scholarly journals Hypoalbuminemia as Surrogate and Culprit of Infections

2021 ◽  
Vol 22 (9) ◽  
pp. 4496
Author(s):  
Christian J. Wiedermann
Keyword(s):  
Serum Albumin ◽  
Fungal Infections ◽  
Human Albumin ◽  
Causal Link ◽  
Infectious Complications ◽  
Antimicrobial Treatment ◽  
Beneficial Effects ◽  
Secondary Infections ◽  
Healthcare Associated ◽  
Endogenous Albumin

Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.

scholarly journals Epidemiology of infectious complications in endo-arterial interventional radiology in France: Feasibility of the nationwide hospital discharge database (PMSI), 2010 – 2013

2021 ◽  
Vol 319 ◽  
pp. 01023
Author(s):  
Kaoutar Aid Mellouk ◽  
Abdelmajid Soulaymani ◽  
Benoit Misset
Keyword(s):  
Interventional Radiology ◽  
Hospital Discharge ◽  
International Classification Of Diseases ◽  
Causal Link ◽  
Infectious Complications ◽  
National Commission ◽  
Classification Of Diseases ◽  
Systèmes D’Information ◽  
Healthcare Associated

Introduction : The epidemiology of the Healthcare-Associated Infections (HAI) post-EndoArterial Interventional Radiology Procedures (EAIRP) is unknown. The objective is to test the feasibility of the nationwide hospital discharge French database, named, le Programme de Médicalisation des Systèmes d’Information (PMSI) to determine the incidence of IN post- EAIRP. The procedures selected are: Angioplasty, angioplasty with stent, embolization and thrombectomy. Subjects and methods: Denominator: patients with at least one stay including the code "trans/arterial route" of the French Common Classification of Medical Acts. Numerator: cases of HAIs according to the International Classification of Diseases in its French version, Tenth Revision. The study was approved by the French National Commission for Data Protection and Liberties. Results: 460,461 patients included in 692 centers from 2010 to 2013. 9,227 (2.01%) infections within 3 months of an EAIRP. Mortality 2.79% without HAI, versus 9.77% with HAI (P <0.001). Conclusion: Measuring the incidence of HAI secondary to an EAIRP with the PMSI is feasible. The HAI appears to be associated with excess mortality. The causal link between HAI and death deserves to be deepened. Comparisons with databases from other countries are necessary.

scholarly journals 342. Secondary Infections following Tocilizumab for Treatment of COVID-19 Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
Adam Warner ◽  
Mujahed Abbas ◽  
Benjamin S Avner ◽  
Thomas E Flynn ◽  
Todd A Walroth ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
Infectious Complications ◽  
Adult Patients ◽  
Control Group ◽  
Secondary Infections ◽  
Fraction Of Inspired Oxygen ◽  
Disproportionate Number ◽  
And Control

Abstract Background Guidelines recommend use of tocilizumab (TCZ), an inhibitor of pro-inflammatory IL-6 signaling, for hospitalized patients with progressive severe or critical Coronavirus disease 2019 (COVID-19). The incidence of infectious complications following the use of TCZ for COVID-19 has not been well-described. Methods We conducted a retrospective, observational matched cohort study of severely ill, hospitalized adult patients with confirmed COVID-19 who were treated with TCZ between 2/24/2021 and 6/1/2021. The intervention group, comprised of patients who received a single dose of TCZ, was matched based on c-reactive protein (CRP) and fraction of inspired oxygen (FiO2) with a control group who did not receive TCZ, and were hospitalized between 10/12/2020 and 3/6/2021. The primary outcome of the study was diagnosis of a bacterial or fungal infection after day 3 of the index hospitalization. Secondary outcomes included all-cause mortality during the study period and length of stay. Results 75 patients who received TCZ were identified during the study period, and matched 1:1 with 75 control patients. Baseline CRP and FiO2 were similar between groups, while the median age in the TCZ group was younger (61 versus 71 years), reflecting the epidemiology of the outbreak during the TCZ and control study periods. 15 bacterial and fungal infections were identified in the TCZ group (20.0%) and 4 (5.3%) infections in the control group (p = 0.012). The majority of infections in both groups were bacterial, with a disproportionate number of bloodstream infections in the TCZ group [7 (9.3%) vs 2(2.6%); p = 0.166]. 28 patients (37.3%) died in the TCZ group compared to 39 (52.0%) in the matched control (p = 0.068). Median time to discharge was similar between TCZ and control patients (11 versus 12 days; 95% CI -2,2). Conclusion Secondary infections in adult patients with severe and critical COVID-19 were more common in patients who had received TCZ. Prospective studies are needed to confirm and further describe this association. Disclosures All Authors: No reported disclosures

scholarly journals Appropriateness of antibiotics for medical prophylaxis: evaluation of data from the Italian PPS-2

