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  1. Article ; Online: Body temperature and infection in critically ill patients on continuous kidney replacement therapy.

    Challener, Douglas W / Gao, Xiaolan / Tehranian, Shahrzad / Kashani, Kianoush B / O'Horo, John C

    BMC nephrology

    2023  Volume 24, Issue 1, Page(s) 161

    Abstract: Purpose: Continuous kidney replacement therapy (CKRT) is an increasingly common intervention for critically ill patients with kidney failure. Because CKRT affects body temperature, detecting infections in patients on CKRT is challenging. Understanding ... ...

    Abstract Purpose: Continuous kidney replacement therapy (CKRT) is an increasingly common intervention for critically ill patients with kidney failure. Because CKRT affects body temperature, detecting infections in patients on CKRT is challenging. Understanding the relation between CKRT and body temperature may facilitate earlier detection of infection.
    Methods: We retrospectively reviewed adult patients (≥ 18 years) admitted to the intensive care unit at Mayo Clinic in Rochester, Minnesota, from December 1, 2006, through November 31, 2015, who required CKRT. We summarized central body temperatures for these patients according to the presence or absence of infection.
    Results: We identified 587 patients who underwent CKRT during the study period, of whom 365 had infections, and 222 did not have infections. We observed no statistically significant differences in minimum (P = .70), maximum (P = .22), or mean (P = .55) central body temperature for patients on CKRT with infection vs. those without infection. While not on CKRT (before CKRT initiation and after cessation), all three body temperature measurements were significantly higher in patients with infection than in those without infection (all P < .02).
    Conclusion: Body temperature is insufficient to indicate an infection in critically ill patients on CKRT. Clinicians should remain watchful for other signs, symptoms, and indications of infection in patients on CKRT because of expected high infection rates.
    MeSH term(s) Adult ; Humans ; Body Temperature ; Critical Illness/therapy ; Retrospective Studies ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/therapy ; Acute Kidney Injury/etiology ; Continuous Renal Replacement Therapy/adverse effects ; Renal Replacement Therapy/adverse effects
    Language English
    Publishing date 2023-06-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041348-8
    ISSN 1471-2369 ; 1471-2369
    ISSN (online) 1471-2369
    ISSN 1471-2369
    DOI 10.1186/s12882-023-03225-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: 1,3-β-D-glucan testing for nocardiosis in solid organ transplant recipients.

    Yetmar, Zachary A / Challener, Douglas W / Seville, Maria Teresa / Bosch, Wendelyn / Theel, Elitza S / Beam, Elena

    Transplant infectious disease : an official journal of the Transplantation Society

    2022  , Page(s) e13991

    Language English
    Publishing date 2022-11-09
    Publishing country Denmark
    Document type Letter
    ZDB-ID 1476094-0
    ISSN 1399-3062 ; 1398-2273
    ISSN (online) 1399-3062
    ISSN 1398-2273
    DOI 10.1111/tid.13991
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  3. Article ; Online: Outcomes of Nocardiosis and Treatment of Disseminated Infection in Solid Organ Transplant Recipients.

    Yetmar, Zachary A / Challener, Douglas W / Seville, Maria Teresa / Bosch, Wendelyn / Beam, Elena

    Transplantation

    2022  Volume 107, Issue 3, Page(s) 782–791

    Abstract: Background: Nocardia is an environmental pathogen with a predilection for causing opportunistic infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Although risk factors have been identified for developing ... ...

    Abstract Background: Nocardia is an environmental pathogen with a predilection for causing opportunistic infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Although risk factors have been identified for developing nocardiosis in this population, little is known regarding clinical factors resulting in poor outcomes. We evaluated a cohort of SOT recipients with nocardiosis for associations with 12-month mortality.
    Methods: We performed a multicenter retrospective cohort study of adult SOT recipients diagnosed with culture-confirmed nocardiosis from 2000 to 2020. Patients were followed for 12 months after diagnosis, unless abbreviated by mortality. Multivariable Cox regression was performed to analyze associations with 12-month mortality. A subgroup analysis of patients with disseminated nocardiosis was performed to analyze treatment variables.
    Results: A total of 125 SOT recipients met inclusion criteria; 12-month mortality was 16.8%. Liver transplantation (hazard ratio [HR] 3.52; 95% confidence interval [CI] 1.27-9.76) and time from symptom onset to presentation (HR 0.92/d; 95% CI 0.86-0.99) were independently associated with 12-month mortality, whereas disseminated infection was not (HR 1.23; 95% CI 0.49-3.13). No treatment-specific factors were significantly associated with mortality in 33 patients with disseminated nocardiosis, although survivors had a higher rate of linezolid use.
    Conclusions: This study identified 2 independent associations with 12-month mortality, representing demographics and infection severity. Disseminated infection was not independently associated with poor outcomes, and specific sites of infection may be more important than dissemination itself. No treatment-specific factors were associated with mortality, though this analysis was likely underpowered. Further study of treatment strategies based on specific Nocardia syndromes is warranted.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Nocardia Infections/diagnosis ; Nocardia Infections/drug therapy ; Nocardia Infections/epidemiology ; Nocardia ; Organ Transplantation/adverse effects ; Linezolid/therapeutic use ; Transplant Recipients
    Chemical Substances Linezolid (ISQ9I6J12J)
    Language English
    Publishing date 2022-10-28
    Publishing country United States
    Document type Multicenter Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/TP.0000000000004343
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  4. Article: Epidemiology, Timing, and Secondary Prophylaxis of Recurrent Nocardiosis.

