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Article ; Online: Multidrug-resistant bacteria in lung transplantation.

Dominguez, Fernando / Blodget, Emily

Current opinion in organ transplantation

2020 Volume 25, Issue 4, Page(s) 348–350

Abstract: Purpose of review: The review of infections in lung transplantation is beyond the scope of this article as it is a comprehensive topic, however we aim to focus on infections with multidrug-resistant (MDR) microorganisms in this patient population.: ... ...

Abstract	Purpose of review: The review of infections in lung transplantation is beyond the scope of this article as it is a comprehensive topic, however we aim to focus on infections with multidrug-resistant (MDR) microorganisms in this patient population. Recent findings: New emerging clinical studies have provided data regarding outcomes in lung transplant recipients with MDR bacterial infections. Summary: Isolation of MDR bacteria from lung donors preoperatively has not been associated with worse outcomes in recipients. Patients with cystic fibrosis colonized with MDR bacteria do not have increased 1 year mortality rates compared to those without MDR bacteria.
MeSH term(s)	Bacterial Infections/epidemiology ; Bacterial Infections/microbiology ; Drug Resistance, Multiple, Bacterial ; Humans ; Lung Diseases/epidemiology ; Lung Diseases/microbiology ; Lung Transplantation/adverse effects ; Lung Transplantation/statistics & numerical data ; Retrospective Studies ; Tissue Donors/statistics & numerical data
Language	English
Publishing date	2020-06-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000000782
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Article ; Online: Community-acquired respiratory viruses.

Dominguez, Fernando / Blodget, Emily

Current opinion in organ transplantation

2019 Volume 24, Issue 4, Page(s) 511–514

Abstract: Purpose of review: Community-acquired respiratory viruses (CARV) have been historically linked to upper respiratory tract infections; however, new data has emerged in recent years that has provided new insight into their role as causative pathogens for ... ...

Abstract	Purpose of review: Community-acquired respiratory viruses (CARV) have been historically linked to upper respiratory tract infections; however, new data has emerged in recent years that has provided new insight into their role as causative pathogens for lower respiratory tract infections. We aim to discuss the importance of recognition of viruses both epidemiologically and clinically as causes of lower respiratory tract infection. Recent findings: With advances of molecular testing it is now possible to identify viruses from clinical specimens which have many implications that range from therapeutics to antibiotic stewardship. Recent studies suggest that most of the cases of community-acquired pneumonia are caused by viruses, which corresponds to a paradigm shift for most clinicians. Summary: As community-acquired lower respiratory infections are the most common cause of ICU admission in the USA, it is important for medical providers to be aware of the association with viruses, especially in patients with immunosuppression because of solid organ transplant and hematologic malignancies when sometimes diagnosis can be challenging and patients can be exposed to unnecessary antibiotics.
MeSH term(s)	Community-Acquired Infections/diagnosis ; Community-Acquired Infections/pathology ; Humans ; Respiratory Tract Infections/diagnosis ; Respiratory Tract Infections/pathology
Language	English
Publishing date	2019-06-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000000667
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Article ; Online: Coccidioidomycosis in solid organ transplant recipients.

Nanayakkara, Deepa D / Blodget, Emily

Current opinion in organ transplantation

2019 Volume 24, Issue 4, Page(s) 465–468

Abstract: Purpose of review: The purpose of the review is an update of diagnosis and treatment of coccidioidomycosis infection in solid organ transplant (SOT) patients. Endemic fungal infections continue to be a cause of serious morbidity and mortality in ... ...