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Cremona ◽  
J Garlasco ◽  
I Gintoli ◽  
A D'Ambrosio ◽  
F Quattrocolo ◽  
...  
Keyword(s):  
Empirical Therapy ◽  
Infectious Complications ◽  
High Rate ◽  
National Guidelines ◽  
Prevalence Survey ◽  
Inappropriate Use ◽  
Healthcare Associated ◽  
Evaluation Of Data ◽  
The Eu ◽  
Made In

Abstract Background Antibiotics (AB) are administered for medical prophylaxis (MP) to prevent infectious complications. The second national point prevalence survey (PPS) of healthcare-associated infections and AB use was conducted in Italy in 2016-2017. The survey found MP accounted for nearly 25% of all registered ABs, more than twice the EU/EEA proportion. The aim of this study was to evaluate how many ABs were administered for MP and how frequently general indications were followed. Methods Data from the PPS were used to evaluate the prevalence of indications for MP over the total number of ABs, the proportion - among these indications - of those justified by a motivation in the patients' charts, and the prevalence of ABs considered appropriate for MP. The evaluation was made in 12 hospitals out of 14 participating in the PPS in Piedmont, chosen on the basis of patient traceability. According to national guidelines, the indications for MP that were considered appropriate in this study were: Trimethoprim/sulfamethoxazole for P. carinii pneumonia, Rifaximin for diverticulitis, Penicillin for Streptococcal infections and for splenectomized patients, and Rifampin for TB infections. Results 1844 AB prescriptions were registered among 1334 traceable inpatients in Piedmont. The prevalence of indications for MP was 16.2% and 253 ABs (84.6%) were prescribed with a motivation. Only 3% of ABs registered as MP were appropriate for this indication: Bactrim 2%, Rifaximin 0.3%, Penicillin 0.2% and Rifampin 0.4%. Conclusions This study found an extremely high rate of inappropriate ABs for MP, that will be further investigated through qualitative analysis of medical records to evaluate whether a misunderstanding of the PPS protocol occurred and empirical therapy was confused with MP. Nevertheless, this study highlighted the need for interventions to improve prescribing appropriateness for MP. Key messages This study found that only 2.98% of ABs registered as MP among traceable patients in Piedmont were appropriate for this indication. 15.38% of prescriptions for MP were not justified by a motivation. Interventions to improve prescribing appropriateness for MP could lead to a considerable reduction in inappropriate use of ABs, which is crucial in a country facing hyperendemic levels of AMR.

scholarly journals Partial non-cleavage by cyanogen bromide of a methionine–cystine bond from human serum albumin and bovine α-lactalbumin

1979 ◽  
Vol 177 (1) ◽  
pp. 251-254 ◽  
Author(s):  
N Doyen ◽  
C Lapresle
Keyword(s):  
Human Serum Albumin ◽  
Serum Albumin ◽  
Human Serum ◽  
Cyanogen Bromide ◽  
Human Albumin ◽  
Alpha Lactalbumin

When human albumin was treated with CNBr, a fragment designated D was obtained and attributed to the absence from some of the albumin molecules of methionine at position 123 [Lapresle & Doyen (1975) Biochem. J. 151, 637-643]. The present study shows that methionine-123 is converted into homoserine without cleavage of the subsequent methionine-cystine bond. With bovine alpha-lactalbumin, a further example of non-cleavage of a methionine-cystine bond with conversion of methionine into homoserine is reported.

scholarly journals Effects of Rituximab on the Development of Viral and Fungal Infections in Renal Transplant Recipients

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Samir J. Patel ◽  
Jennifer M. Devos ◽  
Richard J. Knight ◽  
Kyle L. Dawson ◽  
Wadi N. Suki ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Odds Ratio ◽  
Viral Infections ◽  
Fungal Infections ◽  
Graft Function ◽  
Deceased Donor ◽  
Infectious Complications ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background. Rituximab is becoming increasingly utilized in renal transplant recipients; however, its association with infections remains unclear. Methods. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with () or without () rituximab (RTX) in addition to standard immunosuppression. Results. Infections occurred in 134 (30%) patients, with a greater proportion in RTX versus no RTX patients (47% versus 28%; ). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively (). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% () and 15% versus 2% (), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; ). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; ) and rituximab exposure (odds ratio = 2.2; ) as independent risk factors for infection. Older patients, deceased donor recipients, those on dialysis longer, and those with delayed graft function tended to be at a greater risk for infections following rituximab. Conclusions. Rituximab is associated with an increased incidence of viral and fungal infections in kidney transplantation. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab.

