scholarly journals Allo-HSCT recipients with invasive fungal disease and ongoing immunosuppression have a high risk for developing tuberculosis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Apeng Yang ◽  
Jimin Shi ◽  
Yi Luo ◽  
Yishan Ye ◽  
Yamin Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Control Group ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Risk Patients ◽  
Independent Risk Factors ◽  
Nested Case Control

AbstractPatients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of acquiring tuberculosis (TB) due to a status of immunosuppression. We conducted a nested case control study to investigate the incidence and risk factors for TB after allo-HSCT. Between 2012 and 2017, 730 consecutive allo-HSCT recipients were enrolled, and 14 patients (1.92%) were diagnosed with TB. Relatively, 54 allo-HSCT recipients were selected as control. Patients who suffered TB had a significantly higher 3-year non-relapse mortality rate than the control group (30.36% vs 5.39%, P < 0.01). In multivariate analysis, invasive fungal disease (HR 4.87, 95% CI 1.39–17.09), treatment with a relatively high dose of prednisone (HR 10.34, 95% CI 1.12–95.47) and treatment with tacrolimus (HR 4.79, 95% CI 1.18–19.44) were identified independent risk factors for TB occurrence post allo-HSCT (P < 0.05). Meanwhile, donor type, dose and type of anti-thymocyte globulin (ATG) administrated, as well as treatment intensity, did not alter the incidence of TB. Therefore, allo-HSCT recipients with unexplained fever, especially those who suffer from invasive fungal disease and ongoing immunosuppression with a relatively high dose of prednisone or tacrolimus, are at a high-risk of developing active TB. Closely Monitoring TB occurrence, making a timely diagnosis and administering the proper treatment may be beneficial to those high-risk patients.

scholarly journals Risk factors for methicillin-resistantStaphylococcus aureusbacteraemia differ depending on the control group chosen

2013 ◽  
Vol 141 (11) ◽  
pp. 2376-2383 ◽  
Author(s):  
M. POGORZELSKA-MAZIARZ ◽  
E. Y. FURUYA ◽  
E. L. LARSON
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Organ Transplant ◽  
Severity Of Illness ◽  
Venous Catheter ◽  
Case Control ◽  
Control Group ◽  
Major Organ ◽  
Independent Risk Factors ◽  
Nested Case Control

SUMMARYMethicillin-resistantStaphylococcus aureus(MRSA) bacteraemia cause significant morbidity and mortality in hospitalized patients. Using a nested case-control design, 204 MRSA bacteraemia cases were compared to 301 unmatched methicillin-susceptibleStaphylococcus aureus(MSSA) bacteraemia controls and were matched 1:2 with non-infected controls. The independent risk factors for MRSA bacteraemia compared to MSSA bacteraemia were older age (P = 0·048), major organ transplant during current hospital stay (P = 0·016) and quinolone use (P = 0·016). Cases were more likely than non-infected controls to have renal failure (P = 0·003), cirrhosis (P = 0·013), and a central venous catheter (P = 0·003) after controlling for other risk factors. This large case-control study made it possible to assess risk factors for MRSA bacteraemia using two sets of controls and showed that risk factors differed greatly depending on the control group chosen. These results confirm the need for careful selection of appropriate control groups and the need to carefully adjust for underlying severity of illness.

A GITIL Prospective Randomized Multicenter Phase III Study of High Dose Sequential Chemotherapy with Rituximab (R-HDS) and Autologous Transplantation (ASCT) of Peripheral Blood Stem Cells Versus CHOP and Rituximab Delivered Every 14 Days (R-CHOP-14) in High-Risk Patients with Diffuse Large B-Cell Lymphomas (DLBCL): Interim Analysis on Feasibility and Toxicity (Protocol R-HDS 0305).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1898-1898
Author(s):  
Sergio Cortelazzo ◽  
Atto Billio ◽  
Alessandro Rambaldi ◽  
Corrado Tarella ◽  
Ingnazio Majolino ◽  
...  
Keyword(s):  
High Risk ◽  
Phase Iii ◽  
Control Group ◽  
High Dose ◽  
Advanced Stage ◽  
Bulky Disease ◽  
Free Survival ◽  
High Risk Patients ◽  
Risk Patients ◽  
Ecog Ps

