scholarly journals Cytomegalovirus in Adult Allogeneic Blood and Marrow Transplant Patients Before or Around the Period of Neutrophil Recovery: A Single-Center, Retrospective, Descriptive Study

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Isabella Martin ◽  
Alexandra Valsamakis ◽  
Douglas Gladstone ◽  
Richard Jones ◽  
Richard Ambinder ◽  
...  
Keyword(s):  
Invasive Disease ◽  
Potential Effect ◽  
Marrow Transplant ◽  
Allogeneic Blood ◽  
Single Center ◽  
Neutrophil Recovery ◽  
Dna Test ◽  
Clinical Consequences ◽  
Ganciclovir Resistance ◽  
Cmv Dnaemia

Abstract Background Few reports exist on pre-engraftment cytomegalovirus (CMV) DNAemia in allogeneic blood or marrow transplant (allo BMT) recipients. We describe this clinical entity, its management, and the potential effect of 3 different quantitative CMV deoxyribonucleic acid (DNA) tests used during the 6-year study period. Methods We performed a retrospective, single-center study of allo BMT recipients from 2010 to 2015 who developed CMV DNAemia before neutrophil recovery (absolute neutrophil count [ANC] <1000 cells/mm3, “pre-engraftment CMV”) or who became neutropenic concomitant with detectable CMV DNA (“peri-engraftment CMV”). Clinical data were collected from the electronic medical record. Results Among 1151 adult allo BMT patients, 73 developed CMV DNAemia before engraftment or while neutropenic after initial engraftment. Most patients were eventually treated (valganciclovir or ganciclovir, N = 68; foscarnet, N = 1); 4 were not treated. First CMV detection occurred at median day +12 (range, 0–48), but treatment was not started until median day +33 (range, 4–105) at median ANC of 760 cells/mm3. Six patients had peak viral loads >5000 IU/mL; none had tissue-invasive disease. One developed ganciclovir resistance. No significant differences were observed upon stratification by quantitative CMV DNA test. Conclusions Cytomegalovirus DNA was detected in 6.3% of pre- and peri-engraftment allo-HSCT patients. Ganciclovir derivatives were commonly used for treatment despite risk of neutropenia. Treatment was typically deferred until CMV DNA and ANC rose. With rare exceptions, this treatment strategy did not appear to have adverse clinical consequences with respect to acute CMV. Different CMV DNA quantification tests used performed similarly from a clinical perspective despite different analytical performance characteristics.

scholarly journals 855. Significance of Invasive Infections due to Methicillin Sensitive Staphylococcus aureus in the neonatal population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S468-S468
Author(s):  
Mariawy Riollano ◽  
Deena Altman ◽  
shanna kowalsky ◽  
Stephanie Pan
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Characteristics ◽  
Invasive Disease ◽  
Control Measures ◽  
Invasive Infection ◽  
Single Center ◽  
Infection Control Measures ◽  
Invasive Infections ◽  
Mrsa Colonization ◽  
Neonatal Population

Abstract Background Staphylococcus aureus is a well-known cause of hospital acquired infections. Methicillin resistant staphylococcus aureus (MRSA) colonization is a recognized risk factor for invasive infections. The neonatal population in the intensive care unit (NICU) is particularly vulnerable to these types of infections, resulting in high mortality and morbidity. However, only scant data is available to establish the risk for invasive disease in patients with Methicillin sensitive staphylococcus aureus (MSSA). As a result, surveillance and prevention strategies are only address for MRSA colonization. Here, we describe the clinical characteristics of S. aureus colonized patients identified in late 2018 during transmission events in a single center NICU. As a result of the targeted surveillance investigation for MRSA infection control measures, S. aureus colonization was stratified, and we were able to compare the differences in invasive disease between MRSA and MSSA. Methods This is a retrospective chart review of the 47 colonized patients identified during October 2018- January 2019 SA transmission events in single center NICU. Risk factors, clinical characteristics, and the hospital course of these cases, including the proportion of invasive illness were reviewed. Results We found that most clinical characteristic, risk factors, and hospital course were the same between MRSA and MSSA colonized infants (p values > 0.05). Additionally, there was no difference in the proportion of invasive infection between MRSA and MSSA colonized patients (p value > 0.05). The type of invasive infections identified were SSTI, bacteremia, and osteomyelitis. Conclusion The proportion of invasive infection was the same in MSSA and MRSA colonized patients. This data provides us with supportive material for future recommendations of infection control measures for MSSA colonized patients. Disclosures All Authors: No reported disclosures

