scholarly journals 1385. Impact of Deceased Organ Donor Injection Drug Use on Donor Culture Positivity

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S778-S778
Author(s):  
Krista Moore ◽  
Ebbing Lautenbach ◽  
Emily Blumberg ◽  
Jennifer Han ◽  
Dong Heun Lee ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Safety Monitoring ◽  
Recent History ◽  
Organ Donors ◽  
Scientific Advisory Committee ◽  
Material Support ◽  
Culture Positivity ◽  
Scientific Advisory ◽  
History Of ◽  
Research Grant

Abstract Background With the ongoing opioid epidemic in the US, there has been an increase in the proportion of deceased organ donors with a history of injection drug use (IDU), raising concern for additional infectious risks to transplantation.We sought to determine how recent IDU among deceased organ donors impacted donor culture results. Methods A retrospective cohort study was conducted at four transplant centers in Philadelphia between 1/1/2015 and 6/30/2016. All deceased organ donors who donated ≥ 1 organ to one of the centers were included. Exposed donors were those with a recent history of IDU (defined by use in the prior 12 months based on donor chart review). Unexposed donors were those with no recent history of IDU. The primary outcome was any positive donor culture (taken during the terminal hospitalization or at the time of organ procurement) for bacteria or Candida. Multivariable logistic regression was used to determine the association between recent IDU and donor culture positivity. Secondarily, the association between donor IDU and isolation of (1) a multidrug-resistant organism (MDRO) on culture, (2) Staphylococcus aureus on culture, (3) Candida on non-respiratory culture, and (4) bacteria or Candida on blood culture were determined. Results Of 394 total donors, 66 (17%) had a history of recent IDU and 343 (87%) had at least one positive donor culture. On multivariable analysis, recent IDU was associated with significantly increased odds of having at least one positive donor culture (aOR 3.6, 95% CI 1.1-11.9, P=0.04) and Candida on non-respiratory culture (aOR 2.6, 95% CI 1.1-6.2, P=0.03). However, recent IDU was not significantly associated with increased odds of MDRO on culture (OR 0.90, 95% CI 0.41-1.93, P=0.79), S. aureus on culture (OR 1.35, 95% CI 0.79-2.28, P=0.27), or positive blood culture (OR 0.79, 95% CI 0.32-1.95, P=0.60). Conclusion Donors with a recent history of IDU are more likely to have bacteria or Candida identified on cultures taken during their terminal hospitalization or at organ procurement. This increase does not appear to be driven by MDROs, S. aureus, or bloodstream infections but rather by Candida isolated from non-respiratory sites, potentially alleviating some fears surrounding the acceptance of solid organs from donors with a history of recent IDU. Disclosures Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB)) Emily Blumberg, MD, Amplyx (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB))Hologic (Research Grant or Support)Merck (Grant/Research Support, Other Financial or Material Support, Member of Scientific Advisory Committee)Takeda (Research Grant or Support, Other Financial or Material Support, Member of Scientific Advisory Committee) Jennifer Han, MD, MSCE, GlaxoSmithKline (Employee, Shareholder) Judith A. Anesi, MD, MSCE, Nothing to disclose

A Randomized Trial of Intravenous Thyroxine for Brain-Dead Organ Donors With Impaired Cardiac Function

2019 ◽  
Vol 30 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Rajat Dhar ◽  
Emily Stahlschmidt ◽  
Gary Marklin
Keyword(s):  
Drug Use ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Randomized Trial ◽  
Organ Procurement ◽  
Randomized Study ◽  
Organ Donors ◽  
History Of ◽  
Impaired Cardiac Function ◽  
Single Organ

Rationale: Brain death (BD) precipitates cardiac dysfunction impairing the ability to transplant hearts from eligible organ donors. Retrospective studies have suggested that thyroid hormone may enhance myocardial recovery and increase hearts transplanted. We performed a randomized trial evaluating whether intravenous thyroxine (T4) improves cardiac function in BD donors with impaired ejection fraction (EF). Methods: All heart-eligible donors managed at a single-organ procurement organization (OPO) underwent protocolized fluid resuscitation. Those weaned off vasopressors underwent transthoracic echocardiography (TTE) within 12 hours of BD and, if EF was below 60%, were randomized to T4 infusion or no T4 for 8 hours, after which TTE was repeated. Results: Of 77 heart-eligible donors, 36 were weaned off vasopressors. Ejection fraction was depressed in 30, of whom 28 were randomized to T4 (n = 17) vs control (n = 11). Baseline EF was comparable (45%, interquartile range [IQR] 42.5-47.5 vs 40%, 40-50, P = .32). Ejection fraction did not improve more with T4 (10%, IQR 5-15 vs 5%, 0-12.5, P = .24), although there was a trend to more hearts transplanted (59% vs 27%, P = .14). This difference appeared to be accounted for by more donors with a history of drug use in the T4 group, who exhibited greater improvements in EF (15% vs 0% without drug use, P = .01) and more often had hearts transplanted (12 of 19 vs 1 of 9, P = .01). Conclusions: In this small randomized study of BD donors with impaired cardiac function, T4 infusion did not result in greater cardiac recovery. A larger randomized trial comparing T4 to placebo appears warranted but would require collaboration across multiple OPOs.