Abstract	Purpose of review: The purpose of the review is an update of diagnosis and treatment of coccidioidomycosis infection in solid organ transplant (SOT) patients. Endemic fungal infections continue to be a cause of serious morbidity and mortality in transplant recipients. Recent findings: In transplant patients there are recommendations regarding screening in areas that are endemic for coccidioidomycosis. This screening involves serologic testing and chest imaging. In endemic areas pretransplant seropositivity varies from 1.4 to 5.6%. In immunocompromised patients with elevated complement fixation titers, evaluation of cerebrospinal fluid is recommended even in the absence of symptoms. Although coccidioidomycosis can be a self-limited disease in immunocompotent patients, all SOT patients should be treated regardless of severity. This may include intravenous amphotericin B in severe cases and fluconazole therapy in milder episodes. In those SOT recipients with evidence of prior coccidioidomycosis, lifelong secondary prophylaxis with fluconazole given risk of recurrent disease. Summary: Coccidioidomycosis continues to be a cause of serious morbidity and mortality in transplant recipients but with proper screening and treatment can be successfully managed.
MeSH term(s)	Coccidioidomycosis/etiology ; Coccidioidomycosis/pathology ; Humans ; Organ Transplantation/adverse effects ; Organ Transplantation/methods ; Transplant Recipients/statistics & numerical data
Language	English
Publishing date	2019-06-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000000668
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Article: Increased risk of 100-day and 1-year infection-related mortality and complications in haploidentical stem cell transplantation.

Chang, Jeremy / Hsiao, Mindy / Blodget, Emily / Akhtari, Mojtaba

Journal of blood medicine

2019 Volume 10, Page(s) 135–143

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2019-05-15
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2587464-0
ISSN	1179-2736
ISSN	1179-2736
DOI	10.2147/JBM.S201073
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Article ; Online: Cryptococcal disease in the solid organ transplant setting: review of clinical aspects with a discussion of asymptomatic cryptococcal antigenemia.

Wald-Dickler, Noah / She, Rosemary / Blodget, Emily

Current opinion in organ transplantation

2017 Volume 22, Issue 4, Page(s) 307–313

Abstract: Purpose of review: Cryptococcal infections are an important cause of morbidity and mortality in solid organ transplant patients. Here, we review the microbiology, epidemiology, clinical course, treatment, and outcomes of Cryptococcus in solid organ ... ...

Abstract	Purpose of review: Cryptococcal infections are an important cause of morbidity and mortality in solid organ transplant patients. Here, we review the microbiology, epidemiology, clinical course, treatment, and outcomes of Cryptococcus in solid organ transplant recipients. Recent findings: We identify the unique findings in solid organ transplant patients when compared to other immunocompromised patients such as those with HIV. We also describe our experience and outcomes with regard to solid organ transplant patients who do not have positive fungal cultures, but cryptococcal antigen positivity and concern for cryptococcal disease. Summary: Our review will highlight the importance of these new diagnostic techniques in those with Cryptococcus and solid organ transplant, which will be the subject of new research.
MeSH term(s)	Antigens, Fungal/metabolism ; Cryptococcosis/epidemiology ; Cryptococcosis/etiology ; Cryptococcosis/pathology ; Cryptococcosis/therapy ; Humans ; Organ Transplantation/adverse effects ; Organ Transplantation/mortality ; Survival Analysis
Chemical Substances	Antigens, Fungal
Language	English
Publishing date	2017-05-31
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000000426
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Article ; Online: Once-Daily Foscarnet Is Effective for Human Herpesvirus 6 Reactivation after Hematopoietic Stem Cell Transplantation.

Vittayawacharin, Pongthep / E'Leimat, Ghayda' / Lee, Benjamin J / Griffin, Shawn / Doh, Jean / Nam, Hannah / Blodget, Emily / Jeyakumar, Deepa / Kongtim, Piyanuch / Ciurea, Stefan O

Transplantation and cellular therapy

2023 Volume 29, Issue 6, Page(s) 397.e1–397.e6

Abstract: Human herpesvirus 6 (HHV-6) reactivation is common after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with higher mortality and increased transplantation-related complications. We hypothesized that preemptive treatment ...