Abstract R-HDS 0305 (Clinical Trials. gov. number NCT00355199) is a multi-centre, unblinded, randomized controlled phase III trial involving 240 patients in 3 years from 16 Italian Cancer Centres, with DLBCL without CNS involvement, advanced stage (stage ≥IIB, bulk), age from 18 to 60 years with ECOG-PS=0–3 and aaIPI=2–3 or age from 61 to 65 years with ECOG-PS=0–2 and IPI 3–5. The control group received R-CHOP-14, which comprised 8 courses of chemotherapy every 14 days, supported by GCSF (day 7–11)±IFRT, if they achieved at least a PR after 4 cycles. Cases refractory to R-CHOP-14 were given R-HDS as salvage therapy. Experimental arm consisted in a R-HDS program, including a debulking phase of 3 courses of doxorubicin-containing chemotherapy (APO), followed by high-dose (HD)-cyclophosphamide (CTX) 7g/sqm, HD-Ara-C (2 g/sqm every 12 hours for 6 days), HD-etoposide 2g/sqm+Cisplatin 100 mg/sqm. After HDS chemotherapy, HD-mitoxantrone plus melphalan (60 and 180 mg/sqm) or a BEAM (BCNU 300 mg/sqm, etoposide 200 mg/sqm, Ara-C 4000 mg/sqm, L-PAM 140 mg/sqm) conditioning regimen with ASCT±IFRT was planned. Rituximab (375 mg/sqm) is given for a total of 6 doses, twice after HD-CTX and HD-Ara-C, as in vivo purging before CD34+ cells harvest, and twice after ASCT. The primary outcomes of the study are complete remission and disease-free survival, overall survival, event-free survival and toxicity. From July 2005 to July 2007, 89 patients were enrolled in the study (R-CHOP-14=43; R-HDS=46). The median age was 51 (range 19–65 years), 11 (12%) had ≥60 years and the M/F was 1.3. Patients presented with adverse features such as advanced stage (88%), BM infiltration (28%), bulky disease (71%), elevated LDH (84%), poor ECOG-PS (55%) and &gt;1 extranodal sites (59%). Until now only 3 patients (3.4%) were refractory to planned treatment: 1/43 (2%) patients belonging to R-CHOP-14 arm shifted to R-HDS salvage treatment and other 2 patients died from lymphoma progression. The main G 3–4 WHO toxicity was haematological: anemia, granulocytopenia and thrombocytopenia occurred in 8%, 18% and 13% of patients, respectively. Grade 2–3 gastrointestinal toxicity and infectious episodes were recorded in 6% and 9% of patients, respectively. Two patients recovered from acute respiratory distress and 2 died of treatment-related toxicity (2.2%). In conclusion, if the R-HDS trial confirms earlier results, preliminary data show that intensive programs such as dose-dense chemo-immunotherapy and R-HDS with ASCT are feasible until 65 years with an acceptable toxic profile, also on the multi-centre basis. At completion of the trial we will assess the role of R-HDS and ASCT on the outcome of high-risk patients with DLBCL.

scholarly journals Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital

2020 ◽  
Author(s):  
Li Yan ◽  
Jide Sun ◽  
Xiuyu Xu ◽  
Shifeng Huang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
University Hospital ◽  
Health Concern ◽  
Urinary System ◽  
Fecal Samples ◽  
High Risk Patients ◽  
Risk Patients ◽  
Independent Risk Factors ◽  
Rectal Colonization

