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  • 1
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    356. Risk Assessment of Pneumocystis jirovecii Pneumonia among Hospitalized Patients with Hypoxic Respiratory Failure - A Proposed Multivariable Calculator Based on Previous Prednisone Equivalent Dose
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: Corticosteroids increase the risk of Pneumocystis jirovecii pneumonia (PJP). It is unknown how much corticosteroid dose exposure would modify the risk of PJP in different populations. We aim to develop a PJP risk calculator based on the previous dose of corticosteroids and modulated by additional clinical factors. Methods A multicenter retrospective case-control study was performed on patients tested for PJP within the UCHealth system from 2000 to 2021. We developed a model for estimating PJP risk based on previous prednisone equivalent daily dose (PEDD) and adjustable for additional clinical variables. PJP was fit to a generalized additive model (GAM), with a spline for prednisone dose and additive covariates for demographics and risk factors. We used a multicenter federated network to calibrate the model to estimate the PJP prevalence among hospitalized patients with hypoxic respiratory failure. Results We had a complete sample of 199 patients, 104 cases with PJP, and 95 controls. Patients with HIV (OR: 19 CI: 6.3-60.8, p & lt; 0.0001), diabetes (OR: 4.1 CI: 1.2-14.8, p & lt; 0.0288), and autoimmune disease (OR: 5.2 CI: 1.4-19.2, p & lt; 0.0139) were more likely to have PJP. Patients with preexisting lung disease (OR: 0.3 CI: 0.1-0.6, p & lt; 0.0041) and on PJP prophylaxis (OR: 0.06 CI: 0.02-0.2, p & lt; 0.0001) were less likely to have PJP. 36.8% of controls and 49% of cases were on steroids with a mean PEDD of 15 mg/day and 20.4 mg/day, respectively. We found a prevalence of PJP of 0.126% among hospitalized patients with hypoxic respiratory failure. The developed model can estimate the PJP risk based on a previous PEDD in 32 different clinical combinations: e.g., a PEDD of 20 mg/day would give a calculated annual PJP risk of approximately 1.74% (95% CI: [0.39, 7.42]) if a patient has autoimmune disease only but 6.29% (95% CI: [1.34, 24.91] ) if a patient has HIV only (Figure 1). Figure 1.Predicted probability of PJP based on previous prednisone dose among hospitalized patients with hypoxic respiratory failure for three different clinical scenarios Conclusion Previous corticosteroid dose alone is inadequate to inform of an increased risk of PJP. A multivariable calculator incorporating the absence or presence of additional traditional risk factors could optimally stratify the PJP risk. Future directions include validating the findings in external cohorts and modeling PJP risk in the ambulatory setting to inform the need for PJP prophylaxis. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.434
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
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  • 2
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    1003. Cytokine Levels in Sepsis and TNFα Association with Mortality but not Sepsis Severity or Infection Source: a Systematic Review and Meta-analysis
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. Supplement_1 ( 2021-12-04), p. S592-S592
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. Supplement_1 ( 2021-12-04), p. S592-S592
    Abstract: Sepsis is a global health problem associated with significant morbidity and mortality and is attributed to a “cytokine storm.”. However, anti-cytokine therapies have failed to lower sepsis mortality in clinical trials. Linking cytokine excess to sepsis pathogenesis requires quantification of cytokine levels in sepsis. This systematic review and meta-analysis characterizes levels of key cytokines in the circulation of sepsis patients and relates TNFα levels to mortality and patient characteristics. Methods Medline, Embase, Cochrane Library, and Web of Science Core Collection databases were searched from 1946 to May 2020 for studies in English disclosing cytokine levels in sepsis. Keywords included sepsis, septic shock, purpura fulminans, and tumor necrosis factor (TNF)α. We related cytokine amounts to 28-day mortality. Data analyses were performed using a random-effects model to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). This systematic review is registered in PROSPERO under number CRD42020179800. Results A total of 3656 records were identified. After exclusions, 103 studies were included. Among these studies, 72 disclosed TNFα levels, 25 showed interleukin (IL)-1β levels, and 6 presented interferon (IFN)γ levels. The pooled estimate mean TNFα concentration in sepsis patients was 58.4 pg/ml (95% CI, 39.8-85.8 pg.ml; I2 = 99.4%). Pooled estimate means for IL-1α and IFNγ in sepsis patients were 21.8 pg/ml (95% CI, 12.6-37.8 pg.ml; I2 =99.8%) and 63.3 pg/ml (95% CI, 19.4-206.6 pg/ml; I2 = 99.7%), respectively. Elevated TNFα concentrations were associated with increased 28-day mortality (P=0.001). In a subgroup analysis, TNFα levels did not relate to sepsis source, sepsis severity, or sequential organ failure assessment (SOFA) score (figure 1). In a metaregression, TNFα associated with age, percentage of females and mortality at 28 days. Figure 1: A: TNFa levels according to sepsis source. B: TNFa levels according to measurement technique. C: TNFa levels according to presence or absence of cardiovascular disease. D: TNFa levels according to presence or absence of malignancy. E: TNFa levels according to sepsis severity. F: TNFa levels in fungal compared to other causes of sepsis (Yes=fungal sepsis; No= Other types of sepsis). G: TNFa levels according to SOFA score. H: TNFa levels and mortality at 28 days. Conclusion We presented levels of TNFα, IL-1β, and IFNγ in human sepsis and showed that TNFα elevations are associated with sepsis mortality. TNFα concentrations did not correlate with sepsis severity. We believe the concept that elevated cytokines cause sepsis should be revisited in the context of these data. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofab466.1197
