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1.
Transpl Infect Dis ; 20(3): e12862, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29512233

ABSTRACT

Organ Procurement & Transplantation Network policy requires post-transplant screening of recipients of organs from donors at increased risk for transmission of HIV, hepatitis B virus, and hepatitis C virus. Available data suggest that follow-up testing of recipients is not routinely conducted. Data on increased risk donors and recipients of their organs from 2008 to 2012 were retrospectively collected from 6 transplant centers after IRB approval. Descriptive statistics were performed. About 363 (60%) recipients were screened for transmission of HIV, HBV, and/or HCV at some time point; 257 (70.8%) within 90 days of transplant. The type of test used to screen for infection was variable with many recipients (25%-43%) screened with serology alone. Our results reveal that post-transplant screening for HIV, HBV, and HCV in recipients of increased risk donor organs did not universally occur and testing methods were variable.


Subject(s)
HIV Infections/transmission , Hepatitis B/transmission , Hepatitis C/transmission , Mass Screening , Tissue Donors , Transplant Recipients/statistics & numerical data , Adolescent , Adult , Aged , Child , Child, Preschool , Female , HIV Infections/prevention & control , Hepatitis B/prevention & control , Hepatitis C/prevention & control , Humans , Infant , Infant, Newborn , Male , Middle Aged , Organ Transplantation/adverse effects , Organ Transplantation/statistics & numerical data , Retrospective Studies , Risk Factors , Tissue and Organ Procurement , Young Adult
2.
J Clin Virol ; 80: 12-9, 2016 07.
Article in English | MEDLINE | ID: mdl-27130980

ABSTRACT

BACKGROUND: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. OBJECTIVES: To describe the spectrum and clinical impact of co-infections. STUDY DESIGN: Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. RESULTS: Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23-0.73], p=0.003), leukocytosis (>11K/µl, OR 3.7 [2.2-6.2], p<0.001; reference: normal WBC 3.5-11K/µl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0-1.2], p=0.001). Bacterial co-infections (OR 2.2 [1.4-3.6], p=0.001) and viral co-infections (OR 3.1 [1.3-7.4], p=0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p<0.05) in bivariable analysis. CONCLUSIONS: Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.


Subject(s)
Bacterial Infections/epidemiology , Coinfection/epidemiology , Influenza, Human/microbiology , Influenza, Human/virology , Virus Diseases/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Coinfection/microbiology , Coinfection/virology , Critical Care , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Retrospective Studies , Staphylococcal Infections/epidemiology , Survival Analysis , Young Adult
3.
Infect Control Hosp Epidemiol ; 36(11): 1251-60, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26224364

ABSTRACT

BACKGROUND: Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013-2014 influenza season. Little is known about the epidemiology of severe influenza during this season. METHODS: A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes. RESULTS: A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4-6.9], P=.006 and 50-64 years, 2.5 [1.3-4.9], P=.007; reference age 18-49 years), male sex (1.9 [1.1-3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9-37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2-1.4], P<.001). CONCLUSION: Risk factors for death among US patients with severe influenza during the 2013-2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.


Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza, Human/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , Child , Child, Preschool , Comorbidity , Female , Hospitalization/statistics & numerical data , Hospitals , Humans , Infant , Infant, Newborn , Influenza Vaccines/therapeutic use , Influenza, Human/drug therapy , Intensive Care Units , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors , United States/epidemiology , Young Adult
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