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9. Nosocomial Infections in Adults Receiving Extracorporeal Membrane Oxygenation: A Review for Infectious Diseases Clinicians.

Author

Marcus, Joseph E, Shah, Aditya, Peek, Giles J, and MacLaren, Graeme

Subjects
*INFECTION prevention, *COMMUNICABLE diseases, *EXTRACORPOREAL membrane oxygenation, *CROSS infection, *POPULATION health, *ANTIMICROBIAL stewardship, *VENTILATOR-associated pneumonia, *INFORMATION needs, *ATTITUDES of medical personnel, *SEPSIS, *ANTIBIOTIC prophylaxis, *ALGORITHMS
Abstract

Over the past 10 years, there has been a rapid expansion in the use of extracorporeal membrane oxygenation (ECMO) in the care of patients with refractory cardiac or respiratory failure. Infectious diseases clinicians must reconcile conflicting evidence from limited studies as they develop practices at their own institutions, which has resulted in considerably different practices globally. This review describes infection control and prevention as well as antimicrobial prophylaxis strategies in this population. Data on diagnostics and treatment for patients receiving ECMO with a focus on diagnostic and antimicrobial stewardship is then examined. This review summarizes gaps in the current ECMO literature and proposes future needs, including developing clear definitions for infections and encouraging transparent reporting of practices at individual facilities in future clinical trials. [ABSTRACT FROM AUTHOR]

Published
2024
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11. The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation.

Author

Lee, Daniel G, Sobieszczyk, Michal J, Barsoumian, Alice E, and Marcus, Joseph E

Subjects
RISK assessment, CROSS infection, EXTRACORPOREAL membrane oxygenation, GRAM-positive bacterial infections, ACADEMIC medical centers, STAPHYLOCOCCAL diseases, BACTEREMIA, QUESTIONNAIRES, ENTEROCOCCAL infections, DESCRIPTIVE statistics, RETROSPECTIVE studies, MANN Whitney U Test, HOSPITAL mortality, SEPSIS, ENTEROCOCCUS faecium, CASE-control method, STAPHYLOCOCCUS, DATA analysis software, GRAM-negative bacterial diseases, DISEASE risk factors
Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in identifying blood stream infections (BSI) in this population is unknown as measurement of multiple variables commonly associated with infection are altered by the circuit. Methods: This study compares all blood stream infections for patients receiving ECMO between January 2012 and December 2020 to timepoints when blood cultures were negative using the Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) scores. Results: Of the 220 patients who received ECMO during the study period, 40 (18%) had 51 blood stream infections and were included in this study. Gram-positive infections composed 57% (n = 29) of infections with E. faecalis (n = 12, 24%) being the most common organism isolated. There were no significant differences in sepsis prediction scores at the time of infection compared to infection-free time points for SOFA (median (IQR) 7 (5–9) vs. 6 (5–8), p = 0.22), LODS (median (IQR) 12 (10–14) vs. 12 (10–13), p = 0.28), ABA (median (IQR) 2 (1–3) vs. 2 (1–3) p = 0.75), or SIRS (median (IQR) 3 (2–3) vs. 3 (2–3), p = 0.20). Conclusions: Our data shows that previously published sepsis scores are elevated throughout a patient's ECMO course, and do not correlate with bacteremia. Better predictive tools are needed to determine the appropriate timing for blood cultures in this population. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Impact of SARS-CoV-2 Arrival Surveillance Screening by Nucleic Acid Amplification Versus Rapid Antigen Detection on Subsequent COVID-19 Infections in Military Trainees

Author

Cybulski, Daniel J, primary, Matthews, Zachary, additional, Kieffer, John F, additional, Casey, Theresa M, additional, Osuna, Angela B, additional, Kasper, Korey, additional, Frankel, Dianne N, additional, Aden, James, additional, Yun, Heather C, additional, and Marcus, Joseph E, additional

Published
2023
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18. Impact of SARS-CoV-2 Arrival Surveillance Screening by Nucleic Acid Amplification Versus Rapid Antigen Detection on Subsequent COVID-19 Infections in Military Trainees.