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 3
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    Experiences with Diagnosis and Treatment of Chagas Disease at a United States Teaching Hospital—Clinical Features of Patients with Positive Screening Serologic Testing
    MDPI AG ; 2021
    In:  Tropical Medicine and Infectious Disease Vol. 6, No. 2 ( 2021-05-31), p. 93-
    Details
    In: Tropical Medicine and Infectious Disease, MDPI AG, Vol. 6, No. 2 ( 2021-05-31), p. 93-
    Abstract: Chagas disease (CD) is the third most common parasitic infection globally and can cause cardiac and gastrointestinal complications. Around 300,000 carriers of CD live in the U.S., with about 3000 of those in Colorado. We described our experience in diagnosing CD at a Colorado teaching hospital to revise screening eligibility criteria. From 2006 to 2020, we reviewed Trypanosoma cruzi (TC) IgG serology results for 1156 patients in our institution. We identified 23 patients (1.99%) who had a positive test. A total of 14/23 (60%) of positive serologies never had confirmatory testing, and 7 of them were lost to follow up. Confirmatory testing, performed in 9 patients, resulted in being positive in 3. One additional case of CD was identified by positive tissue pathology. All four confirmed cases were among patients born in Latin America. While most of the testing for CD at our institution is part of the pretransplant screening, no confirmed cases of CD derived from this strategy. Exposure risk in this population is not always documented, and initial positive results from screening are not always confirmed. The lack of standardized screening protocols for CD in our institution contributes to underdiagnosis locally and in health systems nationwide. Given a large number of individuals in the U.S. with chronic CD, improved screening is warranted.
    Type of Medium: Online Resource
    ISSN: 2414-6366
    URL: Article
    DOI: 10.3390/tropicalmed6020093
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2934690-3
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  • 4
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    1383. Necrotizing Fasciitis and Streptococcus pyogenes (GAS) Infection Seasonality and Risk Factors for Infection— a Multicenter Research Network Study
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: Streptococcus pyogenes causes acute pharyngitis and type II necrotizing fasciitis. Seasonal variations in the incidence of S. pyogenes infections are not robustly characterized. We aim to identify seasonal variations and risk factors of S. pyogenes infections and all causes of necrotizing fasciitis. Methods From 2010 to 2019, we identified all infectious adult cases of S. pyogenes using ICD-10 diagnoses and lab results (PCR and antigen-based assays) and cases of necrotizing fasciitis using ICD-10 diagnoses within a federated research network. We extracted seasonal (quarterly) incidence rates. We used an autoregressive integrated moving average (ARIMA) model to assess the seasonality of the cases (6-month intervals). Demographic characteristics and 3-month outcomes of S. pyogenes pharyngitis were compared to a cohort of patients with acute upper respiratory illnesses excluding S. pyogenes. Results We identified 238,088 cases of S. pyogenes pharyngitis and 26,931 cases of necrotizing fasciitis in adults. S. pyogenes infection average incidence was higher during the winter than the summer: 0.34 vs. 0.20 cases per 1,000 patients. Necrotizing fasciitis diagnoses were highest during the summer months (average 0.026 per 1000 patients). There was a significant ARIMA seasonal variation in the time series analysis for S. pyogenes infections (p=0.006) (figure 1). However, necrotizing fasciitis was not significant (p=0. 0.79) (Figure 2). Compared to adults with acute respiratory infections other than S. pyogenes, adults with S. pyogenes pharyngitis were more likely to be younger (25.8 ± 14.9 vs. 45.4 ± 19.9 years old, p & lt; 0.0001) and of Hispanic or Latino ethnicity (11% vs. 8%, p & lt; 0.0001). For age-matched outcomes, adults with S. pyogenes pharyngitis had lower rates of hospitalization (0.888% vs. 1.714%, p & lt; 0.0001) and mortality (0.114% vs. 0.174%, p & lt; 0.0001) at three months relative to adults with acute respiratory infections other than S. pyogenes. Figure 1.Seasonal variation of adults with established ICD code or testing for Streptococcus pyogenes (GAS) infectionsFigure 2.Seasonal variation of adults with established ICD code for necrotizing fasciitis Conclusion Peaks in S. pyogenes infections are more likely to occur in the winter months, although spring and fall seasons can display variably high rates of S. pyogenes year over year. Necrotizing fasciitis of any microbiological did not show a significant seasonal variation. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.1212
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 5
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    S1252 Can a Single Decision-Making Support Tool Spare Inpatients From Inappropriate Testing for Nosocomial Diarrhea?