scholarly journals 41. Assessing Past vs Present COVID-19 Infection: A Survey of Criteria for Discontinuing Precautions in Asymptomatic Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S29-S31
Author(s):  
Shruti K Gohil ◽  
Annabelle De St Maurice ◽  
Deborah S Yokoe ◽  
Deborah S Yokoe ◽  
Stuart H Cohen ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Infection Prevention ◽  
Unintended Consequences ◽  
Research Network ◽  
Trauma Patients ◽  
Material Support ◽  
Cleaning Products ◽  
Asymptomatic Patients ◽  
History Of ◽  
Research Grant

Abstract Background COVID-19 patients can remain positive by PCR-testing for several months. Pre-admission or pre-procedure testing can identify recovered asymptomatic patients who may no longer be contagious but would require precautions according to current CDC recommendations (10 days). This can result in unintended consequences, including procedure delays or transfer to appropriate care (e.g., psychiatric or post-trauma patients requiring admission to COVID-19 units instead of psychiatric or rehabilitation facilities, respectively). Methods We conducted a structured survey of healthcare epidemiologists and infection prevention experts from the SHEA Research Network between March-April, 2021. The 14-question survey, presented a series of COVID-19 PCR+ asymptomatic patient case scenarios and asked respondents if (1) they would consider the case recovered and not infectious, (2) if they have cleared precautions in such cases, and if so, (3) how many transmission events occurred after discontinuing precautions. The survey used one or a combination of 5 criteria: history of COVID-19 symptoms, history of exposure to a household member with COVID-19, COVID-19 PCR cycle threshold (CT), and IgG serology. Percentages were calculated among respondents for each question. Results Among 60 respondents, 56 (93%) were physicians, 51 (86%) were hospital epidemiologists, and 46 (77%) had >10y infection prevention experience. They represented facilities that cumulatively cared for >29,000 COVID-19 cases; 46 (77%) were academic, and 42 (69%) were large ( >400 beds). One-third to one-half would consider an incidentally found PCR+ case as recovered based on solo criteria, particularly those with two consecutive high CTs or COVID IgG positivity recovered (53-55%) (Table 1). When combining two criteria, half to four-fifths of respondents deemed PCR+ cases to be recovered (Table 2). Half of those had used those criteria to clear precautions (45-64%) and few to none experienced a subsequent transmission event resulting from clearance. Conclusion The majority of healthcare epidemiologists consider a combination of clinical and diagnostic criteria as recovered and many have used these to clear precautions without high numbers of transmission. Disclosures Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Deborah S. Yokoe, MD, MPH, Nothing to disclose Stuart H. Cohen, MD, Seres (Research Grant or Support) Jonathan Grein, MD, Gilead (Other Financial or Material Support, Speakers fees) Richard Platt, MD, MSc, Medline (Research Grant or Support, Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)

Physiologic Measures In Patients with PTSD with and Without A Recent History of Alcohol Abuse

2007 ◽  
Author(s):  
Eileen Ahearn ◽  
Mary Mussey ◽  
Catherine Johnson ◽  
Amy Krohn ◽  
Timothy Juergens ◽  
...  
Keyword(s):  
Alcohol Abuse ◽  
Recent History ◽  
History Of

Fictive Mode, ‘Journey to the West’, and Transformation of Space: ‘Ali Mubarak’s Discourses of Modernization

2007 ◽  
Vol 4 (3) ◽  
pp. 331-358
Author(s):  
WEN-CHIN OUYANG
Keyword(s):  
Cultural Transformation ◽  
Recent History ◽  
Theoretical Principle ◽  
Time And Space ◽  
The West ◽  
Arab Culture ◽  
History Of ◽  
Journey To The West

I begin my exploration of ‘Ali Mubarak (1823/4–1893) and the discourses on modernization ‘performed’ in his only attempt at fiction, ‘Alam al-Din (The Sign of Religion, 1882), with a quote from Guy Davenport because it elegantly sums up a key theoretical principle underpinning any discussion of cultural transformation and, more particularly, of modernization. Locating ‘Ali Mubarak and his only fictional work at the juncture of the transformation from the ‘traditional’ to the ‘modern’ in the recent history of Arab culture and of Arabic narrative, I find Davenport's pronouncement tantalizingly appropriate. He not only places the stakes of history and geography in one another, but simultaneously opens up the imagination to the combined forces of time and space that stand behind these two distinct yet related disciplines.

Predictors of Treatment Response to Fluoxetine in PTSD Following a Recent History of War Zone Stress Exposure

2012 ◽  
Author(s):  
Paul S. Hicks ◽  
Michael L. Adams ◽  
Brett Litz ◽  
Keith Young ◽  
Jed Goldart ◽  
...  
Keyword(s):  
Treatment Response ◽  
Recent History ◽  
Stress Exposure ◽  
War Zone ◽  
History Of

On the nature of chemistry

2018 ◽  
Vol 10 (2) ◽  
pp. 74 ◽  
Author(s):  
Eric R. Scerri
Keyword(s):  
19Th Century ◽  
The Other ◽  
Recent History ◽  
History Of Chemistry ◽  
History Of ◽  
The One ◽  
Fundamental Unity ◽  
The 19Th Century

<span>The very nature of chemistry presents us with a tension. A tension between the exhilaration of diversity of substances and forms on the one hand and the safety of fundamental unity on the other. Even just the recent history of chemistry has been al1 about this tension, from the debates about Prout's hypothesis as to whether there is a primary matter in the 19th century to the more recent speculations as to whether computers will enable us to virtually dispense with experimental chemistry.</span>

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