Author

Cybulski, Daniel J, Matthews, Zachary, Kieffer, John W, Casey, Theresa M, Osuna, Angela B, Kasper, Korey, Frankel, Dianne N, Aden, James, Yun, Heather C, and Marcus, Joseph E

Subjects
PUBLIC health surveillance, MILITARY education, SARS-CoV-2, CONFIDENCE intervals, COVID-19, COMMUNICABLE diseases, MEDICAL screening, RAPID diagnostic tests, RETROSPECTIVE studies, INTERNSHIP programs, DESCRIPTIVE statistics, COVID-19 testing, NUCLEIC acid amplification techniques, MILITARY personnel
Abstract

Background For persons entering congregate settings, optimal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) arrival surveillance screening method, nucleic acid amplification test (NAAT) versus rapid antigen detection test (RADT), is debated. To aid this, we sought to determine the risk of secondary symptomatic coronavirus disease 19 (COVID-19) among military trainees with negative arrival NAAT or RADT screening. Methods Individuals who arrived for US Air Force basic military training from 1 January–31 August 2021 were placed into training groups and screened for SARS-CoV-2 via NAAT or RADT. Secondary symptomatic COVID-19 cases within 2 weeks of training were then measured. A case cluster was defined as ≥5 individual symptomatic COVID-19 cases. Results 406 (1.6%) of 24 601 trainees screened positive upon arrival. The rate of positive screen was greater for those tested with NAAT versus RADT (2.5% vs 0.4%; RR: 5.4; 95% CI: 4.0–7.3; P <.001). The proportion of training groups with ≥1 positive individual screen was greater in groups screened via NAAT (57.5% vs 10.8%; RR: 5.31; 95% CI: 3.65–7.72; P <.001). However, NAAT versus RADT screening was not associated with a difference in number of training groups to develop a secondary symptomatic case (20.3% vs 22.5%; RR:.9; 95% CI:.66–1.23; P =.53) or case cluster of COVID-19 (4% vs 6.6%; RR:.61; 95% CI:.3–1.22; P =.16). Conclusions NAAT versus RADT arrival surveillance screening method impacted individual transmission of COVID-19 but had no effect on number of training groups developing a secondary symptomatic case or case cluster. This study provides consideration for RADT arrival screening in congregate settings. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Fever and Leukocytosis Are Poor Predictors of Bacterial Coinfection in Patients With COVID-19 and Influenza Who Are Receiving Extracorporeal Membrane Oxygenation.

Author

Jackson, Luke B, Sobieszczyk, Michal J, Aden, James K, and Marcus, Joseph E

Subjects
COVID-19, EXTRACORPOREAL membrane oxygenation, LEUKOCYTE count, LEUCOCYTOSIS, INFLUENZA
Abstract

Background Fever and leukocytosis are 2 parameters commonly cited in clinical practice as indications to perform an infectious workup in patients receiving extracorporeal membrane oxygenation (ECMO), but their utility is unknown. Methods All patients who received ECMO between December 2014 and December 2020 with influenza or COVID-19 were included in this retrospective cohort study. Cultures were included if they were drawn from patients without signs of decompensation. Maximum temperature and white blood cell count were recorded on the day of culture collection. Workups with infections were compared with those that were negative. Results Of the 137 infectious workups in this 45-patient cohort, 86 (63%) were performed in patients with no signs of decompensation, totaling 165 cultures. These workups yielded 10 (12%) true infections. There were no differences in median (IQR) temperature (100.4 °F [100.2–100.8] vs 100.4 °F [99.3–100.9], P =.90) or white blood cell count (18.6 cells/mL [16.8–20.1] vs 16.7 cells/mL [12.8–22.3], P =.90) between those with and without infections. Conclusions In patients with influenza or COVID-19 who require ECMO, fever and leukocytosis were common indications for infectious workups, yet results were frequently negative. Despite their use in clinical practice, fever and leukocytosis are not reliable indicators of infection in patients who are hemodynamically stable and receiving ECMO. [ABSTRACT FROM AUTHOR]

Published
2023
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31. Response to a Serogroup B Meningococcal Disease Case Among Military Trainees

Author

Marcus, Joseph E, primary, Bennett, William N, additional, Frankel, Dianne N, additional, Kieffer, John W, additional, Casey, Theresa M, additional, Huston, Amanda E, additional, Hintz, Courtney N, additional, Keller, Alexander P, additional, Smolka, Michael T, additional, Sikorski, Cynthia S, additional, Yun, Heather C, additional, Dolan, Matthew J, additional, and Kiley, John L, additional

Published
2022
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32. Tracheostomy Placement in Patients with Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation: Did COVID-19 Change Our Practice?