High-Dose Acyclovir for Cytomegalovirus Prophylaxis in Seropositive Abdominal Transplant Recipients

2017 ◽  
Vol 52 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Margaret R. Jorgenson ◽  
Jillian L. Descourouez ◽  
Glen E. Leverson ◽  
Erin K. McCreary ◽  
Michael R. Lucey ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Invasive Disease ◽  
High Dose ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Composite Failure ◽  
Significant Difference ◽  
Low Incidence ◽  
Ganciclovir Resistance ◽  
Long Term Impact

Background: Following abdominal solid organ transplant (aSOT), valganciclovir (VGC) is recommended for cytomegalovirus (CMV) prophylaxis. This agent is associated with efficacy concerns, toxicity, and emergence of ganciclovir resistance. Objective: To evaluate the incidence of high-dose acyclovir (HD-A) prophylaxis failure in seropositive aSOT recipients (R+). Methods: This was a retrospective, single-center study of R+ transplanted without lymphocyte-depleting induction between January 1, 2000, and June 30, 2013, discharged with 3 months of HD-A prophylaxis (800 mg 4 times daily). The primary outcome was incidence of prophylaxis failure. Secondary outcomes were incidence of biopsy-proven tissue-invasive disease and prophylaxis failure for each allograft subgroup. Results: A total of 1525 patients met inclusion criteria: 944 renal (RTX), 108 simultaneous pancreas-kidneys (SPK), 462 liver (LTX), and 11 pancreas (PTX) transplant recipients. The composite rate of HD-A prophylaxis failure was 7%; incidence of tissue-invasive disease was 0.4%. Failure rates were 4.5%, 6.1%, 11%, and 20% in the RTX, SPK, LTX, and PTX populations, respectively; tissue-invasive disease rates were 0.2%, 0%, 0.7%, and 10%. Failure occurred more frequently in the LTX and PTX populations ( P < 0.0001, HR = 2.6; P = 0.04 HR = 4.4). Incidence of tissue-invasive disease was minimal and not different in the RTX, LTX and SPK populations ( P = 0.34). When evaluating recipients of seronegative allografts (D−), the composite failure rate was 3.4% with no significant difference between allograft subgroups ( P = 0.45). Conclusion: HD-A may be a reasonable prophylaxis alternative for D−/R+ recipients, in the absence of lymphocyte-depleting induction, if low incidence viremia is tolerable. Future studies are needed to determine the long-term impact of CMV viremia in the setting of this prophylaxis approach.

scholarly journals Late Cytomegalovirus Pneumonia in Adult Allogeneic Blood and Marrow Transplant Recipients

1999 ◽  
Vol 28 (3) ◽  
pp. 618-623 ◽  
Author(s):  
Q. Nguyen ◽  
R. Champlin ◽  
S. Giralt ◽  
K. Rolston ◽  
I. Raad ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Allogeneic Blood ◽  
Transplant Recipients ◽  
Blood And Marrow Transplant ◽  
Cytomegalovirus Pneumonia

Analysis of sepsis in allogeneic bone marrow transplant recipients: a single-center study

