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4. Outcomes and Genetic Relatedness of Carbapenem-Resistant Enterobacteriaceae at Detroit Medical Center

Author

Marchaim, Dror, Chopra, Teena, Perez, Federico, Hayakawa, Kayoko, Lephart, Paul R., Bheemreddy, Suchitha, Blunden, Christopher, Hujer, Andrea M., Rudin, Susan, Shango, Maryann, Campbell, Michelle, Varkey, Jastin, Slim, Jessica, Ahmad, Farah, Patel, Diixa, Chen, Ting-Yi, Pogue, Jason M., Salimnia, Hossein, Dhar, Sorabh, Bonomo, Robert A., and Kaye, Keith S.

Published
2011
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6. “Swimming in resistance”: Co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa

Author

Marchaim, Dror, Perez, Federico, Lee, Jiha, Bheemreddy, Suchitha, Hujer, Andrea M., Rudin, Susan, Hayakawa, Kayoko, Lephart, Paul R., Blunden, Christopher, Shango, Maryann, Campbell, Michelle L., Varkey, Jastin, Manickam, Palaniappan, Patel, Diixa, Pogue, Jason M., Chopra, Teena, Martin, Emily T., Dhar, Sorabh, Bonomo, Robert A., and Kaye, Keith S.

Published
2012
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7. Clinical application of next generation sequencing in lymphoma.

Author

Scott, Anthony J., Tokaz, Molly C., Shango, Maryann, Devata, Sumana, Carty, Shannon A., Kaminski, Mark S., Chinnaiyan, Arul M., Phillips, Tycel J., and Wilcox, Ryan A.

Subjects
LYMPHOMAS, TREATMENT effectiveness, DISEASE progression, TIME trials, CLINICAL trials
Abstract

Successful treatment of relapsed/refractory and rare subtypes of lymphomas remains a therapeutic challenge. Though the use of tumor profiling is increasing, little is described about how providers ultimately utilize this information in clinical decision-making. We reviewed 92 adult lymphoma patients who underwent an IRB-approved tumor sequencing protocol at the University of Michigan, MI-ONCOSEQ. Of this cohort, 60 had a targeted treatment suggested by their test results, and 11 patients ultimately underwent the MI-ONCOSEQ recommended therapy. One obtained complete response based on precision treatment recommendations. The two main barriers for targeted treatment utilization included inopportune timing (the patient either was sequenced too early or too late in their disease course) and clinical trial availability. While this study demonstrates the success of sequencing lymphomas for the identification of novel therapies, it also underlines the clinical challenges, namely the optimal timing and availability of trials, inherent in the successful application of this technology. [ABSTRACT FROM AUTHOR]

Published
2021
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9. Multicentre retrospective study of intravascular large B‐cell lymphoma treated at academic institutions within the United States

Author

Geer, Marcus, primary, Roberts, Emily, additional, Shango, Maryann, additional, Till, Brian G., additional, Smith, Stephen D., additional, Abbas, Hashim, additional, Hill, Brian T., additional, Kaplan, Jason, additional, Barr, Paul M., additional, Caimi, Paolo, additional, Stephens, Deborah M., additional, Lin, Emily, additional, Herrera, Alex F., additional, Rosenbaum, Evan, additional, Amengual, Jennifer E., additional, Boonstra, Philip S., additional, Devata, Sumana, additional, Wilcox, Ryan A., additional, Kaminski, Mark S., additional, and Phillips, Tycel J., additional

Published
2019
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11. Pazopanib with low fat meal (PALM) in advanced renal cell carcinoma

Author

Reimers, Melissa A., primary, Shango, Maryann M., additional, Daignault-Newton, Stephanie, additional, Dedinsky, Rachel, additional, Karsies, Danielle, additional, Kraft, Shawna, additional, Riddle, Liam, additional, Felton, Jeremy A., additional, Wen, Bo, additional, Gersch, Christina, additional, Rae, James M., additional, Redman, Bruce G., additional, and Alva, Ajjai S., additional

Published
2018
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14. Multicenter Retrospective Study of Features and Outcomes of Patients with Intravascular DLBCL Treated at Academic Institutions within the United States

Author

Geer, Marcus, Shango, Maryann, Till, Brian G., Smith, Stephen D., Abbas, Hashim, Hill, Brian T., Kaplan, Jason, Barr, Paul M., Caimi, Paolo, Stephens, Deborah M., Lin, Emily, Herrera, Alex F., Rosenbaum, Evan, Amengual, Jennifer E, Roberts, Emily, Boonstra, Philip S, Devata, Sumana, Wilcox, Ryan A., Kaminski, Mark S, and Phillips, Tycel J.

