The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients

2016 ◽  
Vol 37 (7) ◽  
pp. 845-851 ◽  
Author(s):  
Marie-Paule Fernandez-Gerlinger ◽  
Anne-Sophie Jannot ◽  
Sophie Rigaudeau ◽  
Juliette Lambert ◽  
Odile Eloy ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Severe Infection ◽  
Hematologic Malignancies ◽  
Preventive Strategies ◽  
European Organization ◽  
Exact Test ◽  
Eortc Criteria ◽  
Neutropenic Patients ◽  
Chemotherapy Induced Neutropenia ◽  
The Impact

OBJECTIVEInvasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study.DESIGNRetrospective cohort studyMETHODSPatients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher’s exact test, and a multivariate analysis was performed to take into account potential confounding factors.RESULTSData from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00–0.84).CONCLUSIONIn this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies.Infect Control Hosp Epidemiol 2016;37:845–851

scholarly journals Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies

Leukemia ◽  
2005 ◽  
Vol 19 (4) ◽  
pp. 545-550 ◽  
Author(s):  
K Mühlemann ◽  
C Wenger ◽  
R Zenhäusern ◽  
M G Täuber
Keyword(s):  
Risk Factors ◽  
Invasive Aspergillosis ◽  
Hematologic Malignancies ◽  
Neutropenic Patients

scholarly journals 334. Impact of Overall Dexamethasone Exposure on Development of Invasive Pulmonary Aspergillosis in Hospitalized Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S272-S272
Author(s):  
Erik Skoglund ◽  
Amy Kum ◽  
Allison Mac ◽  
Mark Nguyen
Keyword(s):  
Low Dose ◽  
Opportunistic Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
High Dose ◽  
Pulmonary Aspergillosis ◽  
European Organization ◽  
Eortc Criteria ◽  
Dexamethasone Therapy ◽  
Expanded Criteria ◽  
The Impact

Abstract Background Abbreviated courses of corticosteroids, such as dexamethasone, have demonstrated significant improvements in clinical outcomes among patients infected with COVID-19, although chronic corticosteroid use can predispose patients to opportunistic infections. The RECOVERY trial investigators showed reduced 28-day mortality among patients treated with 6 mg/day dexamethasone for up to 10 days, however in clinical practice the dosage and duration of dexamethasone therapy can vary widely based on severity of disease and provider discretion. Upon observing an anecdotal increase in the number of patients presenting with potential invasive aspergillosis during the third wave of COVID-19, we sought to evaluate the impact of overall dexamethasone exposure on the development of invasive pulmonary aspergillosis. Methods Patients presenting to our institution from Dec. 2020 – Jan. 2021 with positive PCR for SARS-CoV-2 were screened for dexamethasone therapy. Assignment of high vs low dose dexamethasone groups were retrospectively made based on overall dexamethasone exposure. Low dose dexamethasone assignment was restricted to a total exposure of no more than 78 mg during a patient’s hospitalization. Adjudication of invasive pulmonary aspergillosis was made based on criteria that included host factors, radiologic findings, clinical factors, and mycological evidence. Results Dexamethasone therapy was provided to 202 patients admitted to the hospital with COVID-19. Invasive pulmonary aspergillosis was determined to be probable in n=7 patients based on European Organization for Research and Treatment of Cancer (EORTC) criteria, and in n=13 patients based on expanded criteria. Patients in the low dose dexamethasone group were less likely to be diagnosed with probable IPA based on EORTC criteria (n=0, 0% on low dose vs. n=7, 11% on high dose) as well as expanded criteria (n=9, 5% on low dose vs. n=11, 17% on high dose), p< 0.001. Conclusion Patients hospitalized with COVID-19 receiving high-dose dexamethasone may be at a higher risk of opportunistic infections such as invasive pulmonary aspergillosis compared to patients who receive low-dose dexamethasone therapy. Further investigation is needed to obtain higher certainty of IPA diagnosis. Disclosures All Authors: No reported disclosures

scholarly journals Clinical Outcomes of Oral Suspension versus Delayed-Release Tablet Formulations of Posaconazole for Prophylaxis of Invasive Fungal Infections

