scholarly journals Bacterial and Fungal Co-infections with SARS-CoV-2 in Solid Organ Recipients, A Retrospective Study

Author(s):  
Mojtaba Shafiekhani ◽  
Zahra Shekari ◽  
Arash Boorboor ◽  
Zahra Zare ◽  
Sara Arabsheybani ◽  
...  

Abstract Background SARS-CoV-2, a novel corona virus, has caused clusters of fatal pneumonia worldwide. Immune compromised patients are among the high risk groups with poor prognosis of the disease. The presence of bacterial or fungal co-infections with SARS-CoV-2 is associated with increased mortality. Methods The electronic data of the liver and kidney recipients, hospitalized in COVID-19 intensive care unit in an 8-month period in 2020 were retrospectively assessed. The documented bacterial or fungal infections alongside with outcome and risk factors were recorded and analyzed by binary logistic regression model and multivariate analyses. Results Sixty-Six liver and kidney recipients were included this study. Twenty one percent of the patients had at least one episode of co-infection during their COVID-19 course. Bacterial and fungal co-infections contributed to a significantly higher mortality. Urine and sputum were the most common sites of pathogen isolation (45.45 % and 36.36%; respectively). The majority of infections were caused by vancomycin- resistant Enterococci (30%). Escherichia coli stood in the next position with 23.3%. Prior hospitalization and high does corticosteroid use were associated with co-infections (p=0<0.001 and p=0.02; respectively.)Conclusions Bacterial and fungal co-infections with COVID-19 are more prevalent in solid organ recipients compared to the general population. Prior hospitalizations and use of broad-spectrum antimicrobial agents lead to emergence of multi-drug resistant pathogens in this susceptible patient population. Early detection and treatment of co-infections as well as antibiotic stewardship is recommended in solid organ recipients.

2021 ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Zahra Shekari ◽  
Arash Boorboor ◽  
Zahra Zare ◽  
Sara Arabsheybani ◽  
...  

Abstract Background SARS-CoV-2, a novel corona virus, has caused clusters of fatal pneumonia worldwide. Immune compromised patients are among the high risk groups with poor prognosis of the disease. The presence of bacterial or fungal co-infections with SARS-CoV-2 is associated with increased mortality.Methods The electronic data of the liver and kidney recipients, hospitalized in COVID-19 intensive care unit in an 8-month period in 2020 were retrospectively assessed. The documented bacterial or fungal infections alongside with outcome and risk factors were recorded and analyzed by binary logistic regression model and multivariate analyses.Results Sixty-Six liver and kidney recipients were included this study. Twenty one percent of the patients had at least one episode of co-infection during their COVID-19 course. Bacterial and fungal co-infections contributed to a significantly higher mortality. Urine and sputum were the most common sites of pathogen isolation (45.45 % and 36.36%; respectively). The majority of infections were caused by vancomycin- resistant Enterococci (30%). Escherichia coli stood in the next position with 23.3%. Prior hospitalization and high does corticosteroid use were associated with co-infections (p=0<0.001 and p=0.02; respectively.)Conclusions Bacterial and fungal co-infections with COVID-19 are more prevalent on solid organ recipients compared to the general population. Prior hospitalizations and use of broad-spectrum antimicrobial agents leads to emergence of multi-drug resistant pathogens in this susceptible patient population. Early detection and treatment of co-infections as well as antibiotic stewardship is recommended in solid organ recipients.


2020 ◽  
Vol 9 (11) ◽  
pp. 3613
Author(s):  
Boyoung Park ◽  
Junghyun Yoon ◽  
Han Joon Kim ◽  
Yun Kyung Jung ◽  
Kyeong Geun Lee ◽  
...  