Author

Adams, Alexandra M., primary, Laverty, Robert B., additional, McCarthy, Patrick M., additional, Marcus, Joseph E., additional, Boster, Joshua M., additional, Sattler, Lauren A., additional, Sobieszczyk, Michal J., additional, Mason, Phillip E., additional, and Sams, Valerie G., additional

Published
2021
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35. An RNA Interference (RNAi) Toolkit and Its Utility for Functional Genetic Analysis of Leishmania (Viannia).

Author

Lye, Lon-Fye, Owens, Katherine L., Jang, Soojin, Marcus, Joseph E., Brettmann, Erin A., and Beverley, Stephen M.

Subjects
LEISHMANIA, FUNCTIONAL analysis, RNA, GENETIC testing, CELL differentiation, RECOMBINASES
Abstract

RNA interference (RNAi) is a powerful tool whose efficacy against a broad range of targets enables functional genetic tests individually or systematically. However, the RNAi pathway has been lost in evolution by a variety of eukaryotes including most Leishmania sp. RNAi was retained in species of the Leishmania subgenus Viannia, and here we describe the development, optimization, and application of RNAi tools to the study of L. (Viannia) braziliensis (Lbr). We developed vectors facilitating generation of long-hairpin or "stem-loop" (StL) RNAi knockdown constructs, using GatewayTM site-specific recombinase technology. A survey of applications of RNAi in L. braziliensis included genes interspersed within multigene tandem arrays such as quinonoid dihydropteridine reductase (QDPR), a potential target or modulator of antifolate sensitivity. Other tests include genes involved in cell differentiation and amastigote proliferation (A600), and essential genes of the intraflagellar transport (IFT) pathway. We tested a range of stem lengths targeting the L. braziliensis hypoxanthine-guanine phosphoribosyl transferase (HGPRT) and reporter firefly luciferase (LUC) genes and found that the efficacy of RNAi increased with stem length, and fell off greatly below about 128 nt. We used the StL length dependency to establish a useful 'hypomorphic' approach not possible with other gene ablation strategies, with shorter IFT140 stems yielding viable cells with compromised flagellar morphology. We showed that co-selection for RNAi against adenine phosphoryl transferase (APRT1) using 4-aminopyrazolpyrimidine (APP) could increase the efficacy of RNAi against reporter constructs, a finding that may facilitate improvements in future work. Thus, for many genes, RNAi provides a useful tool for studying Leishmania gene function with some unique advantages. [ABSTRACT FROM AUTHOR]

Published
2023
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43. Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation

Author

Marcus, Joseph E., Sams, Valerie G., Aden, James K., Batchinsky, Andriy, Sobieszczyk, Michal J., Okulicz, Jason F., and Barsoumian, Alice E.

Abstract

AbstractObjectives:Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection.Design:Retrospective cohort study.Setting:A 425-bed academic tertiary-care hospital.Patients:All adult patients who received ECMO for >48 hours between May 2012 and May 2020.Methods:The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared.Results:In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P= .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8–4.2; P= .20).Conclusion:In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.

Published
2022
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44. Retrotransposons Are the Major Contributors to the Expansion of theDrosophila ananassaeMuller F Element

