4 research outputs found
Biomarkers in infection and sepsis: Can they really indicate final outcome?
Infectious diseases are among the most common reasons for admission to
hospital and can easily lead to sepsis. Sepsis is globally associated
with increased mortality, and although biomarkers could help clinicians
in the early diagnosis of sepsis and immediate onset of antibiotics,
there are always questions to be answered about their usefulness in the
prognosis of infectious diseases. This article reviews some of the
available biomarkers used in infectious diseases and sepsis in order to
evaluate their utility to predict mortality and unfavourable outcome.
Several studies present the pros and cons of each compound, but it is
obvious that the ideal biomarker, with high sensitivity and specificity,
cost effectiveness and with definite cut-off ranges and time of blood
sampling, is yet to be found. (C) 2015 Elsevier B.V. and the
International Society of Chemotherapy. All rights reserved
Oral minocycline plus rifampicin versus oral linezolid for complicated skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus: the AIDA open label, randomized, controlled Phase 4 trialResearch in context
Summary: Background: The need for oral, cost-effective treatment for complicated skin and skin structure infections (cSSSIs) due to methicillin-resistant Staphylococcus aureus (MRSA) was addressed by the non-inferiority comparisons of oral minocycline plus rifampicin with linezolid. Methods: In the AIDA multicenter, open label, randomized, controlled clinical trial, hospitalized adults with cSSSI and documented MRSA were randomly assigned at a 2:1 ratio to either oral 600 mg rifampicin qd plus 100 mg minocycline bid or oral 600 mg linezolid bid for 10 days. The primary endpoint was the clinical cure rate in the clinically evaluable (CE) population at the test-of-cure visit (14 days). Non-inferiority was confirmed if the lower confidence limit (CI) did not fall below the accepted error margin of 15%. The study is registered with EudraCT number 2014-001276-56. Findings: 123 patients recruited between November 2014 and January 2017 were randomly assigned to treatment (81 patients to minocycline plus rifampicin and 42 patients to linezolid). Cure rates were 78.% (46/59, 90% CI 67.3–86.5) and 68.6% (24/35, 90% CI 53.4–81.3), respectively (P = 0.337). The percent difference in cure rates was 9.4% (90% CI −7.2 to 26.8%). Minocycline plus rifampicin combination was deemed non-inferior to linezolid as the lower CI was −7.2% i.e. smaller than the accepted error margin of −15%. Although statistically not significant, the overall rate of adverse events was higher in the linezolid group (47.6%, 20/42 versus 38.3%, 31/81). Interpretation: Oral minocycline plus rifampicin was non-inferior to oral linezolid treatment providing alternative oral treatment for cSSSI. Funding: The EU Seventh Research Framework Programme
NF-kappa-B essential modulator (NEMO) gene polymorphism in an adult woman with systemic lupus erythematosus and recurrent non-tuberculous mycobacterial disseminated infections
Infections are among the most serious complications in patients with systemic lupus erythematosus (SLE), with bacterial and viral infections being the most common. Non-tuberculous mycobacterial (NTM) infections are quite rare and are typically seen in older patients with SLE with longstanding disease duration treated with corticosteroids. Here, we describe a 39-year-old woman with SLE and an unusual pattern of recurrent NTM disseminated infections. After excluding the presence of autoantibodies against interferon-γ, whole exome sequencing revealed a homozygous polymorphism in the NF-kappa-B essential modulator (NEMO) gene. Primary immunodeficiencies should be included in the differential diagnosis of patients with recurrent opportunistic infections, even in those with iatrogenic immunosuppression
Real-Life Effectiveness and Safety of Baricitinib as Adjunctive to Standard-of-Care Treatment in Hospitalized Patients With Severe Coronavirus Disease 2019
Background. Therapeutic options for hospitalized patients with severe
coronavirus disease 2019 (sCOVID-19) are limited. Preliminary data have
shown promising results with baricitinib, but real-life experience is
lacking. We assessed the safety and effectiveness of add-on baricitinib
to standard-of-care (SOC) including dexamethasone in hospitalized
patients with sCOVID-19.
Methods. This study is a 2-center, observational, retrospective cohort
study of patients with sCOVID-19, comparing outcomes and serious events
between patients treated with SOC versus those treated with SOC and
baricitinib combination.
Results. We included 369 patients with sCOVID-19 (males 66.1%; mean age
65.2 years; median symptom duration 6 days). The SOC was administered in
47.7% and combination in 52.3%. Patients treated with the combination
reached the composite outcome (intensive care unit [ICU] admission or
death) less frequently compared with SOC (22.3% vs 36.9%, P = .002).
Mortality rate was lower with the combination in the total cohort
(14.7% vs 26.6%, P = .005), and ICU admission was lower in patients
with severe acute respiratory distress syndrome (29.7% vs 44.8%, P =
.03). By multivariable analysis, age (odds ratio [OR] = 1.82, 95%
confidence interval [CI] = 1.36-2.44, per 10-year increase), partial
pressure of oxygen/fraction of inspired oxygen ratio (OR = 0.60, 95% CI
= .52-0.68, per 10 units increase), and use of high-flow nasal cannula
(OR = 0.34; 95% CI, .16-0.74) were associated with the composite
outcome, whereas baricitinib use was marginally not associated with the
composite outcome (OR = 0.52; 95% CI, .26-1.03). However, baricitinib
use was found to be significant after inverse-probability weighted
regression (OR = 0.93; 95% CI, .87-0.99). No difference in serious
events was noted between treatment groups.
Conclusions. In real-life settings, addition of baricitinib to SOC in
patients hospitalized with sCOVID-19 is associated with decreased
mortality without concerning safety signals