    Yetmar, Zachary A / Khodadadi, Ryan B / Chesdachai, Supavit / McHugh, Jack W / Challener, Douglas W / Wengenack, Nancy L / Bosch, Wendelyn / Seville, Maria Teresa / Beam, Elena

    Open forum infectious diseases

    2024  Volume 11, Issue 4, Page(s) ofae122

    Abstract: Background: Nocardia: Methods: We performed a multicenter, retrospective cohort study of adults diagnosed with nocardiosis from November 2011 to April 2022, including patients who completed primary treatment and had at least 30 days of posttreatment ... ...

    Abstract Background: Nocardia
    Methods: We performed a multicenter, retrospective cohort study of adults diagnosed with nocardiosis from November 2011 to April 2022, including patients who completed primary treatment and had at least 30 days of posttreatment follow-up. Propensity score matching was used to analyze the effect of secondary prophylaxis on
    Results: Fifteen of 303 (5.0%) patients developed recurrent nocardiosis after primary treatment. Most recurrences were diagnosed either within 60 days (N = 6/15, 40.0%) or between 2 to 3 years (N = 4/15, 26.7%). Patients with primary disseminated infection tended to recur within 1 year, whereas later recurrences were often nondisseminated pulmonary infection. Seventy-eight (25.7%) patients were prescribed secondary prophylaxis, mostly trimethoprim-sulfamethoxazole (N = 67/78). After propensity-matching, secondary prophylaxis was not associated with reduced risk of recurrence (hazard ratio, 0.96; 95% confidence interval, .24-3.83), including in multiple subgroups. Eight (53.3%) patients with recurrent nocardiosis required hospitalization and no patients died from recurrent infection.
    Conclusions: Recurrent nocardiosis tends to occur either within months because of the same
    Language English
    Publishing date 2024-03-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofae122
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  5. Article ; Online: Risk factors and prophylaxis for nocardiosis in solid organ transplant recipients: A nested case-control study.

    Yetmar, Zachary A / Chesdachai, Supavit / Duffy, Dustin / Smith, Byron H / Challener, Douglas W / Seville, Maria Teresa / Bosch, Wendelyn / Beam, Elena

    Clinical transplantation

    2023  Volume 37, Issue 9, Page(s) e15016

    Abstract: Background: Nocardia is an opportunistic pathogen that primarily affects immunocompromised individuals, including solid organ transplant (SOT) recipients. Up to 2.65% of SOT recipients develop nocardiosis; however, few studies have examined risk factors ...

    Abstract Background: Nocardia is an opportunistic pathogen that primarily affects immunocompromised individuals, including solid organ transplant (SOT) recipients. Up to 2.65% of SOT recipients develop nocardiosis; however, few studies have examined risk factors and prophylaxis for nocardiosis.
    Methods: We performed a multicenter, matched nested case-control study of adult SOT recipients with culture-confirmed nocardiosis from 2000 through 2020. Controls were matched up to 2:1 by sex, first transplanted organ, year of transplant, transplant center, and adequate post-transplant follow-up. Multivariable conditional logistic regression was performed to analyze associations with nocardiosis. Cox proportional hazards regression compared 12-month mortality between infection and uninfected patients.
    Results: One hundred and twenty-three SOT recipients were matched to 245 uninfected controls. Elevated calcineurin inhibitor level, acute rejection, cytomegalovirus infection, lymphopenia, higher prednisone dose, and older age were significantly associated with nocardiosis while trimethoprim-sulfamethoxazole prophylaxis was protective (odds ratio [OR] .34; 95% confidence interval [CI] .13-.84). The effect of prophylaxis was similar, though not always statistically significant, in sensitivity analyses that only included prophylaxis dosed more than twice-per-week (OR .30; 95% CI .11-.80) or restricted to years 2015-2020 (OR .33, 95% CI .09-1.21). Nocardiosis was associated with increased 12-month mortality (hazard ratio 5.47; 95% confidence interval 2.42-12.35).
    Conclusions: Multiple measures of immunosuppression and lack of trimethoprim-sulfamethoxazole prophylaxis were associated with nocardiosis in SOT recipients. Effectiveness of prophylaxis may be related to trimethoprim-sulfamethoxazole dose or frequency. Trimethoprim-sulfamethoxazole should be preferentially utilized over alternative agents in SOT recipients with augmented immunosuppression or signs of heightened immunocompromise.
    MeSH term(s) Adult ; Humans ; Case-Control Studies ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Risk Factors ; Nocardia Infections/drug therapy ; Nocardia Infections/etiology ; Nocardia Infections/prevention & control ; Transplant Recipients ; Organ Transplantation/adverse effects ; Retrospective Studies
    Chemical Substances Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
    Language English
    Publishing date 2023-05-11
    Publishing country Denmark
    Document type Multicenter Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 639001-8
    ISSN 1399-0012 ; 0902-0063
    ISSN (online) 1399-0012
    ISSN 0902-0063
    DOI 10.1111/ctr.15016
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  6. Article ; Online: The Proliferation of Reports on Clinical Scoring Systems: Issues About Uptake and Clinical Utility.