Abstract	Human herpesvirus 6 (HHV-6) reactivation is common after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with higher mortality and increased transplantation-related complications. We hypothesized that preemptive treatment with a short course of foscarnet at a lower cutpoint of plasma HHV-6 viral load would be effective in treating early HHV-6 reactivation, preventing complications and precluding hospitalization of these patients. We reviewed outcomes of adult patients (age ≥18 years) who received preemptive treatment with once-daily foscarnet 60 to 90 mg/kg for 7 days for HHV-6 reactivation after allo-HSCT at our institution between May 2020 and November 2022. Plasma HHV-6 viral load was monitored by quantitative PCR twice monthly in the first 100 days post-transplantation and twice weekly after reactivation until resolution. Eleven patients with a median age of 46 years (range, 23 to 73 years) were included in the analysis. HSCT was performed with a haploidentical donor in 10 patients and with an HLA-matched related donor in 1 patient. The most common diagnosis was acute leukemia (9 patients). Myeloablative and reduced-intensity conditioning regimens were used in 4 and 7 patients, respectively. Ten of the 11 patients received post-transplantation cyclophosphamide-based graft-versus-host disease prophylaxis. The median follow-up was 440 days (range, 174 to 831 days), and the median time to HHV-6 reactivation was 22 days post-transplantation (range, 15 to 89 days). The median viral load at first reactivation was 3,100 copies/mL (range, 210 to 118,000 copies/mL), and the median peak viral load was 11,300 copies/mL (range, 600 to 983,000 copies/mL). All patients received a short course of foscarnet at either 90 mg/kg/day (n = 7) or 60 mg/kg/day (n = 4). In all patients, plasma HHV-6 DNA was undetectable at completion of 1 week of treatment. No HHV-6 encephalitis or pneumonitis occurred. All patients achieved neutrophil and platelet engraftment after a median of 16 days (range, 8 to 22 days) and 26 days (range, 14 to 168 days), respectively, with no secondary graft failure. No complications related to foscarnet administration were noted. One patient with very high HHV-6 viremia had recurrent reactivation and received a second course of foscarnet as an outpatient. A short course of once-daily foscarnet is effective in treating early HHV-6 reactivation post-transplantation and may reduce the incidence of HHV-6-related and treatment-related complications and preclude hospitalization in these patients.
MeSH term(s)	Adult ; Humans ; Young Adult ; Middle Aged ; Aged ; Adolescent ; Foscarnet/therapeutic use ; Herpesvirus 6, Human/physiology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Transplantation, Homologous ; DNA, Viral
Chemical Substances	Foscarnet (364P9RVW4X) ; DNA, Viral
Language	English
Publishing date	2023-03-04
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	3062231-1
ISSN	2666-6367
ISSN (online)	2666-6367
DOI	10.1016/j.jtct.2023.02.022
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Zs.A 5082: Show issues

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Article ; Online: Strategies to Mitigate the Drug-Drug Interaction between Nirmatrelvir/Ritonavir and Tacrolimus in Allogeneic Hematopoietic Stem Cell Transplant Recipients on Azole Antifungals: Results of a Case Series.

Griffin, Shawn P / Lee, Benjamin / Doh, Jean / Paradyse, Alexander R / Jeyakumar, Deepa / Arter, Zhaohui / Nam, Hannah / Blodget, Emily / Smith, Julie / Valek, Anitram / Vittayawacharin, Pongthep / Kongtim, Piyanuch / Ciurea, Stefan O

Acta haematologica

2023 , Page(s) 1–7

Abstract: Introduction: Nirmatrelvir/ritonavir (NIM/r) inhibits tacrolimus metabolism resulting in a profound drug-drug interaction that is further complicated by the use of azole antifungals.: Case presentations: We describe three strategies, in 4 patient ... ...