Abstract Background: Nosocomial infections caused by carbapenemase-producing Enterobacterieceae (CPE) constitute a major global health concern and are associated with increased morbidity and mortality. Rectal colonization with CPE is a risk factor for bacterial translocation leading to subsequent endogenous CPE infections. This prospective observational study was aimed to investigate the prevalence and epidemiology of rectal colonization of CPE, the carbapenemase genotypes, and to identify the independent risk factors for the acquisition of CPE colonization in high-risk patients from ICU and HSCT wards in a university hospital in China. Methods: In a prospective cohort study, 150 fecal samples from rectal swabs were consecutively obtained for inpatients from the ICU and HSCT wards from November 2018 to May 2019, and screening test for CPE was conducted by using home-made trypsin soybean broth (TSB) selective media and MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and carbapenemase genes were characterized by both the GeneXpert Carba-R and PCR for blaKPC, blaNDM, blaIMP, blaVIM and blaOXA. In order to further investigate the risk factors and clinical outcomes of CPE colonization, a prospective case-control study was also performed.Results: 26 suspected CPE strains, including 17 Klebsiella pneumoniae, 6 Escherichia coli, 1 Citrobacter freundii, 1 Enterobacter Kobe, and 1 Raoultella ornithinolytica, were identified in 25 non-duplicated fecal samples from 25 patients, with a carriage rate of 16.67% (25/150). Through GeneXpert Carba-R and subsequent PCR and sequencing, all the suspected CPE isolates were identified to be positive for the carbapenemase genes, of which 17 were blaKPC-carriers, and another 9 were blaNDM-producers. Multivariate analysis indicated that urinary system diseases, operation of bronchoscopy, and combined use of antibiotics were independent risk factors for acquiring CPE colonization in high-risk patients from the ICU and HSCT wards. Conclusions: This study revealed a high prevalence of rectal CPE colonization in high-risk patients from ICU and HSCT wards, and a predominant colonization of the KPC-producing K. pneumoniae strains. Stricter infection control measures are urgently needed to limit the dissemination of CPE strains, especially in patients who were afflicted by urinary system diseases, have underwent bronchoscopy, and were previously exposed to combined antibiotic use.

scholarly journals Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Li Yan ◽  
Jide Sun ◽  
Xiuyu Xu ◽  
Shifeng Huang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
University Hospital ◽  
Health Concern ◽  
Urinary System ◽  
High Risk Patients ◽  
Broth Microdilution Method ◽  
Risk Patients ◽  
Independent Risk Factors ◽  
Rectal Colonization

Abstract Background Nosocomial carbapenemase-producing Enterobacterieceae (CPE) infections constitute a major global health concern and are associated with increased morbidity and mortality. Rectal colonization with CPE is a risk factor for bacterial translocation leading to subsequent endogenous CPE infections. This prospective observational study was aimed to investigate the prevalence and epidemiology of rectal colonization of CPE, the carbapenemase genotypes, and to identify the independent risk factors for the acquisition of CPE colonization in high-risk patients from ICU and HSCT wards in a university hospital in China. Methods In a prospective cohort study, 150 fecal samples from rectal swabs were consecutively obtained for inpatients from the intensive care unit (ICU) and hematopoietic stem cell transplantation (HSCT) wards from November 2018 to May 2019, and screening test for CPE was conducted by using prepared in-house trypsin soybean broth (TSB) selective media and MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and carbapenemase genes were characterized by both the GeneXpert Carba-R and PCR for blaKPC, blaNDM, blaIMP, blaVIM and blaOXA. Multi-locus sequence typing (MLST) was employed to characterize the genetic relationships among the carbapenemase-producing K. Pneumonia (CPKP) isolates. In order to further investigate the risk factors and clinical outcomes of CPE colonization, a prospective case-control study was also performed. Results Twenty-six suspected CPE strains, including 17 Klebsiella pneumoniae, 6 Escherichia coli, 1 Citrobacter freundii, 1 Enterobacter Kobe, and 1 Raoultella ornithinolytica, were identified in 25 non-duplicated rectal swab samples from 25 patients, with a carriage rate of 16.67% (25/150). Through GeneXpert Carba-R and subsequent PCR and sequencing, all the suspected CPE isolates were identified to be positive for the carbapenemase genes, of which 17 were blaKPC-carriers, and another 9 were blaNDM-producers. MLST designated all the CPKP isolates to be ST11 clone. Multivariate analysis indicated that urinary system diseases, operation of bronchoscopy, and combined use of antibiotics were independent risk factors for acquiring CPE colonization in high-risk patients from the ICU and HSCT wards. Conclusions This study revealed a high prevalence of rectal CPE colonization in high-risk patients from ICU and HSCT wards, and a predominant colonization of the KPC-producing K. pneumoniae clone ST11. Stricter infection control measures are urgently needed to limit the dissemination of CPE strains, especially in patients who were afflicted by urinary system diseases, have underwent bronchoscopy, and were previously exposed to combined antibiotic use.