    Challener, Douglas W / Prokop, Larry J / Abu-Saleh, Omar

    JAMA

    2019  Volume 321, Issue 24, Page(s) 2405–2406

    MeSH term(s) Algorithms ; Bibliometrics ; Clinical Decision-Making ; Decision Support Techniques ; Humans ; Severity of Illness Index
    Language English
    Publishing date 2019-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2019.5284
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  7. Article ; Online: Analytics and Prediction Modeling During the COVID-19 Pandemic.

    Challener, Douglas W / Dowdy, Sean C / O'Horo, John C

    Mayo Clinic proceedings

    2020  Volume 95, Issue 9S, Page(s) S8–S10

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Global Health ; Humans ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Public Health Surveillance/methods ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-06-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2020.05.040
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  8. Article ; Online: Vaccination Safety: Don't Toss the Champagne With the Cork.

    Shah, Aditya / Challener, Douglas W / O'Horo, John C / Badley, Andrew D

    Mayo Clinic proceedings

    2021  Volume 96, Issue 7, Page(s) 1712–1713

    MeSH term(s) Adverse Drug Reaction Reporting Systems/statistics & numerical data ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; COVID-19 Vaccines/pharmacology ; Humans ; Mass Vaccination/adverse effects ; Mass Vaccination/methods ; Mass Vaccination/psychology ; Mass Vaccination/statistics & numerical data ; Risk Assessment/statistics & numerical data ; SARS-CoV-2 ; Vaccination Refusal/psychology ; Venous Thromboembolism/chemically induced ; Venous Thromboembolism/diagnosis ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2021-07-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2021.05.004
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  9. Article ; Online: Leptotrichia

    Ranganath, Nischal / Shirley, Joshua D / Challener, Douglas W / Stevens, Ryan W / Kind, Dalton R / Comba, Isin Y / Patel, Robin / Schuetz, Audrey N / Shah, Aditya S

    Journal of clinical microbiology

    2023  Volume 61, Issue 2, Page(s) e0173322

    Abstract: ... ...

    Abstract Leptotrichia
    MeSH term(s) Adult ; Female ; Humans ; Middle Aged ; Metronidazole ; Leptotrichia ; Retrospective Studies ; Bacteremia/microbiology ; Anti-Infective Agents ; Piperacillin, Tazobactam Drug Combination ; Gram-Negative Bacteria ; Sepsis ; Anti-Bacterial Agents ; Microbial Sensitivity Tests
    Chemical Substances Metronidazole (140QMO216E) ; Anti-Infective Agents ; Piperacillin, Tazobactam Drug Combination (157044-21-8) ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-01-30
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 390499-4
    ISSN 1098-660X ; 0095-1137
    ISSN (online) 1098-660X
    ISSN 0095-1137
    DOI 10.1128/jcm.01733-22
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  10. Article: Mortality After Nocardiosis: Risk Factors and Evaluation of Disseminated Infection.

    Yetmar, Zachary A / Khodadadi, Ryan B / Chesdachai, Supavit / McHugh, Jack W / Challener, Douglas W / Wengenack, Nancy L / Bosch, Wendelyn / Seville, Maria Teresa / Beam, Elena

    Open forum infectious diseases

    2023  Volume 10, Issue 8, Page(s) ofad409

    Abstract: Background: Nocardia: Methods: We performed a retrospective cohort study of adults with culture-confirmed nocardiosis. Advanced infection was defined as disseminated infection, cavitary pulmonary infection, or pleural infection. The primary outcome ... ...

    Abstract Background: Nocardia
    Methods: We performed a retrospective cohort study of adults with culture-confirmed nocardiosis. Advanced infection was defined as disseminated infection, cavitary pulmonary infection, or pleural infection. The primary outcome was 1-year mortality, as analyzed by multivariable Cox regression.
    Results: Of 511 patients with culture growth of
    Conclusions: Advanced infection, rather than dissemination alone, predicted worse 1-year mortality after nocardiosis.
    Language English
    Publishing date 2023-08-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofad409
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