Marijuana use in transplantation: A call for clarity.

Transplant centers have varying policies for marijuana (MJ) use in donors, transplant candidates, and recipients. Rationales for these differences range from concerns for fungal complications, impaired adherence, and drug interactions. This paper reviews the current status of MJ policies and practices in transplant centers and results of a survey sent to the American Society of Transplantation (AST) membership by the Executive Committee of the AST Infectious Diseases Community of Practice.The purpose of the survey was to compare policies and concerns of MJ use to actual observed complications. Of the 3321 surveys sent, 225 members (8%) responded. Transplant centers varied in their approval processes, differing even in organ types within the same institutions. Furthermore, there was discordance among transplant centers in their perceived risks of marijuana use as opposed to complications actually observed. An increasing number of states continue to legalize medical and recreational MJ resulting in widespread availability. Further research is needed to assess the validity of concerns for complications of MJ use in potential donors and recipients. Ultimately, standardized guidelines should be established based on studies and evidence-based criteria to assist transplant programs in their policies around the use of cannabis in their donors and recipients.

Estimating Local Costs Associated With Clostridium difficile Infection Using Machine Learning and Electronic Medical Records.

BACKGROUND Reported per-patient costs of Clostridium difficile infection (CDI) vary by 2 orders of magnitude among different hospitals, implying that infection control officers need precise, local analyses to guide rational decision making between interventions. OBJECTIVE We sought to comprehensively estimate changes in length of stay (LOS) attributable to CDI at a single urban tertiary-care facility using only data automatically extractable from the electronic medical record (EMR). METHODS We performed a retrospective cohort study of 171,938 visits spanning a 7-year period. In total, 23,968 variables were extracted from EMR data recorded within 24 hours of admission to train elastic-net regularized logistic regression models for propensity score matching. To address time-dependent bias (reverse causation), we separately stratified comparisons by time of infection, and we fit multistate models. RESULTS The estimated difference in median LOS for propensity-matched cohorts varied from 3.1 days (95% CI, 2.2-3.9) to 10.1 days (95% CI, 7.3-12.2) depending on the case definition; however, dependency of the estimate on time to infection was observed. Stratification by time to first positive toxin assay, excluding probable community-acquired infections, showed a minimum excess LOS of 3.1 days (95% CI, 1.7-4.4). Under the same case definition, the multistate model averaged an excess LOS of 3.3 days (95% CI, 2.6-4.0). CONCLUSIONS In this study, 2 independent time-to-infection adjusted methods converged on similar excess LOS estimates. Changes in LOS can be extrapolated to marginal dollar costs by multiplying by average costs of an inpatient day. Infection control officers can leverage automatically extractable EMR data to estimate costs of CDI at their own institutions. Infect Control Hosp Epidemiol. 2017;38:1478-1486.

Hepatitis C virus infection and kidney transplantation: newer options and a brighter future ahead?

Recent studies including the current article by Sawinski et al. demonstrate that hepatitis C virus (HCV) infection is associated with worse outcomes in kidney transplant recipients with and without HIV infection. We comment on the significance of these findings in the context of newer options for the treatment of HCV infection that have improved efficacy and fewer side effects when administered in both kidney transplant candidates and recipients.

A case study and review of pancreatitis in the AIDS population.

This case study considers a 55-year-old African American woman with the acquired immunodeficiency syndrome (AIDS) who presented with epigastric abdominal pain for 1 week. She was found to have pancreatitis on computed tomography scanning. Unique to this case are the numerous possible etiologies of her pancreatitis. Thus, this case study systematically reviews the different etiologies of pancreatitis in the AIDS population compared to the general population. Furthermore it discusses the management and treatment of pancreatitis in AIDS.

O1 and non-O1 Vibrio cholerae bacteremia produced by hemolytic strains.

Vibrio cholerae are Gram-negative bacteria capable of producing serious infections. They are differentiated into O1 and non-O1 serogroups, depending on their ability to agglutinate with specific antiserum. In contrast to non-O1 V. cholerae, which are more prone to invading the bloodstream, V. cholerae O1 is rarely the cause of bacteremia. We describe 2 cases of O and non-O1 V. cholerae bacteremia in patients with hepatitis C virus cirrhosis. We postulate that the hemolytic properties of the isolates contributed to their virulence in immunocompromised hosts.