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  American Journal of Gastroenterology Vol. 115, No. 1 ( 2020-10), p. S629-S629
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 115, No. 1 ( 2020-10), p. S629-S629
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000707056.09335.dc
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    The Global Prevalence of Human Fascioliasis: A Systematic Review and Meta-Analysis
    Elsevier BV ; 2022
    In:  SSRN Electronic Journal
    Details
    In: SSRN Electronic Journal, Elsevier BV
    Type of Medium: Online Resource
    ISSN: 1556-5068
    URL: Article
    DOI: 10.2139/ssrn.4246632
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 7
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    International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module
    Elsevier BV ; 2014
    In:  American Journal of Infection Control Vol. 42, No. 9 ( 2014-09), p. 942-956
    Details
    In: American Journal of Infection Control, Elsevier BV, Vol. 42, No. 9 ( 2014-09), p. 942-956
    Type of Medium: Online Resource
    ISSN: 0196-6553
    URL: Article
    DOI: 10.1016/j.ajic.2014.05.029
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 2011724-3
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  • 8
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    Seasonal variations and risk factors of Streptococcus pyogenes infection: a multicenter research network study
    SAGE Publications ; 2022
    In:  Therapeutic Advances in Infectious Disease Vol. 9 ( 2022-01), p. 204993612211321-
    Details
    In: Therapeutic Advances in Infectious Disease, SAGE Publications, Vol. 9 ( 2022-01), p. 204993612211321-
    Abstract: Streptococcus pyogenes, or Group A Streptococcus (GAS), causes acute pharyngitis and necrotizing fasciitis. Seasonal variations in GAS infections are not robustly characterized. We assessed seasonal variations and risk factors of GAS pharyngitis and ICD-10-diagnosed necrotizing fasciitis. Methods: From the period 2010–2019, we conducted a case–control study using laboratory-confirmed cases of GAS pharyngitis and a descriptive observational study of necrotizing fasciitis using ICD-10 codes. Data were collected from TriNetX, a federated research network. We extracted seasonal (quarterly) incidence rates. We used an autoregressive integrated moving average (ARIMA) model to assess seasonal variations. Demographic characteristics and 1-month outcomes were compared among adults with or without GAS pharyngitis. Results: We identified 224,471 adults with GAS pharyngitis (test-positive) and 546,142 adults without it (test-negative). GAS pharyngitis adults were younger (25.3 versus 30.2 years of age, p  〈  0.0001), more likely to be Hispanic individuals (10% versus 8%, p  〈  0.0001) and slightly more likely to be Black or African American individuals (14% versus 13%, p  〈  0.0001). Propensity score matching found that adults with test-positive cases of GAS pharyngitis had a higher risk of acute rheumatic fever while having no significant differences in risk of intensive care unit admission and mortality compared with test-negative cases. GAS pharyngitis average incidence peaked in the winter while dipping in the summer (0.32 versus 0.18 and 4.07 versus 1.78 per 1000 adults and pediatric patients, respectively). Necrotizing fasciitis diagnoses were highest during summer (0.032 per 1000 adults). There was a significant ARIMA seasonal variation in the time series analysis for adult and pediatric GAS pharyngitis ( p  〈  0.0001 and p = 0.014, respectively). Necrotizing fasciitis diagnosis was not associated with seasonal variation ( p = 0.861). Conclusion: Peaks in GAS pharyngitis occur in the winter months. ICD code–based necrotizing fasciitis did not show a quarterly seasonal variation.