Published
2017
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17. Growing Prevalence of Vancomycin-ResistantEnterococcus faecalisin the Region with the Highest Prevalence of Vancomycin-ResistantStaphylococcus aureus

Author

Hayakawa, Kayoko, primary, Marchaim, Dror, additional, Vidaillac, Celine, additional, Lephart, Paul, additional, Pogue, Jason M., additional, Sunkara, Bharath, additional, Kotra, Harikrishna, additional, Hasan, Asma, additional, Shango, Maryann, additional, Yerramalla, Yashwanth, additional, Osunlana, Adedayo M., additional, Chopra, Teena, additional, Dhar, Sorabh, additional, Salimnia, Hossein, additional, Rybak, Michael J., additional, and Kaye, Keith S., additional

Published
2011
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18. Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan

Author

Marchaim, Dror, primary, Chopra, Teena, additional, Pogue, Jason M., additional, Perez, Federico, additional, Hujer, Andrea M., additional, Rudin, Susan, additional, Endimiani, Andrea, additional, Navon-Venezia, Shiri, additional, Hothi, Jatinder, additional, Slim, Jessica, additional, Blunden, Christopher, additional, Shango, Maryann, additional, Lephart, Paul R., additional, Salimnia, Hossein, additional, Reid, Deborah, additional, Moshos, Judy, additional, Hafeez, Wasif, additional, Bheemreddy, Suchitha, additional, Chen, Ting-Yi, additional, Dhar, Sorabh, additional, Bonomo, Robert A., additional, and Kaye, Keith S., additional

Published
2011
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19. Outcomes and Genetic Relatedness of Carbapenem-Resistant Enterobacteriaceaeat Detroit Medical Center

Author

Marchaim, Dror, Chopra, Teena, Perez, Federico, Hayakawa, Kayoko, Lephart, Paul R., Bheemreddy, Suchitha, Blunden, Christopher, Hujer, Andrea M., Rudin, Susan, Shango, Maryann, Campbell, Michelle, Varkey, Jastin, Slim, Jessica, Ahmad, Farah, Patel, Diixa, Chen, Ting-Yi, Pogue, Jason M., Salimnia, Hossein, Dhar, Sorabh, Bonomo, Robert A., and Kaye, Keith S.

Abstract

Background.Carbapenem-resistant Enterobacteriaceae(CRE) are rapidly emerging in hospitals in the United States and are posing a significant threat. To better understand the transmission dynamics and the acquisition of resistant strains, a thorough analysis of epidemiologic and molecular characteristics was performed.Methods.CRE isolated at Detroit Medical Center were analyzed from September 2008 to September 2009. blaKPCgenes were investigated by polymerase chain reaction (PCR), and repetitive extragenic palindromic PCR (rep-PCR) was used to determine genetic similarity among strains. Epidemiologic and outcomes analyses were performed.Results.Ninety-two unique patient CRE isolates were recovered. Sixty-eight strains (74%) were Klebsiella pneumoniae, 7 were Klebsiella oxytoca, 15 were Enterobacterspecies, and 2 were Escherichia coli. Fifteen isolates (16%) were resistant to Colistin, 14 (16%) were resistant to tigecycline, and 2 were resistant to all antimicrobials tested. The mean ± standard deviation age of patients was 63 ± 2 years. Sixty patients (68%) were admitted to the hospital from long-term care facilities. Only 70% of patients received effective antimicrobial therapy when infection was suspected, with a mean time to appropriate therapy of 120 ± 23 hours following sample culturing. The mean length of hospitalization after sample culturing was 18.6 ± 2.5 days. Of 57 inpatients, 18 (32%) died in the hospital. Independent predictors for mortality were intensive care unit stay (odds ratio [OR], 15.8; P= .003) and co-colonization with CRE and either Acinetobacter baumanniior Pseudomonas aeruginosa(OR, 17.2; P= .006). Among K. pneumoniaeCRE, rep-PCR revealed 2 genetically related strains that comprised 70% and 20% of isolates, respectively.Conclusions.In this large U.S. cohort of patients with CRE infection, which reflects the modern continuum of medical care, co-colonization with CRE and A. baumanniior P. aeruginosawas associated with increased mortality. Two predominant clones of K. pneumoniaeaccounted for the majority of cases of CRE infection.

Published
2011
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20. Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniaein Metropolitan Detroit, Michigan

Author

Marchaim, Dror, Chopra, Teena, Pogue, Jason M., Perez, Federico, Hujer, Andrea M., Rudin, Susan, Endimiani, Andrea, Navon-Venezia, Shiri, Hothi, Jatinder, Slim, Jessica, Blunden, Christopher, Shango, Maryann, Lephart, Paul R., Salimnia, Hossein, Reid, Deborah, Moshos, Judy, Hafeez, Wasif, Bheemreddy, Suchitha, Chen, Ting-Yi, Dhar, Sorabh, Bonomo, Robert A., and Kaye, Keith S.