Abstract	Introduction: Nirmatrelvir/ritonavir (NIM/r) inhibits tacrolimus metabolism resulting in a profound drug-drug interaction that is further complicated by the use of azole antifungals. Case presentations: We describe three strategies, in 4 patient cases, for the initiation of NIM/r in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients on tacrolimus at the time of diagnosis. Patients 1 and 2 (strategy 1) experienced prolonged, elevated tacrolimus concentrations after an empiric 33% reduction in tacrolimus dose and adjustment of azole antifungal at NIM/r initiation (strategy 1) and with complete discontinuation of tacrolimus and azole antifungal at NIM/r initiation (strategy 2). Patients 3 and 4 (strategy 3) did not experience elevated tacrolimus concentrations on NIM/r treatment with complete discontinuation of tacrolimus and azole antifungal and a 12-24-h delay in NIM/r initiation. Reinitiation of tacrolimus after NIM/r completion resulted in variable tacrolimus concentrations. Conclusion: NIM/r-tacrolimus is a serious drug-drug interaction which can be mitigated by early discontinuation of tacrolimus and azole antifungals, close monitoring, and reinitiation of tacrolimus and antifungal 48-72 h after completion of therapy.
Language	English
Publishing date	2023-10-09
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	80008-9
ISSN	1421-9662 ; 0001-5792
ISSN (online)	1421-9662
ISSN	0001-5792
DOI	10.1159/000534445
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Article ; Online: A Programmatic Response, Including Bamlanivimab or Casirivimab-imdevimab Administration, Reduces Hospitalization and Death in COVID-19 Positive Abdominal Transplant Recipients.

Ahearn, Aaron J / Thin Maw, Thin / Mehta, Rishi / Emamaullee, Juliet / Kim, Jim / Blodget, Emily / Kahn, Jeffrey / Sher, Linda / Genyk, Yuri

Transplantation

2021 Volume 106, Issue 2, Page(s) e153–e157

Abstract: Background: (COVID-19) has resulted in significant morbidity and mortality in solid organ transplant recipients. In December 2020, at the peak of the Los Angeles outbreak, our center rapidly implemented a protocol to improve outpatient management and ... ...

Abstract	Background: (COVID-19) has resulted in significant morbidity and mortality in solid organ transplant recipients. In December 2020, at the peak of the Los Angeles outbreak, our center rapidly implemented a protocol to improve outpatient management and provide bamlanivimab or casirivimab-imdevimab [COVID monoclonal antibody (mAb) therapies] to all eligible COVID-19 positive liver and kidney transplant recipients. Methods: A retrospective review of all abdominal organ transplant recipients who were COVID-19 polymerase chain reaction positive between February 2020 and February 2021 from our center was performed. Patient demographics, COVID-19 treatments, hospitalizations, and survival were reviewed. Patients were considered eligible for COVID mAb therapy if they met outpatient criteria at the time of diagnosis. Results: In the study period, 121 patients in the kidney transplant recipients group (KG) and 105 patients in the liver or combined liver/kidney transplant recipients group (LG) were COVID-19 polymerase chain reaction positive. Hospitalization rates were similar for the KG (45%) versus LG (35%) (P = 0.20), but mortality was higher for the KG (22%) when compared to LG (10%) (P = 0.02). Our programmatic response, including outpatient COVID mAb therapies, reduced hospitalizations (P = 0.01) and deaths (P = 0.01). Ninety-four KG and 87 LG patients were identified as potentially eligible for COVID mAb therapy, and 17 KG and 17 LG patients were treated. COVID mAb therapies reduced hospitalization from 32% to 15% (P = 0.045) and eliminated mortality (13% versus 0%, P = 0.04). Conclusions: An aggressive approach including outpatient COVID mAb therapy in the COVID positive abdominal organ transplant recipients significantly decreased hospitalization and death. Early outpatient intervention for COVID-19 disease in transplant patients should be considered where possible.
MeSH term(s)	Aged ; Antibodies, Monoclonal/adverse effects ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/administration & dosage ; Antibodies, Neutralizing/administration & dosage ; COVID-19/diagnosis ; COVID-19/mortality ; COVID-19 Nucleic Acid Testing ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Organ Transplantation/adverse effects ; Polymerase Chain Reaction ; Retrospective Studies ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification ; Transplant Recipients ; COVID-19 Drug Treatment
Chemical Substances	Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Antibodies, Neutralizing ; imdevimab (2Z3DQD2JHM) ; bamlanivimab (45I6OFJ8QH) ; casirivimab (J0FI6WE1QN)
Language	English
Publishing date	2021-09-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000003953
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Zs.A 488: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness - Experience in an Urban Gastroenterology Practice.