2018 ◽  
Vol 62 (10) ◽  
Author(s):  
Jon P. Furuno ◽  
Gregory B. Tallman ◽  
Brie N. Noble ◽  
Joseph S. Bubalo ◽  
Graeme N. Forrest ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hematologic Malignancies ◽  
Invasive Fungal Infections ◽  
Oral Suspension ◽  
European Organization ◽  
Delayed Release ◽  
Suspension Formulation ◽  
Eortc Criteria ◽  
Significant Difference ◽  
Release Tablet

ABSTRACT Posaconazole is used for prophylaxis for invasive fungal infections (IFIs) among patients with hematologic malignancies. We compared the incidence of breakthrough IFIs and early discontinuation between patients receiving delayed-release tablet and oral suspension formulations of posaconazole. This was a retrospective cohort study of patients receiving posaconazole between 1 January 2010 and 30 June 2016. We defined probable or proven breakthrough IFIs using the European Organization for Research and Treatment of Cancer (EORTC) criteria. Overall, 547 patients received 860 courses of posaconazole (53% received the oral suspension and 48% received the tablet); primary indications for prophylaxis were acute myeloid leukemia (69%), graft-versus-host disease (18%), and myelodysplastic syndrome (3%). There were no significant differences in demographics or indications between patients receiving the different formulations. The incidence and incidence rate of probable or proven IFIs were 1.6% and 3.2 per 10,000 posaconazole days, respectively. There was no significant difference in the rate of IFIs between suspension courses (2.8 per 10,000 posaconazole days) and tablet courses (3.7 per 10,000 posaconazole days) (rate ratio = 0.8, 95% confidence interval [CI] = 0.3 to 2.3). Of the 14 proven or probable cases of IFI, 8/14 had posaconazole serum concentrations measured, and the concentrations in 7/8 were above 0.7 μg/ml. Posaconazole was discontinued early in 15.5% of courses; however, the frequency of discontinuation was also not significantly different between the tablet (16.5%) and oral suspension (14.6%) formulations (95% CI for difference = −0.13 to 0.06). In conclusion, the incidence of breakthrough IFIs was low among patients receiving posaconazole prophylaxis and not significantly different between patients receiving the tablet formulation and those receiving the oral suspension formulation.

scholarly journals Early Diagnosis of Invasive Aspergillosis in Neutropenic Patients. Comparison between Serum Galactomannan and Polymerase chain Reaction

2010 ◽  
Vol 4 ◽  
pp. CMO.S5228 ◽  
Author(s):  
Rodrigo Lopes Da Silva ◽  
Patrícia Ribeiro ◽  
Natacha Abreu ◽  
Teresa Ferreira ◽  
Teresa Fernandes ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Early Diagnosis ◽  
Invasive Aspergillosis ◽  
Fungal Infections ◽  
Chain Reaction ◽  
Serum Samples ◽  
European Organization ◽  
Positive Serum ◽  
Neutropenic Patients ◽  
Polymerase Chain

Background Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients, so early diagnosis is mandatory. Aim Consecutive patients with hematological malignancies undergoing intensive chemotherapy were screened for IA with two different methods which were compared. Methods From October 2000 to August 2003 we tested 1311 serum samples from 172 consecutive patients with a polymerase chain reaction assay and between April 2005 and April 2008 we tested 806 serum samples from 169 consecutive patients with a Galactomannan (GM) test. Bronchoalveolar (BAL) samples were obtained whenever the patient's condition allowed and tested with either method. Results: The serum PCR assay had a sensitivity of 75.0% and a specificity of 91.9% and the serum GM assay had a sensitivity of 87.5% and a specificity of 93.1%, ( P > 0.05). The presence of two or more consecutive positive serum samples was predictive of IA for both assays. BAL GM/PCR was positive in some patients without serum positivity and in patients with 2 or more positive serum GM/PCR. Conclusions: No significant differences between the 2 serum tests were found. The GM assay has the advantage of being standardized among several laboratories and is incorporated in the criteria established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), however is much more expensive. BAL GM and PCR sampling aids in IA diagnosis but needs further validation studies to differentiate between colonization and true infection in cases where serum GM or PCR are negative.

