee J, Reynolds J, Morrell M, and Schenker Y

Subjects
Humans, Lung, Palliative Care, Pulmonologists, Quality of Life, Transplant Recipients, Lung Transplantation, Medicine
Abstract

Background: Lung transplant recipients with serious illness may benefit from but rarely receive specialty palliative care (SPC) services. Transplant pulmonologists' views of SPC may be key to understanding SPC utilization but have not been well characterized. Objectives: (1) To understand how transplant pulmonologists view SPC and decide to refer transplant recipients and (2) to identify unique aspects of lung transplantation that may influence referral decisions. Design: We conducted semistructured interviews with transplant pulmonologists at nine geographically diverse high-volume North American transplant centers with SPC services. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine a coding framework related to SPC views and referral decisions. Results: We interviewed 38 transplant pulmonologists; most (36/38) had referred lung transplant recipients to SPC. Participants described SPC as a medical specialty that aims to improve quality of life and distinguished SPC from hospice care, which was considered end-of-life care. Participants who viewed transplant as a temporary solution ( n  = 17/38, 45%) described earlier utilization of SPC alongside disease-directed therapies, whereas those who viewed transplant as survival-focused ( n  = 21/38, 55%) described utilization of SPC after disease-directed therapies were exhausted. Concerns about one-year survival metrics and use of addicting medications for symptom palliation were barriers to referral. Conclusions: Transplant pulmonologists' SPC referral practices may be related to their views of lung transplantation. Optimizing use of SPC in lung transplantation will require improving communication between transplant pulmonology and SPC to ensure a collaborative effort toward patient-centered goals while addressing unique barriers to SPC referral.

Published
2020
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27. Effective Partnerships in School Reform: Lessons Learned From the Midwest Child-Parent Center Expansion.

Author

Hayakawa M, Englund MM, Candee A, Lease E, Sullivan M, Warner-Richter M, and Reynolds AJ

Abstract

The Midwest Expansion of the Child-Parent Center Education Program (MCPC) is a pre-K to 3rd grade intervention program aimed at improving economically disadvantaged children's school success by enhancing continuity in instruction and increasing parental involvement. Opened in Chicago in the 1960s, this school reform model has undergone significant changes and is currently being expanded in five demographically heterogeneous school districts in Illinois and Minnesota. This paper describes the collaborative process that has contributed to effective implementation of the expansion project within at-risk communities. Three themes of collaboration are emphasized: (a) improving the quality of data, (b) establishing and maintaining implementation fidelity, and (c) using research to inform practice. We discuss lessons learned from our partnerships with a number of collaborators including those involved with implementing the pre-K program, researching and evaluating the project, and providing professional development to teachers. Consideration is given to advancing the field of implementation science by successfully initiating and enhancing exemplary partnerships in comprehensive school reforms through effective research design.

Published
2015
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28. The use of the Reuter centrifugal air sampler for the estimation of bacterial air counts in different hospital locations.

Author

Casewell MW, Desai N, and Lease EJ

Subjects
Centrifugation instrumentation, Filtration instrumentation, Humans, Operating Rooms, Air Microbiology, Cross Infection prevention & control, Hospitals
Abstract

The convenience and portability of the Reuter centrifugal air sampler (RCS) encouraged us to determine a range of 'expected values' for bacterial air counts in nine hospitals at 13 defined locations. Results were recorded as the number of cfu per strip per 4 min. Bacterial air counts were comparable from hospital to hospital; in operating theatres the overall median RCS counts for air-inlets and in empty operating rooms were 13 and 9.8 cfu per strip per 4 min respectively. For surgical wards the median value was 141 and 180 cfu per strip per 4 min with, and without, air conditioning. Increased counts were readily demonstrated during surgical operations, and during bedmaking in wards. Conversion of RCS counts to cfu m-3 of air usually yielded values higher than those established by other methods. Our findings, however, demonstrate that this instrument may replace some of the applications of the slit sampler and facilitate examination of epidemiological problems.

Published
1986
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30. Industrial lunches and public health.

Author

LEASE EJ, ANDERSON HS, MALPHRUS RK, and LEASE JG

Subjects
Humans, Nutritional Physiological Phenomena, Nutritional Sciences, Nutritional Status, Occupational Medicine, Public Health
Published
1963

33. Intestinal parasites and nutritional status. IV. Control of ascaris.

Author

Lease EJ, Dudley BW, and Sargent RG

Subjects
Ascariasis complications, Ascariasis drug therapy, Ascariasis epidemiology, Child, Preschool, Feces, Female, Humans, Male, Nutrition Disorders complications, Parasite Egg Count, Piperazines therapeutic use, South Carolina, Ascariasis prevention & control
Published
1971

34. Nutrition and parasitism among rural pre-school children in South Carolina.

Author

Carter JP, Vanderzwaag R, Darby WJ, Lease EJ, Lauter FH, Dudley BW, High EG, Wright DJ, and Murphree T

Subjects
Black or African American, Ascariasis epidemiology, Child, Child, Preschool, Female, Humans, Intestinal Diseases, Parasitic etiology, Male, Rural Population, Socioeconomic Factors, South Carolina, Trichuriasis epidemiology, Deficiency Diseases epidemiology, Intestinal Diseases, Parasitic epidemiology, Nematode Infections epidemiology
Published
1970

35. Evaluation of the nutritional need for enrichment.

Author

Ledesmw RE, Lease EJ, and Dudley BW

Subjects
Diet, Female, Humans, Minerals, Pregnancy, Socioeconomic Factors, South Carolina, Vitamins, Deficiency Diseases, Food Additives, Food Analysis, Nutrition Surveys
Published
1968

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