#10: Fever and neutropenia. 10 years surveillance in a pediatric Mexican hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S15
Author(s):  
E Sánchez-Medina ◽  
A Reyes-Hernández ◽  
A Severiano-Tellez
Keyword(s):  
Septic Shock ◽  
Defense Mechanisms ◽  
Antibiotic Use ◽  
Infectious Complications ◽  
E Coli ◽  
Pediatric Cancer Patients ◽  
Leukemia Treatment ◽  
Criteria For Diagnosis ◽  
Healthcare Associated ◽  
Epidemiologic Characteristics

Abstract Background Fever and neutropenia, is a very common complication of chemotherapy in the treatment of cancer. It could happen in 10–50% of patients with solid tumors and more than 80% of patients with blood cancer. During leukemia treatment is very important first defense mechanisms integrity, such as skin, mucous membranes, Tlaxcala Children’s Hospital is a pediatric general hospital, located in the center of Mexico and is where the pediatric cancer patients are treated, with almost 30 new cases by year, treatment with chemotherapy and as an adverse event fever and neutropenia, which increases morbidity and mortality Methods We conducted an observational, descriptive, and analytic study aiming to identify fever and neutropenic events in ALL patients, their epidemiologic characteristics, antibiotic use, isolation and antibiogram, and outcome. Results We reviewed 124 files from ALL patients between 2007–2017, we found 204 cases, 70 (33.8%) at induction, 18.6% consolidation, reinduction 17.6%, maintenance 14.2%. Out of 204 cases, we documented 177 with fever and neutropenia, 15 events of septic shock and 12 with fever and neutropenia with an identifiable source; the first-line antibiotic for fever and neutropenia was ceftazidime/amikacin, and for septic shock cefepime with an aminoglycoside, we found 3.39%, 20%, and 0% deaths from each group. Patients with fever and neutropenia with or without identifiable source had a length-stay average of 9.8 days compared with 30 days in patients with septic shock, CRP average was 12.47 mg/dL in the patients who survived and 8.23 mg/dL in those who did not. We found a very low positivity in cultures, and in most cases, those cultures did not meet criteria for diagnosis, the most common bacteria identified were E. coli, P. aeruginosa. Conclusions This is the first approach to get a better knowledge about infectious complications in patients with ALL, these findings could lead to identifying opportunities to improve diagnosis and treatment which lead to reducing cost, morbidity, healthcare-associated infections.

scholarly journals Covid-19-Associated Pulmonary Aspergillosis: The Other Side of the Coin

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 713
Author(s):  
Claudio Costantini ◽  
Frank L. van de Veerdonk ◽  
Luigina Romani
Keyword(s):  
Immune Response ◽  
Clinical Presentation ◽  
Fungal Infections ◽  
Critical Factor ◽  
The Other ◽  
Current View ◽  
Immune Homeostasis ◽  
Pulmonary Aspergillosis ◽  
Secondary Infections ◽  
The Individual

The immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a critical factor in the clinical presentation of COVID-19, which may range from asymptomatic to a fatal, multi-organ disease. A dysregulated immune response not only compromises the ability of the host to resolve the viral infection, but may also predispose the individual to secondary bacterial and fungal infections, a risk to which the current therapeutic immunomodulatory approaches significantly contribute. Among the secondary infections that may occur in COVID-19 patients, coronavirus-associated pulmonary aspergillosis (CAPA) is emerging as a potential cause of morbidity and mortality, although many aspects of the disease still remain unresolved. With this opinion, we present the current view of CAPA and discuss how the same mechanisms that underlie the dysregulated immune response in COVID-19 increase susceptibility to Aspergillus infection. Likewise, resorting to endogenous pathways of immunomodulation may not only restore immune homeostasis in COVID-19 patients, but also reduce the risk for aspergillosis. Therefore, CAPA represents the other side of the coin in COVID-19 and our advances in the understanding and treatment of the immune response in COVID-19 should represent the framework for the study of CAPA.