Prevention and diagnosis of invasive fungal disease in high-risk patients within an integrative care pathway

2013 ◽  
Vol 67 (3) ◽  
pp. 206-214 ◽  
Author(s):  
Rosemary A. Barnes ◽  
Kate Stocking ◽  
Sarah Bowden ◽  
Matthew H. Poynton ◽  
P. Lewis White
Keyword(s):  
High Risk ◽  
Care Pathway ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Integrative Care ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Pneumocystis pneumonia in patients with rheumatic diseases receiving prolonged, non-high-dose steroids—clinical implication of primary prophylaxis using trimethoprim–sulfamethoxazole

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Won Park ◽  
Jeffrey R. Curtis ◽  
Min Jung Kim ◽  
Hajeong Lee ◽  
Yeong Wook Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Rheumatic Diseases ◽  
Dose Group ◽  
Low Dose ◽  
Pneumocystis Pneumonia ◽  
Control Group ◽  
High Dose ◽  
Number Needed To Treat ◽  
Medium Dose

Abstract Objectives To investigate the incidence of pneumocystis pneumonia (PCP) and its risk factors in patients with rheumatic disease receiving non-high-dose steroid treatment, along with the risks and benefits of PCP prophylaxis. Methods This study included 28,292 treatment episodes with prolonged (≥ 4 weeks), non-high-dose steroids (low dose [< 15 mg/day, n = 27,227] and medium dose [≥ 15 to < 30 mg/day, n = 1065], based on prednisone) over a 14-year period. Risk factors for PCP and prophylactic effect of trimethoprim–sulfamethoxazole (TMP-SMX) were investigated if the 1-year incidence rate (IR) of PCP in each dose group was > 0.1/100 person-years. Cox regression with LASSO was used for analysis. Results One-year PCP IR in the low-dose group was 0.01 (95% CI 0.001–0.03)/100 person-years, and only the medium-dose group showed eligible PCP IR for further analysis. In the medium-dose group, prophylactic TMP-SMX was administered in 45 treatment episodes while other episodes involved no prophylaxis (prophylaxis group vs. control group). In 1018.0 person-years, 5 PCP cases occurred exclusively in the control group, yielding an IR of 0.5 (0.2–1.2)/100 person-years. Concomitant steroid-pulse treatment and baseline lymphopenia were the most significant risk factors for PCP. Treatment episodes with at least one of these factors (n = 173, high-risk subgroup) showed higher 1-year PCP IR (3.4 (1.1–8.0)/100 person-years), while no PCP occurred in other treatment episodes. TMP-SMX numerically reduced the risk (adjusted HR = 0.2 (0.001–2.3)) in the high-risk subgroup. The IR of adverse drug reactions (ADRs) related to TMP-SMX was 41.5 (22.3–71.6)/100 person-years, including one serious ADR. The number needed to treat with TMP-SMX to prevent one PCP in the high-risk subgroup (31 (17–226)) was lower than the number needed to harm by serious ADR (45 (15–∞)). Conclusion Incidence of PCP in patients with rheumatic diseases receiving prolonged, medium-dose steroids depends on the presence of risk factors. Prophylactic TMP-SMX may have greater benefit than potential risk in the high-risk subgroup.