Background: This study analyzed the status and trends of transfusion and its associated factors among liver and kidney transplantation recipients. Methods: A total of 10,858 and 16,191 naïve liver or kidney transplantation recipients from 2008 to 2017 were identified through the National Health Insurance Service database. The prescription code for transfusion and the presence, number, and amount of each type of transfusion were noted. The odds ratios and 95% confidence intervals were determined to identify significant differences in transfusion and blood components by liver and kidney transplantation recipient characteristics. Results: In this study, 96.4% of liver recipients and 59.7% of kidney recipients received transfusions related to the transplantation operation, mostly platelet and fresh frozen plasma. Higher perioperative transfusion in women and declining transfusion rates from 2008 to 2017 were observed in both liver and kidney recipients. In liver recipients, the transfusion rate in those who received organs from deceased donors was much higher than that in those who received organs from living donors; however, the mortality rate according to transfusion was higher only in recipients of deceased donor organs. In kidney recipients, a higher mortality rate was observed in those receiving transfusion than that in patients without transfusion. Conclusions: In Korea, the transfusion rates in liver and kidney recipients were relatively higher than those in other countries. Sociodemographic factors, especially sex and year of transplantation, were associated with transfusion in solid organ recipients, possibly as surrogates for other causal clinical factors.


2018 ◽  
Vol 15 (3) ◽  
pp. 389-398
Author(s):  
Ruchi Singh

Rural economies in developing countries are often characterized by credit constraints. Although few attempts have been made to understand the trends and patterns of male out-migration from Uttar Pradesh (UP), there is dearth of literature on the linkage between credit accessibility and male migration in rural Uttar Pradesh. The present study tries to fill this gap. The objective of this study is to assess the role of credit accessibility in determining rural male migration. A primary survey of 370 households was conducted in six villages of Jaunpur district in Uttar Pradesh. Simple statistical tools and a binary logistic regression model were used for analyzing the data. The result of the empirical analysis shows that various sources of credit and accessibility to them play a very important role in male migration in rural Uttar Pradesh. The study also found that the relationship between credit constraints and migration varies across various social groups in UP.


2020 ◽  
Vol 26 (8) ◽  
pp. 867-904 ◽  
Author(s):  
Maria Fesatidou ◽  
Anthi Petrou ◽  
Geronikaki Athina

Background: Bacterial infections are a growing problem worldwide causing morbidity and mortality mainly in developing countries. Moreover, the increased number of microorganisms, developing multiple resistances to known drugs, due to abuse of antibiotics, is another serious problem. This problem becomes more serious for immunocompromised patients and those who are often disposed to opportunistic fungal infections. Objective: The objective of this manuscript is to give an overview of new findings in the field of antimicrobial agents among five-membered heterocyclic compounds. These heterocyclic compounds especially five-membered attracted the interest of the scientific community not only for their occurrence in nature but also due to their wide range of biological activities. Method: To reach our goal, a literature survey that covers the last decade was performed. Results: As a result, recent data on the biological activity of thiazole, thiazolidinone, benzothiazole and thiadiazole derivatives are mentioned. Conclusion: It should be mentioned that despite the progress in the development of new antimicrobial agents, there is still room for new findings. Thus, research still continues.


2020 ◽  
Author(s):  
Gobi Hariyanayagam ◽  
Sera Selvanthan Sundram Gunasekaran ◽  
Shargunan Selvanthan Gunasekaran ◽  
Nur Syafina Insyirah Zaimi ◽  
Nor Amirah Abdul Halim