Ausscheidung von 131J-Humanalbumin im Primärharn der Froschniere

1959 ◽  
Vol 14 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Werner Heinzel ◽  
Ekkehard Kallee
Keyword(s):  
Human Serum Albumin ◽  
Serum Albumin ◽  
Human Serum ◽  
Serum Proteins ◽  
Human Albumin ◽  
Protein Solution ◽  
Bladder Urine

1. The glomerular capsules of 8 Bombinata toads have been tapped. The glomerula have been found to excrete 0.035-0.15 μg of protein in about 0.11 μl of urine per hour, i. e., a 0.1 p.c. protein solution.2. Radioiodinated human serum albumin when injected intraperitoneally was excreted by the toad glomerula into the primary urine and resorbed back by the tubuli in principle in the same ways as toad serum proteins. However, the human albumin was excreted by the glomerula to a significantly larger extent than toad proteins.3. The concentration of both toad protein and 131I-labelled human albumin was approximately seven times lower in the bladder urine than in the primary urine.

scholarly journals Interactions of 7,8-Dihydroxyflavone with Serum Albumin as well as with CYP2C9, CYP2C19, CYP3A4, and Xanthine Oxidase Biotransformation Enzymes

Biomolecules ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 655 ◽  
Author(s):  
Fliszár-Nyúl ◽  
Mohos ◽  
Bencsik ◽  
Lemli ◽  
Kunsági-Máté ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Xanthine Oxidase ◽  
In Vitro Models ◽  
Stable Complex ◽  
Limited Information ◽  
Inhibitory Effects ◽  
Beneficial Effects ◽  
Biotransformation Enzymes ◽  
Pharmacokinetic Properties

7,8-dihydroxyflavone (DHF) is a flavone aglycone which has beneficial effects in several central nervous system diseases. Most of the pharmacokinetic properties of DHF have been characterized, while only limited information is available regarding its interactions with serum albumin and biotransformation enzymes. In this study, the interactions of DHF with albumin was examined employing fluorescence spectroscopy and ultrafiltration. Furthermore, the inhibitory effects of DHF on cytochrome P450 (CYP2C9, CYP2C19, and CYP3A4) and xanthine oxidase (XO) enzymes were also tested using in vitro models. Our results demonstrate that DHF forms a stable complex with albumin (K = 4.9 × 105 L/mol) and that it is able to displace both Site I and Site II ligands. Moreover, DHF proved to be a potent inhibitor of each enzyme tested, showing similar or slightly weaker effects than the positive controls used. Considering the above-listed observations, the coadministration of DHF with drugs may interfere with the drug therapy due to the development of pharmacokinetic interactions.

Physical Activity, Physical Fitness, and Cognition

2017 ◽  
Author(s):  
Jennifer L. Etnier
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cognitive Performance ◽  
Cognitive Training ◽  
Causal Link ◽  
Future Research ◽  
Cross Sectional ◽  
Training Interventions ◽  
Beneficial Effects ◽  
Wide Range

There is substantial interest in identifying the behavioral means by which to improve cognitive performance. Recent research and commercial ventures have focused on cognitive training interventions, but evidence suggests that the effects of these programs are small and task-specific. Researchers have also shown interest in exploring the potential benefits of physical activity for cognitive performance. Because the effects of physical activity have been found to be small to moderate and to be more global in nature, interest in physical activity has been growing over the past several decades. Evidence regarding the efficacy of physical activity is provided through cross-sectional studies, longitudinal prospective studies, and randomized controlled trials. When reviewed meta-analytically, small-to-moderate beneficial effects are reported for children, adults, older adults, and cognitively impaired older adults, and these effects are evident for a wide range of cognitive domains, including executive function, memory, and information processing. Researchers are currently focused on identifying the mechanisms of these effects. Most of this research has been conducted using animal models, but there is a growing body of literature with humans. From this evidence, there is support for the role of changes in cerebral structure, hippocampal perfusion, and growth factors in explaining the observed benefits. Thus far, however, the literature is quite sparse, and future research is needed to clarify our understanding of the mechanisms that provide the causal link between physical activity and cognitive performance. Research is also focused on understanding how to increase the benefits by potentially combining cognitive training with physical activity and by identifying the genetic moderators of the effects. These lines of work are designed to elucidate ways of increasing the magnitude of the benefits that can be obtained. At this point in time, the evidence with respect to the potential of physical activity for benefiting cognitive performance is quite promising, but it is critical that funding agencies commit their support to the continued exploration necessary to allow us to ultimately be able to prescribe physical activity to specific individuals with the express purpose of improving cognition.

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