    Type of Medium: Online Resource
    ISSN: 2049-9361 , 2049-937X
    URL: Article
    DOI: 10.1177/20499361221132101
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 9
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    Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta‐analysis
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 6 ( 2021-12), p. 5466-5481
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 6 ( 2021-12), p. 5466-5481
    Abstract: This study aimed to estimate the annual mortality risk and its determinants in chronic Chagas cardiomyopathy. Methods and results We conducted a systematic search in MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. Longitudinal studies published between 1 January 1946 and 24 October 2018 were included. A random‐effects meta‐analysis using the death rate over the mean follow‐up period in years was used to obtain pooled estimated annual mortality rates. Main outcomes were defined as all‐cause mortality, including cardiovascular, non‐cardiovascular, heart failure, stroke, and sudden cardiac deaths. A total of 5005 studies were screened for eligibility. A total of 52 longitudinal studies for chronic Chagas cardiomyopathy including 9569 patients and 2250 deaths were selected. The meta‐analysis revealed an annual all‐cause mortality rate of 7.9% [95% confidence interval (CI): 6.3–10.1; I 2  = 97.74%; T 2  = 0.70] among patients with chronic Chagas cardiom yopathy. The pooled estimated annual cardiovascular death rate was 6.3% (95% CI: 4.9–8.0; I 2  = 96.32%; T 2  = 0.52). The annual mortality rates for heart failure, sudden death, and stroke were 3.5%, 2.6%, and 0.4%, respectively. Meta‐regression showed that low left ventricular ejection fraction (coefficient = −0.04; 95% CI: −0.07, −0.02; P  = 0.001) was associated with an increased mortality risk. Subgroup analysis based on American Heart Association (AHA) classification revealed pooled estimate rates of 4.8%, 8.7%, 13.9%, and 22.4% ( P   〈  0.001) for B1/B2, B2/C, C, and C/D stages of cardiomyopathy, respectively. Conclusions The annual mortality risk in chronic Chagas cardiomyopathy is substantial and primarily attributable to cardiovascular causes. This risk significantly increases in patients with low left ventricular ejection fraction and those classified as AHA stages C and C/D.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.6
    DOI: 10.1002/ehf2.13648
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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  • 10
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    370. Toxoplasma gondii IgG Seropositivity is Associated with Increased Schizophrenia, Hospitalization, and 1-year Mortality— a Multicenter Research Network Study
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: Despite Toxoplasma seropositivity found in about one-third of the global population, we lack information about the clinical outcomes of patients with past exposure to this parasite without the manifested disease. We aim to evaluate 1-year mortality and mental health diagnosis in patients with Toxoplasma IgG seropositivity. Methods We queried a federated national multicenter network to validate mortality risk differences between Toxoplasma IgG seropositive and seronegative patients from 2010 to 2021, excluding patients with active disease. We used propensity score matching to assess independent mental health outcomes and mortality risk 1-year after serology. Results We found 6244 patients with Toxoplasma IgG positivity without toxoplasmosis and 29,179 patients with negative Toxoplasma IgG. Patients with positive Toxoplasma IgG were slightly older (46.1 ± 17 vs. 45±16.5, p & lt; 0.0001) and more likely to be Hispanic (15% vs. 12%, p & lt; 0.0001). Toxoplasma gondii IgG seropositivity was more often present in patients with neoplasms (25% vs 22%, & lt; 0.0001), type 2 diabetes mellitus (13% vs 12%, p=0.0284), and less likely in transplant recipients (7% vs. 8%, p=0.0015), and liver cirrhosis (5% vs 7%, p. & lt; 0.0001). Propensity score matching to 6099 seronegative patients adjusted for age, gender, race, ethnicity, heart disease, transplant, neoplasm, and cirrhosis found that seropositive patients had an increased risk of 1-year mortality (OR: 1.2, CI: 1.06-1.4, p=0.0036) (Figure 1), hospitalization (OR:1.2, CI: 1.1-1.3, p & lt; 0.0001) and schizophrenia (OR: 1.4, CI: 1.01-1.8, p=0.04). An increased risk was not seen with bipolar disorder (OR: 0.86, CI: 0.66-1.15, p=0.3206). Figure 1.Kaplan-Meier survival analysis comparing the survival probability of patients without toxoplasmosis with a positive toxoplasma IgG (purple line) to those with a negative Toxoplasma IgG (green line) Conclusion Toxoplasma IgG seropositivity without clinical disease is associated with an increased risk of one-year mortality, hospitalization, and schizophrenia diagnosis. Further prospective studies are needed to clarify the association of Toxoplasma exposure with schizophrenia and worse outcomes. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.448
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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