BACKGROUND In late December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was epidemiologically linked to seafood and wet animal market in Wuhan, Hubei, China. This event has instigated negative stigma among the general population to view the wet market as a high-risk location for potential transmission of coronavirus. OBJECTIVE This study investigated the prevalence of facemask use among general population visiting the wet market as well as factors contributing to unacceptable facemask practice. Setting The visitors to a district wet market selling range of live or freshly slaughtered animals during COVID-19 pandemic outbreak was observed for facemask practice. METHODS All Individuals visiting the market were observed for the type, category and practice of wearing facemas. Subjects were categorized into two groups of acceptable and unacceptable facemask practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting and Binary Logistic regression model was used in the multivariate setting. Main outcome measure Prevalence, acceptance practice and odds ratio of unacceptance of facemask use. RESULTS Among 1697 individuals included in the final analysis, 1687 (99.7%) was observed wearing facemask with 1338 (78.8%) using medical-grade facemask. Among them, 1615 (95.7%) individuals facemask practice was acceptable while the reaming 72 (4.3%) individuals were observed with unacceptable facemask practice. Individuals using medical-grade facemask and high-risk age group are 6.4 times (OR=6.40; 95% CI, 2.00-20.43; p=.002) and 2.06 times practice (OR=2.06; 95% CI, 1.08-3.94; p=.028) more likely to have unacceptable facemask practice respectively. CONCLUSIONS High saturation of facemask among the general population is an adequate indicator of public hygiene measures strategy which can help to mitigate the COVID-19 epidemic impact. Alarmingly, the unacceptable facemask practice among high-risk population raises the need for a targeted approach by healthcare authorities to ensure satisfactory facemask use.


Author(s):  
Jeremy Freese

This article presents a method and program for identifying poorly fitting observations for maximum-likelihood regression models for categorical dependent variables. After estimating a model, the program leastlikely will list the observations that have the lowest predicted probabilities of observing the value of the outcome category that was actually observed. For example, when run after estimating a binary logistic regression model, leastlikely will list the observations with a positive outcome that had the lowest predicted probabilities of a positive outcome and the observations with a negative outcome that had the lowest predicted probabilities of a negative outcome. These can be considered the observations in which the outcome is most surprising given the values of the independent variables and the parameter estimates and, like observations with large residuals in ordinary least squares regression, may warrant individual inspection. Use of the program is illustrated with examples using binary and ordered logistic regression.


2021 ◽  
Vol 7 (6) ◽  
pp. 451
Author(s):  
Georgios Karavalakis ◽  
Evangelia Yannaki ◽  
Anastasia Papadopoulou

Despite the availability of a variety of antifungal drugs, opportunistic fungal infections still remain life-threatening for immunocompromised patients, such as those undergoing allogeneic hematopoietic cell transplantation or solid organ transplantation. Suboptimal efficacy, toxicity, development of resistant variants and recurrent episodes are limitations associated with current antifungal drug therapy. Adjunctive immunotherapies reinforcing the host defense against fungi and aiding in clearance of opportunistic pathogens are continuously gaining ground in this battle. Here, we review alternative approaches for the management of fungal infections going beyond the state of the art and placing an emphasis on fungus-specific T cell immunotherapy. Harnessing the power of T cells in the form of adoptive immunotherapy represents the strenuous protagonist of the current immunotherapeutic approaches towards combating invasive fungal infections. The progress that has been made over the last years in this field and remaining challenges as well, will be discussed.


2021 ◽  
Vol 8 ◽  
pp. 204993612198954
Author(s):  
Isabel Ruiz-Camps ◽  
Juan Aguilar-Company

Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.


2021 ◽  
Author(s):  
Matthew Briggs ◽  
Christine Ulses ◽  
Lucas VanEtten ◽  
Cody Mansfield ◽  
Anthony Ganim ◽  
...  

Abstract Objective The objective of this study was to xamine primary factors which may predict patients’ failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. Methods A retrospective analysis of patients’ demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to clinic were analyzed. Independent variables were considered significant if the 95% Cis of the odds ratios did not include 1.0. Results A total of 6971 patients were included in the final analysis with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042 to 1.074), unemployment status (OR = 1.96; 95% CI = 1.41 to 2.73), unknown employment status (OR = 3.22; 95% CI = 1.12 to 8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43 to 6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10 to 4.49), unknown payer source (OR = 262.84; 95% CI = 188.72 to 366.08), and distance traveled ≥5 miles (OR = 1.31; 95% CI = 1.01 to 1.70). Female sex [OR = 0.73; 95% CI = 0.57 to 0.95) and age ≥ 40 years (OR = 0.44; 95% CI = 0.33 to 0.60) decreased the odds of a no-show event. Conclusion Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. Impact Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.


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