Abstract

ABSTRACTCarbapenem-resistant Klebsiella pneumoniaehas spread worldwide and throughout the United States. Colistin is used extensively to treat infections with this organism. We describe a cluster of colistin-resistant, carbapenem-resistant K. pneumoniaeinfection cases involving three institutions in Detroit, MI. A cluster of five cases of colistin-resistant, carbapenem-resistant K. pneumoniaewas identified at Detroit Medical Center (DMC) from 27 July to 22 August 2009. Epidemiologic data were collected, and transmission opportunities were analyzed. Isolates were genotyped by using pulsed-field gel electrophoresis and repetitive extragenic palindromic PCR. Data regarding the use of colistin were obtained from pharmacy records. The index case of colistin-resistant, carbapenem-resistant K. pneumoniaewas followed 20 days later by four additional cases occurring in a 6-day interval. All of the patients, at some point, had stayed at one particular institution. The mean number of opportunities for transmission between patients was 2.3 ± 0.5, and each patient had at least one opportunity for transmission with one of the other patients. Compared to 60 colistin-susceptible, carbapenem-resistant K. pneumoniaecontrols isolated in the previous year at DMC, case patients were significantly older (P= 0.05) and the carbapenem-resistant K. pneumoniaeorganisms isolated from them displayed much higher MICs to imipenem (P< 0.001). Colistin use was not enhanced in the months preceding the outbreak. Genotyping revealed two closely related clones. This report of a colistin-resistant, carbapenem-resistant K. pneumoniaeoutbreak is strongly linked to patient-to-patient transmission. Controlling the spread and novel emergence of bacteria with this phenotype is of paramount importance.

Published
2010
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22. "Swimming in resistance": Co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa.

Author

Marchaim D, Perez F, Lee J, Bheemreddy S, Hujer AM, Rudin S, Hayakawa K, Lephart PR, Blunden C, Shango M, Campbell ML, Varkey J, Manickam P, Patel D, Pogue JM, Chopra T, Martin ET, Dhar S, Bonomo RA, and Kaye KS

Subjects
Acinetobacter Infections complications, Acinetobacter Infections epidemiology, Acinetobacter baumannii classification, Acinetobacter baumannii drug effects, Acinetobacter baumannii genetics, Acinetobacter baumannii isolation & purification, Adult, Aged, Aged, 80 and over, Carrier State epidemiology, Cohort Studies, Coinfection epidemiology, Enterobacteriaceae classification, Enterobacteriaceae drug effects, Enterobacteriaceae genetics, Enterobacteriaceae isolation & purification, Enterobacteriaceae Infections complications, Enterobacteriaceae Infections epidemiology, Female, Humans, Male, Middle Aged, Molecular Epidemiology, Molecular Typing, Pseudomonas Infections complications, Pseudomonas Infections epidemiology, Pseudomonas aeruginosa classification, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa genetics, Pseudomonas aeruginosa isolation & purification, beta-Lactam Resistance, Acinetobacter Infections microbiology, Anti-Bacterial Agents pharmacology, Carbapenems pharmacology, Carrier State microbiology, Coinfection microbiology, Enterobacteriaceae Infections microbiology, Pseudomonas Infections microbiology
Abstract

Background: Co-colonization of patients with carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (AB) or Pseudomonas aeruginosa (PA) is reported to be associated with increased antibiotic resistance and mortality., Methods: CREs isolated between September 2008 and September 2009 were analyzed at Detroit Medical Center. Patients who had an additional isolation of AB or PA during the period spanning 7 days before to 7 days after CRE isolation were considered co-colonized. Molecular typing was used to determine genetic similarity among CRE strains., Results: Eighty-six unique patient isolates of CREs were analyzed. Thirty-four patients (40%) were co-colonized, and 26 (79%) had AB or PA isolated on the same day as the CRE. High Charlson Comorbidity Index score was an independent predictor for co-colonization. Recent stay at a long-term acute-care facility and previous therapy with antimicrobials with activity only against gram-positive microorganisms also were associated with co-colonization, but did not remain significant independent predictors. Co-colonization was associated with higher levels of resistance to carbapenems among CREs and increased 90-day mortality. Molecular typing revealed CRE polyclonality in co-colonized patients., Conclusions: Co-colonization is found in patients with the greatest disease burden in the hospital and occurs due to the dissemination of multiple CRE strains. This finding calls into question the practice of cohorting patients with CRE in close proximity to patients with AB or PA., (Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Published
2012
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