Interview with Marjorie Harkins Buchanan Kiewit

In this interview with Julia Stringfellow, Marjorie Harkins Buchanan Kiewit, LU class of 1943, discusses her time as a student as well as her time on the Board of Trustees.https://lux.lawrence.edu/oralhistories/1036/thumbnail.jp

Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: A descriptive analysis of the Eurobact II study

Background: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. Methods: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients’ characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. Results: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49–2.45). Conclusions: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245. Registered 3 May 2019

The Guidelines for Febril Neutropenic Patients: The Comparison of Guidelines of IDSA and ECIL

Infections are one of the major cause of death in the patients with hemato-oncological cancer. The prevention and appropriate treatment of infections is lifesaving. Infectious Diseases Society of America (IDSA)-licensed guideline “Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA” and “European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growingresistance: summary of the 2011 4th European Conference on Infections in Leukemia (ECIL)” written by the 4th ECIL expert group are two main guidelines that help clinicians for the diagnosis and treatment of infections in febril neutropenic patients and contribute to evidence-based medicine. The IDSA guideline is more comprehensive than the ECIL. The recommendations of two guidelines are mostly similar. However, there are differences in some issues between the two guidelines. The risk stratification and empiric antibiotics recommendation are different. However, the main differences between the two guidelines result from their recommendations about the empiric antifungal indication and the discontinuation time of therapy. Empirical antifungal treatment is recommended in both febril patients who are clinically stabil or unstabil in the IDSA quideline, although ECIL guideline recommends empirical antifungal treatment in only febril patients who are clinically unstabil. IDSA guideline recommends clinicians to continue antibiotic treatment for at least the duration of neutropenia. However, ECIL guideline recommends to discontinue of antibiotics after 72 hours in neutropenic patients who are hemodynamically stable and afebrile for at least 48 hours, irrespective of neutrophil count

Hepatitis B and Hepatitis C Co-infection

Hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection is occurred generally in highly endemic areas and among persons with a high risk of parenteral infections, because of both virus have common routes of transmission. The worldwide prevalence of coinfection is unknown, but it is estimated to be about 15 million HBV/HCV co-infected patients. HBV/HCV co-infection presents with a heterogeneous clinical appearance depending on the individual differences and diversity of the viral replication. HCV superinfection in patients with chronic HBV infection was the most common clinical features of coinfection in Asia-Pacific countries, while HBV superinfection was more common in Europe and United States. HBV/HCV interact with each other. HBV viral replication is generally suppressed by HCV. However, the longitudinal studies suggest that the viral interference is a fl uctuating dynamic process. Co-infection is characterized by a more severe liver injury and a higher incidence of cirrhosis and hepatocellular carcinoma (HCC). The dominant virus should be determined by pretreatment serological and virological evaluations. A good treatment response was obtained with pegile-interferon(Peg-IFN)/ribavirin in co-infected patients. Treatment outcomes was similar to HCV monoinfection. The effective treatment of HCV infection in the HBV/HCV co-infected patients may lead to HBV reactivation. For this reasons, long-term follow-up and monitoring for HBV infection are recommended in this patients. Although adding to a nucleos(t)ide analogues to the combination of Peg-IFN/ribavirin is a treatment alternative in HBV-active or dually-active co-infection, the optimal treatment strategies remains still unknown. The role of IFN-free direct acting antivirals treatment in co-infection is another issue to be resolved. However, the treatment of HCV with new potent drugs without any anti-HBV effect may increase the risk of HBV reactivation. The introduction of new antiviral for the treatment of hepatitis C may alter the optimal treatment of HBV/HCV coinfection. Further studies are needed in this regard

A Case of Meningococcal Meningitis Due to W135 Strain

Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia, strains isolated from the patients with invasive infections are mainly A, B, C, Y and W135. In our country, meningitis by W135 strain is rarely seen. In this article, a case with meningococcal meningitis due to W135 strain is presented

Evidence of vascular endothelial damage in Crimean-Congo hemorrhagic fever

Background: Endothelial infection has an important role in the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF). In this study, we investigated the causes of vascular endothelial damage in patients with CCHF

Evidence of vascular endothelial damage in Crimean-Congo hemorrhagic fever

Background: Endothelial infection has an important role in the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF). In this study, we investigated the causes of vascular endothelial damage in patients with CCHF