Impact of palliative care on end-of-life outcomes in hematologic malignancies.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12026-12026
Author(s):  
Ari Pelcovits ◽  
Dominic Decker ◽  
Dana Guyer ◽  
Thomas William LeBlanc ◽  
Adam J. Olszewski ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Therapy ◽  
Hematologic Malignancies ◽  
Quality Outcomes ◽  
Exact Test ◽  
Patient Reported ◽  
Embedded Pc ◽  
Eol Care ◽  
The Impact

12026 Background: Patients (pts) with hematologic malignancies (HMs) receive more aggressive end-of-life (EOL) care and often die in the hospital. The impact of palliative care (PC) on EOL quality outcomes in HMs has not been well described. In 2017 we embedded a PC specialist within our inpatient malignant hematology team to facilitate the use of early PC. We sought to determine if this practice was accompanied by a shift in EOL outcomes. Methods: We conducted a retrospective review of pts diagnosed with acute myeloid leukemia (AML) at our institution in the 2 years before (Cohort A) and after (Cohort B) implementation of embedded PC. We identified pts who received PC and if it was early (during initial inpatient stay) or late (sometime after). We then examined EOL quality outcomes: hospitalizations and intensive care (ICU) admissions in the last 30 days of life, chemotherapy use in the last 14 days of life, and use of hospice and death out of hospital (DOH), using Fisher’s exact test to compare proportions. Results: Among 139 AML pts, 46 in Cohort A, 93 in Cohort B, we identified 34 and 47 decedents in each cohort respectively. The use of PC was significantly higher in Cohort B (75% vs 43%, P= 0.0006), with a significant increase in early PC (52% vs 11%, P < 0.0001). There was no significant improvement in EOL quality outcomes between Cohort A and B, or uniquely among pts receiving early PC ( P > 0.05); however, PC use in general across all cohorts was associated with significant increase in hospice use and fewer ICU admissions ( P =0.016 and 0.0043, respectively). Among pts not receiving PC, a numerical improvement was noted in EOL metrics between Cohorts A and B ( P > 0.05; see table). Conclusions: PC for pts with AML was associated with significantly better EOL quality outcomes. We also observed improvement in EOL metrics over time among pts not receiving PC, which may indicate a culture shift with the embedded PC service, whose benefit extended to pts not directly receiving PC. Embedding a PC specialist and early PC in AML, however, was not significantly associated directly with EOL care improvements. The value of these interventions in HMs may be better measured using patient-reported outcomes and quality of life measures rather than strict EOL outcomes. Further research should consider potential differential role of PC among pts with HM undergoing aggressive/curative, or non-intense/palliative therapy. [Table: see text]

scholarly journals Outcome of severe infections in afebrile neutropenic cancer patients

2016 ◽  
Vol 50 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Ksenija Strojnik ◽  
Ksenija Mahkovic-Hergouth ◽  
Barbara Jezersek Novakovic ◽  
Bostjan Seruga
Keyword(s):  
Mortality Rate ◽  
Febrile Neutropenia ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Severe Infection ◽  
Cancer Center ◽  
Exact Test ◽  
Severe Fatigue ◽  
Severe Infections ◽  
Chemotherapy Induced Neutropenia

Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.

scholarly journals A Prospective Multicenter Cohort Surveillance Study of Invasive Aspergillosis in Patients with Hematologic Malignancies in Greece: Impact of the Revised EORTC/MSGERC 2020 Criteria

2021 ◽  
Vol 7 (1) ◽  
pp. 27
Author(s):  
Maria Siopi ◽  
Stamatis Karakatsanis ◽  
Christoforos Roumpakis ◽  
Konstantinos Korantanis ◽  
Helen Sambatakou ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Incidence Rate ◽  
Tertiary Care ◽  
Hematologic Malignancies ◽  
Underlying Disease ◽  
Antifungal Prophylaxis ◽  
Incidence Rates ◽  
Risk Patients ◽  
Serial Serum ◽  
The Impact