Author

Leung, Wilson, primary, Shaffer, Christopher D, additional, Chen, Elizabeth J, additional, Quisenberry, Thomas J, additional, Ko, Kevin, additional, Braverman, John M, additional, Giarla, Thomas C, additional, Mortimer, Nathan T, additional, Reed, Laura K, additional, Smith, Sheryl T, additional, Robic, Srebrenka, additional, McCartha, Shannon R, additional, Perry, Danielle R, additional, Prescod, Lindsay M, additional, Sheppard, Zenyth A, additional, Saville, Ken J, additional, McClish, Allison, additional, Morlock, Emily A, additional, Sochor, Victoria R, additional, Stanton, Brittney, additional, Veysey-White, Isaac C, additional, Revie, Dennis, additional, Jimenez, Luis A, additional, Palomino, Jennifer J, additional, Patao, Melissa D, additional, Patao, Shane M, additional, Himelblau, Edward T, additional, Campbell, Jaclyn D, additional, Hertz, Alexandra L, additional, McEvilly, Maddison F, additional, Wagner, Allison R, additional, Youngblom, James, additional, Bedi, Baljit, additional, Bettincourt, Jeffery, additional, Duso, Erin, additional, Her, Maiye, additional, Hilton, William, additional, House, Samantha, additional, Karimi, Masud, additional, Kumimoto, Kevin, additional, Lee, Rebekah, additional, Lopez, Darryl, additional, Odisho, George, additional, Prasad, Ricky, additional, Robbins, Holly Lyn, additional, Sandhu, Tanveer, additional, Selfridge, Tracy, additional, Tsukashima, Kara, additional, Yosif, Hani, additional, Kokan, Nighat P, additional, Britt, Latia, additional, Zoellner, Alycia, additional, Spana, Eric P, additional, Chlebina, Ben T, additional, Chong, Insun, additional, Friedman, Harrison, additional, Mammo, Danny A, additional, Ng, Chun L, additional, Nikam, Vinayak S, additional, Schwartz, Nicholas U, additional, Xu, Thomas Q, additional, Burg, Martin G, additional, Batten, Spencer M, additional, Corbeill, Lindsay M, additional, Enoch, Erica, additional, Ensign, Jesse J, additional, Franks, Mary E, additional, Haiker, Breanna, additional, Ingles, Judith A, additional, Kirkland, Lyndsay D, additional, Lorenz-Guertin, Joshua M, additional, Matthews, Jordan, additional, Mittig, Cody M, additional, Monsma, Nicholaus, additional, Olson, Katherine J, additional, Perez-Aragon, Guillermo, additional, Ramic, Alen, additional, Ramirez, Jordan R, additional, Scheiber, Christopher, additional, Schneider, Patrick A, additional, Schultz, Devon E, additional, Simon, Matthew, additional, Spencer, Eric, additional, Wernette, Adam C, additional, Wykle, Maxine E, additional, Zavala-Arellano, Elizabeth, additional, McDonald, Mitchell J, additional, Ostby, Kristine, additional, Wendland, Peter, additional, DiAngelo, Justin R, additional, Ceasrine, Alexis M, additional, Cox, Amanda H, additional, Docherty, James E B, additional, Gingras, Robert M, additional, Grieb, Stephanie M, additional, Pavia, Michael J, additional, Personius, Casey L, additional, Polak, Grzegorz L, additional, Beach, Dale L, additional, Cerritos, Heaven L, additional, Horansky, Edward A, additional, Sharif, Karim A, additional, Moran, Ryan, additional, Parrish, Susan, additional, Bickford, Kirsten, additional, Bland, Jennifer, additional, Broussard, Juliana, additional, Campbell, Kerry, additional, Deibel, Katelynn E, additional, Forka, Richard, additional, Lemke, Monika C, additional, Nelson, Marlee B, additional, O'Keeffe, Catherine, additional, Ramey, S Mariel, additional, Schmidt, Luke, additional, Villegas, Paola, additional, Jones, Christopher J, additional, Christ, Stephanie L, additional, Mamari, Sami, additional, Rinaldi, Adam S, additional, Stity, Ghazal, additional, Hark, Amy T, additional, Scheuerman, Mark, additional, Silver Key, S Catherine, additional, McRae, Briana D, additional, Haberman, Adam S, additional, Asinof, Sam, additional, Carrington, Harriette, additional, Drumm, Kelly, additional, Embry, Terrance, additional, McGuire, Richard, additional, Miller-Foreman, Drew, additional, Rosen, Stella, additional, Safa, Nadia, additional, Schultz, Darrin, additional, Segal, Matt, additional, Shevin, Yakov, additional, Svoronos, Petros, additional, Vuong, Tam, additional, Skuse, Gary, additional, Paetkau, Don