2003 ◽  
Vol 9 (3) ◽  
pp. 238-242 ◽  
Author(s):  
Hideki Mitsui ◽  
Takahiro Karasuno ◽  
Taisuke Santo ◽  
Kentaro Fukushima ◽  
Hitomi Matsunaga ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Marrow Transplant ◽  
Allogeneic Bone Marrow ◽  
Allogeneic Bone ◽  
Transplant Recipients ◽  
Single Center ◽  
Allogeneic Bone Marrow Transplant ◽  
Single Center Study ◽  
Center Study

scholarly journals Allogenic Bone Marrow Transplant for Thalassemia Major—a Single Center Experience From India

2018 ◽  
Vol 24 (3) ◽  
pp. S422
Author(s):  
Dharma Choudhary ◽  
Divya Doval ◽  
Sanjeev Sharma ◽  
Vipin Khandelwal ◽  
Rasika Setia ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Thalassemia Major ◽  
Marrow Transplant ◽  
Single Center ◽  
Allogenic Bone ◽  
Allogenic Bone Marrow ◽  
Single Center Experience

scholarly journals High Rates of Pneumocystis carinii Pneumonia in Allogeneic Blood and Marrow Transplant Recipients Receiving Dapsone Prophylaxis

1999 ◽  
Vol 29 (6) ◽  
pp. 1467-1471 ◽  
Author(s):  
James P. Souza ◽  
Michael Boeckh ◽  
Ted A. Gooley ◽  
Mary E. D. Flowers ◽  
Stephen W. Crawford
Keyword(s):  
Pneumocystis Carinii Pneumonia ◽  
Pneumocystis Carinii ◽  
Marrow Transplant ◽  
Allogeneic Blood ◽  
Transplant Recipients ◽  
Blood And Marrow Transplant

Sequence Effect of Epirubicin and Paclitaxel Treatment on Pharmacokinetics and Toxicity

2000 ◽  
Vol 18 (10) ◽  
pp. 2116-2125 ◽  
Author(s):  
Marco Venturini ◽  
Gianluigi Lunardi ◽  
Lucia Del Mastro ◽  
Maria Ornella Vannozzi ◽  
Giuseppina Tolino ◽  
...  
Keyword(s):  
Pharmacokinetic Data ◽  
Breast Cancer Patients ◽  
Time Curve ◽  
Neutrophil Recovery ◽  
Sequence Dependent ◽  
Nonhematologic Toxicity ◽  
Significant Difference ◽  
Clinical Consequences ◽  
Opposite Sequence ◽  
Consecutive Stage

PURPOSE: Sequence-dependent clinical and pharmacokinetic interactions between paclitaxel and doxorubicin have been reported. Some data have shown an influence of paclitaxel on epirubicin metabolism, but no data are available about the effect of diverse sequences of these drugs. We investigated whether reversing the sequence of epirubicin and paclitaxel affects the pattern or degree of toxicity and pharmacokinetics. PATIENTS AND METHODS: Patients receiving epirubicin 90 mg/m2 by intravenous bolus followed by paclitaxel 175 mg/m2 over 3-hour infusion or the opposite sequence every 3 weeks for four cycles were eligible. Toxicity was recorded at nadir. Pharmacokinetic data were evaluated at the first and the second cycle and were correlated with toxicity parameters. RESULTS: Thirty-nine consecutive stage II breast cancer patients were treated. Twenty-one patients received epirubicin followed by paclitaxel (ET group), and 18 received the opposite sequence (TE group). No significant difference in nonhematologic toxicity was seen. A lower neutrophil and platelet nadir and a statistically significant slower neutrophil recovery was observed in the TE group. Area under the concentration-time curve (AUC) of epirubicin was higher in the TE group (2,346 ng/mL · h v 1,717 ng/mL · h; P = .002). An inverse linear correlation between epirubicin AUC and neutrophil recovery was also observed (P = .012). No difference was detected in paclitaxel pharmacokinetics. CONCLUSION: Our results support a sequence-dependent effect of paclitaxel over epirubicin pharmacokinetics that is associated with increased myelotoxicity. Because schedule modifications of anthracyclines and paclitaxel can have clinical consequences, the classical way of administration (ie, anthracyclines followed by paclitaxel) should be maintained in clinical practice.

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