Erdman, Michael D / Kossari, Niloofar / Ye, Jessica / Reynolds, Kristen H / Blodget, Emily / Mozayeni, B Robert / Rahbar, Farshid Sam

Journal of patient-centered research and reviews

2021 Volume 8, Issue 1, Page(s) 39–47

Abstract: Purpose: In the clinical setting, it is not common practice to consider a vector bite, such as from a tick or flea, to be a contributing factor to chronic digestive symptoms. This article investigates associations we have observed among symptomatic ... ...

Abstract	Purpose: In the clinical setting, it is not common practice to consider a vector bite, such as from a tick or flea, to be a contributing factor to chronic digestive symptoms. This article investigates associations we have observed among symptomatic patients and positive blood tests for vector-borne illness (VBI). Methods: Patients who visited an urban gastroenterology clinic over a 3-year period were retrospectively reviewed. A total of 270 patients presenting with a constellation of digestive symptoms - and who had no apparent digestive pathology and reported no prior diagnosis or treatments for VBI - were analyzed. Before the initial visit, all patients completed a review of systems medical history form, which comprised 19 gastrointestinal (GI) symptoms and 73 non-GI-related symptoms and conditions. Patients were tested for small intestinal bacterial overgrowth (SIBO) by lactulose breath test. VBI (babesiosis, ehrlichiosis, anaplasmosis, bartonellosis, borreliosis) was established using 1 or more of several blood tests. Odds ratio (OR) analysis determined associations between exposure to VBI, SIBO, and presenting symptoms/conditions. Two age groups (≤35 years and ≥36 years) were studied using Cochran-Mantel-Haenszel stratum-based test. Results: A higher OR (2.03, 95% CI: 1.5-3.6) was found between patients with ≥3 digestive symptoms and positive blood tests for ≥1 VBI. Five of the 19 GI symptoms were independently associated with VBI-positive samples: food intolerance, indigestion, nausea/vomiting, constipation, and heartburn. A similar association in patients with ≥3 non-GI symptoms (OR: 2.83, 95% CI: 1.3-6.4) was observed. Five of the 73 non-GI symptoms/conditions were independently associated with VBI-positive samples: chest pain, shortness of breath, extremity or joint pain, anxiety, and night sweats. Having ≥3 of any digestive or nondigestive symptoms generated significant relative risk of being VBI-positive. Presence of SIBO alone did not identify significant relative risk for a VBI, and age was not a confounder. Conclusions: Findings revealed an association between positive blood tests for vector-borne illness and chronically symptomatic patients regardless of whether symptoms were digestive or nondigestive. The manifestation of 3 or more gastrointestinal and/or extraintestinal symptoms should raise suspicion for a VBI.
Language	English
Publishing date	2021-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	3022292-8
ISSN	2330-0698 ; 2330-068X
ISSN (online)	2330-0698
ISSN	2330-068X
DOI	10.17294/2330-0698.1729
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Article ; Online: VRE in cirrhotic patients.

Barger, Melissa / Blodget, Emily / Pena, Sol / Mack, Wendy / Fong, Tse-Ling

BMC infectious diseases

2019 Volume 19, Issue 1, Page(s) 711

Abstract: Background: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The ...

Abstract	Background: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [2] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection. Methods: Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE (n = 65) were separately compared to patients infected with gram-negative organisms (n = 80) and uninfected patients (n = 306). Results: In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity. Conclusions: It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death.
MeSH term(s)	Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Child ; Female ; Gram-Positive Bacterial Infections/drug therapy ; Gram-Positive Bacterial Infections/microbiology ; Gram-Positive Bacterial Infections/mortality ; Humans ; Intensive Care Units ; Length of Stay ; Liver Cirrhosis/complications ; Liver Cirrhosis/microbiology ; Liver Cirrhosis/mortality ; Liver Transplantation/adverse effects ; Male ; Middle Aged ; Peritonitis/microbiology ; Peritonitis/prevention & control ; Retrospective Studies ; Risk Factors ; Vancomycin Resistance
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-08-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-019-4352-1
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