W, additional, Bridgman, Rachael K, additional, Brown, Charlotte M, additional, Carroll, Alicia R, additional, Gifford, Francesca M, additional, Gillespie, Julie Beth, additional, Herman, Susan E, additional, Holtcamp, Krystal L, additional, Host, Misha A, additional, Hussey, Gabrielle, additional, Kramer, Danielle M, additional, Lawrence, Joan Q, additional, Martin, Madeline M, additional, Niemiec, Ellen N, additional, O'Reilly, Ashleigh P, additional, Pahl, Olivia A, additional, Quintana, Guadalupe, additional, Rettie, Elizabeth A S, additional, Richardson, Torie L, additional, Rodriguez, Arianne E, additional, Rodriguez, Mona O, additional, Schiraldi, Laura, additional, Smith, Joanna J, additional, Sugrue, Kelsey F, additional, Suriano, Lindsey J, additional, Takach, Kaitlyn E, additional, Vasquez, Arielle M, additional, Velez, Ximena, additional, Villafuerte, Elizabeth J, additional, Vives, Laura T, additional, Zellmer, Victoria R, additional, Hauke, Jeanette, additional, Hauser, Charles R, additional, Barker, Karolyn, additional, Cannon, Laurie, additional, Parsamian, Perouza, additional, Parsons, Samantha, additional, Wichman, Zachariah, additional, Bazinet, Christopher W, additional, Johnson, Diana E, additional, Bangura, Abubakarr, additional, Black, Jordan A, additional, Chevee, Victoria, additional, Einsteen, Sarah A, additional, Hilton, Sarah K, additional, Kollmer, Max, additional, Nadendla, Rahul, additional, Stamm, Joyce, additional, Fafara-Thompson, Antoinette E, additional, Gygi, Amber M, additional, Ogawa, Emmy E, additional, Van Camp, Matt, additional, Kocsisova, Zuzana, additional, Leatherman, Judith L, additional, Modahl, Cassie M, additional, Rubin, Michael R, additional, Apiz-Saab, Susana S, additional, Arias-Mejias, Suzette M, additional, Carrion-Ortiz, Carlos F, additional, Claudio-Vazquez, Patricia N, additional, Espada-Green, Debbie M, additional, Feliciano-Camacho, Marium, additional, Gonzalez-Bonilla, Karina M, additional, Taboas-Arroyo, Mariela, additional, Vargas-Franco, Dorianmarie, additional, Montañez-Gonzalez, Raquel, additional, Perez-Otero, Joseph, additional, Rivera-Burgos, Myrielis, additional, Rivera-Rosario, Francisco J, additional, Eisler, Heather L, additional, Alexander, Jackie, additional, Begley, Samatha K, additional, Gabbard, Deana, additional, Allen, Robert J, additional, Aung, Wint Yan, additional, Barshop, William D, additional, Boozalis, Amanda, additional, Chu, Vanessa P, additional, Davis, Jeremy S, additional, Duggal, Ryan N, additional, Franklin, Robert, additional, Gavinski, Katherine, additional, Gebreyesus, Heran, additional, Gong, Henry Z, additional, Greenstein, Rachel A, additional, Guo, Averill D, additional, Hanson, Casey, additional, Homa, Kaitlin E, additional, Hsu, Simon C, additional, Huang, Yi, additional, Huo, Lucy, additional, Jacobs, Sarah, additional, Jia, Sasha, additional, Jung, Kyle L, additional, Wai-Chee Kong, Sarah, additional, Kroll, Matthew R, additional, Lee, Brandon M, additional, Lee, Paul F, additional, Levine, Kevin M, additional, Li, Amy S, additional, Liu, Chengyu, additional, Liu, Max Mian, additional, Lousararian, Adam P, additional, Lowery, Peter B, additional, Mallya, Allyson P, additional, Marcus, Joseph E, additional, Ng, Patrick C, additional, Nguyen, Hien P, additional, Patel, Ruchik, additional, Precht, Hashini, additional, Rastogi, Suchita, additional, Sarezky, Jonathan M, additional, Schefkind, Adam, additional, Schultz, Michael B, additional, Shen, Delia, additional, Skorupa, Tara, additional, Spies, Nicholas C, additional, Stancu, Gabriel, additional, Vivian Tsang, Hiu Man, additional, Turski, Alice L, additional, Venkat, Rohit, additional, Waldman, Leah E, additional, Wang, Kaidi, additional, Wang, Tracy, additional, Wei, Jeffrey W, additional, Wu, Dennis Y, additional, Xiong, David D, additional, Yu, Jack, additional, Zhou, Karen, additional, McNeil, Gerard P, additional, Fernandez, Robert W, additional, Menzies, Patrick Gomez, additional, Gu, Tingting, additional, Buhler, Jeremy, additional, Mardis, Elaine R, additional, and Elgin, Sarah C R, additional

Published
2017
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