A concise prognostic score system for diffuse large B-cell lymphoma: a retrospective study with long-term follow-up

2021 ◽  
Author(s):  
Ying Yang ◽  
Zhuogang Liu ◽  
Guojun Zhang ◽  
Hongtao Wang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Prognostic Score ◽  
B Cell Lymphoma ◽  
Score System ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Independent Risk Factors

Aim: To identify risk factors and establish a concise prognostic scoring system in patients with diffuse large B-cell lymphoma (DLBCL). Methods: A total of 131 DLBCL patients were enrolled with long-term follow-up who were treated in Shengjing Hospital of the China Medical University. The relationship between clinical parameters and outcomes was analyzed. Results: Multivariate analysis showed that patient age, BMI, CA125 and rituximab application were independent risk factors. Thereafter, a concise scoring system was established, and the new system could identify high-risk patients (p < 0.0001). The patients were divided into three groups: low-risk, medium-risk and high-risk groups. There were significant differences among different groups on overall survival and progression-free survival by log-rank test (p < 0.05). Conclusion: Old age, low BMI, high CA125 and no rituximab application were independent risk factors for DLBCL. The new established prognostic score system, which includes all the risk factors, could identify high-risk patients.

scholarly journals Risk-benefit analysis of isoniazid monotherapy to prevent tuberculosis in patients with rheumatic diseases exposed to prolonged, high-dose glucocorticoids

2020 ◽  
Author(s):  
Jun Won Park ◽  
Jeffrey R Curtis ◽  
Hajeong Lee ◽  
Jung-Kyu Lee ◽  
Yeong Wook Song ◽  
...  
Keyword(s):  
High Risk ◽  
Rheumatic Diseases ◽  
Interferon Γ ◽  
Control Group ◽  
High Dose ◽  
Number Needed To Treat ◽  
Risk Patients ◽  
Release Assay ◽  
Risk Benefit Analysis ◽  
Number Needed To Harm

Abstract Objective To investigate the incidence of tuberculosis (TB) in patients with rheumatic diseases receiving high-dose glucocorticoids and to evaluate the preventive effect of isoniazid (INH). Methods This study included 1618 treatment episodes of prolonged (≥4 weeks), high-dose steroids (≥30mg/day of prednisone) in 1160 patients. Of these, INH was administered in 152 (9.4%) treatment episodes (INH group), while others received no prophylaxis (control group). The high-risk subgroup (n=92) was defined as patients with 1) incomplete adherence to treatment of previous TB, 2) positive interferon-γ release assay, and/or 3) linear/reticular fibrotic lesions on chest radiographs. Primary outcome was 1-year incidence of TB in each group. Results During 1579.8 person-years, 21 cases of TB occurred. The high-risk subgroup showed a significantly higher TB incidence than the non-high-risk subgroup (Incidence rate ratio=8.29). INH did not significantly affect the 1-year TB incidence in the whole population but numerically reduced it only in the high-risk subgroup [adjusted hazards ratio=0.48 (95% CI, 0.003–5.46)]. The incidence of adverse drug reactions (ADRs) related to INH was 111.6 (89.3–137.9)/100 person-years, including one fatal occurrence of fulminant hepatitis. The number needed to treat (NNT) to prevent one case of TB was lower than the number needed to harm (NNH) for one case of serious ADR only in the high-risk subgroup (3 vs. 11). Conclusion INH treatment to prevent TB might be effective in high-risk patients but has a risk of frequent ADRs, which limits its use in general practice in patients not at a high risk of developing TB.