Data concerning the incidence of invasive aspergillosis (IA) in high-risk patients in Greece are scarce, while the impact of the revised 2020 EORTC/MSGERC consensus criteria definitions on the reported incidence rate of IA remains unknown. A total of 93 adult hematology patients were screened for IA for six months in four tertiary care Greek hospitals. Serial serum specimens (n = 240) the sample was considered negative by PCR were collected twice-weekly and tested for galactomannan (GM) and Aspergillus DNA (PCR) detection. IA was defined according to both the 2008 EORTC/MSG and the 2020 EORTC/MSGERC consensus criteria. Based on the 2008 EORTC/MSG criteria, the incidence rates of probable and possible IA was 9/93 (10%) and 24/93 (26%), respectively, while no proven IA was documented. Acute myeloid leukemia was the most (67%) common underlying disease with most (82%) patients being on antifungal prophylaxis/treatment. Based on the new 2020 EORTC/MSGERC criteria, 2/9 (22%) of probable and 1/24 (4%) of possible cases should be reclassified as possible and probable, respectively. The episodes of probable IA were reduced by 33% when GM alone and 11% when GM + PCR were used as mycological criterion. The incidence rate of IA in hematology patients was 10%. Application of the 2020 EORTC/MSGERC updated criteria results in a reduction in the classification of probable IA particularly when PCR is not available.

scholarly journals The dynamics of circulating heparin-binding protein (HBP) - implications for its use as a biomarker

2021 ◽  
Author(s):  
Jane Fisher ◽  
Fredrik Kahn ◽  
Elena Wiebe ◽  
Pontus Gustafsson ◽  
Thomas Kander ◽  
...  
Keyword(s):  
Half Life ◽  
Binding Protein ◽  
Hematologic Malignancies ◽  
Heparin Binding ◽  
Monocytic Cell ◽  
Negative Results ◽  
Heparin Binding Protein ◽  
Neutropenic Patients ◽  
The Impact

Abstract Background Heparin Binding Protein (HBP) is a promising new biomarker for the development and severity of sepsis. To guide the use of HBP as a biomarker it is important to understand the factors that may lead to false positive or negative results. The mechanisms that could lead to falsely elevated HBP levels include inappropriate release and inadequate clearance of HBP by the responsible cells and organs. HBP is presumably released only by neutrophils and the organs responsible for its elimination are unknown. Therefore, in this study we aimed to determine whether non-neutrophil cells can be a source of HBP in the circulation and which organs are responsible for its removal.Results We measured HBP in two cohorts of neutropenic patients and found that 12% and 19% of patients in each cohort respectively had detectable HBP levels. In vitro, we found that three leukemia-derived monocytic cell lines and healthy CD14 + monocytes constitutively released detectable levels of HBP. Next we injected HBP intravenously in rats found that plasma levels of HBP decreased rapidly, with a distribution half-life below 10 minutes and an elimination half-life of 1–2 hours. We measured HBP levels in the liver, spleen, kidneys, lungs, and urine using both ELISA and immunofluorescence quantitation and found that the majority of HBP was present in the liver and a small amount was present in the spleen. Immunofluorescence imaging indicated that HBP is associated mainly with hepatocytes in the liver and monocytes/macrophages in the spleen.Conclusions HBP can be found in some neutropenic patients. Other than neutrophils, malignant myeloid cells and monocytic cells may be an additional source of HBP. HBP disappears rapidly from the circulation and distributes primarily to liver hepatocytes and spleen monocytes/macrophages. The impact of hematologic malignancies and liver diseases on plasma HBP levels should be explored further in clinical studies.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P &lt; .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

scholarly journals Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales

2021 ◽  
pp. jech-2020-216030
Author(s):  
Benjamin J Gray ◽  
Richard G Kyle ◽  
Jiao Song ◽  
Alisha R Davies
Keyword(s):  
Multinomial Logistic Regression ◽  
Household Survey ◽  
Well Being ◽  
Employment Outcomes ◽  
Cross Sectional Study ◽  
Public Health Response ◽  
Cross Sectional ◽  
Exact Test ◽  
Nationally Representative ◽  
The Impact

BackgroundThe public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic.MethodsData were collected from a cross-sectional, nationally representative household survey of the working age population (18–64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher’s exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes.ResultsOf our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on ‘furlough’ was more likely in younger (18–29 years) and older (60–64 years) workers, those in lower skilled jobs and from households with less financial security.ConclusionA number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

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