Revision of CHAARTED and LATTITUDE criteria among Japanese de novo metastatic prostate cancer patients.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 132-132
Author(s):  
Shinichi Sakamoto ◽  
Yasutaka Yamada ◽  
Junryo Rii ◽  
Satoshi Yamamoto ◽  
Shuhei Kamada ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Cancer Patients ◽  
Metastatic Prostate Cancer ◽  
De Novo ◽  
Japanese Cohort ◽  
Significant Difference ◽  
Risk Patients ◽  
Independent Risk Factors

132 Background: Based on the high response rate to the standard androgen deprivation therapy (ADT), the Japanese cohort in LATTITUDE study failed to show the survival benefit by early Abiraterone. In order to identify the "true high-risk" patients, we studied the prognostic factors among Japanese de novo metastatic prostate cancer patients who fit CHAARTED and LATITUDE criteria. Methods: We retrospectively studied patients who fit CHAARTED (292 patients) and LATITUDE (294 patients) criteria from Japanese multi-institutions. All patients received ADT with bicalutamide as an initial treatment. Factors related to overall survival (OS) and progression-free survival (PFS) were statistically analyzed. Results: The median OS was 56 mo and 57 mo in patients who met the CHAARTED and the LATITUDE criteria, respectively. In patients who met CHAARTED criteria, LDH (HR2.6, p < 0.00001) and CRP (HR1.7, p = 0.042) were independent risk factors for OS. In patients who met LATTITUDE criteria, GS≥9 (HR1.7, p = 0.0378) and LDH (HR2.9, p < 0.0001) were independent risk factors for OS. Modified CHAARTED criteria by adding LDH and CRP showed a significant difference in OS (HR2.8, p < 0.0001) with a comparative median OS (30 mo) to placebo of CHAARTED trial (32 mo). Modified LATTITUDE criteria by adding GS≥9 and LDH, showed a significant difference in OS (HR2.7, p < 0.0001) with a comparative median OS (33 mo) to placebo of LATTITUDE trial (34 mo). Conclusions: Modified criteria may potentially elucidate the true "high-volume" and "high-risk" patients in the Japanese cohort who require early intensive therapy.[Table: see text]

High-Dose Caspofungin as a Component of Combination Antifungal Therapy in 91 Patients With Neoplastic Diseases and Hematopoietic Stem Cell Transplantation

2013 ◽  
Vol 28 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Amar Safdar ◽  
Gilhen Rodriguez ◽  
Jorge Zuniga ◽  
Fadi Al Akhrass ◽  
Anupam Pande
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Antifungal Therapy ◽  
Invasive Fungal Disease ◽  
Median Number ◽  
Fungal Disease ◽  
High Dose ◽  
Drug Induced ◽  
Hematopoietic Stem

The antifungal activity of echinocandins is concentration dependent. Previously, we demonstrated that high-dose caspofungin (HD-CSP; 100 mg daily) was well tolerated in 34 immunosuppressed patients with cancer and may have favorably influenced outcomes. We retrospectively assessed all 91 patients in whom HD-CSP was given for the treatment of invasive fungal disease (IFD). The median number of doses was 18.5 ± 21.5, and in 8 (9%) patients more than 40 doses were given. Most (62%) of the patients had leukemia. A total of 45 (49%) patients had undergone stem cell transplantation; 80% received allogeneic grafts and 47% had graft-versus-host disease. High-dose corticosteroids were given during antifungal therapy in 26 (29%) patients. In all, 8 (9%) patients had new elevation in serum bilirubin during HD-CSP therapy; normalization occurred after voriconazole and HD-CSP were discontinued in 4 patients each. No other short-term or delayed adverse events were observed. In all, 40 (44%) patients died of IFD. High-dose corticosteroids during HD-CSP (odds ratio [OR] 8, 95% confidence interval [CI] 2.1-30.4; P < .002) and starting HD-CSP in the critical care unit (OR 67.5, 95% CI 5.25-868.9; P < .001) were associated with death from fungal disease. Prolonged HD-CSP therapy was well tolerated. Drug-induced hyperbilirubinemia may pose a potential limitation for continued HD-CSP use in highly susceptible patients with hematologic neoplasms and stem cell transplantation.

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