Lara Danziger-Isakov

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

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Publications (81)292.41 Total impact

  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S304. DOI:10.1016/j.healun.2015.01.855 · 5.61 Impact Factor
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    ABSTRACT: SMX/TMP is the current gold standard for prophylaxis against PCP in immunocompromised pediatric patients. Currently, there are several second-line options for prophylaxis but many, including intravenous (IV) pentamidine, have not been reported to be as effective or as safe as SMX/TMP in the pediatric transplant population. This study is to determine the efficacy and safety of IV pentamidine in preventing PCP in pediatric transplant patients. A retrospective chart review was conducted to evaluate all transplant patients that received at least one dose of IV pentamidine from January 2010 to July 2013. The primary outcome, IV pentamidine efficacy, was evaluated by the incidence of PCP diagnosis for 28 days after the last dose of IV pentamidine if patient was transitioned to another agent for PCP prophylaxis. Patients on IV pentamidine for entire course of PCP prophylaxis were followed at least six months after discontinuation of IV pentamidine. The safety of IV pentamidine was assessed by the incidence of adverse events leading to pentamidine discontinuation. All data were analyzed using descriptive statistics. All transplant patients at CCHMC who had received IV pentamidine were reviewed, and 333 patients met inclusion criteria. The overall incidence of PCP was found to be 0.3% for pediatric transplant patients on pentamidine. Pentamidine was found to be safe, and the incidence of adverse events leading to discontinuation was 6% with the most common reason being tachycardia 2.1%. IV pentamidine is safe and effective as PCP prophylaxis in pediatric transplant patients with a PCP breakthrough rate of 0.3% (1 of 333 patients), and only 20 adverse events led to discontinuation. We recommend that IV pentamidine be considered as a second-line option in pediatric transplant patients who cannot tolerate SMX/TMP. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Pediatric Transplantation 02/2015; 19(3). DOI:10.1111/petr.12441 · 1.63 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2015; 21(2):S371. DOI:10.1016/j.bbmt.2014.11.598 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2015; 21(2):S216-S217. DOI:10.1016/j.bbmt.2014.11.333 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2015; 21(2):S234-S235. DOI:10.1016/j.bbmt.2014.11.361 · 3.35 Impact Factor
  • Biology of Blood and Marrow Transplantation 02/2015; 21(2):S219-S220. DOI:10.1016/j.bbmt.2014.11.338 · 3.35 Impact Factor
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    Michael G Ison, Lara Danziger-Isakov
    Transplantation 10/2014; DOI:10.1097/TP.0000000000000502 · 3.78 Impact Factor
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    ABSTRACT: Background: Hematopoietic Stem Cell Transplant recipients (HSCT) are at increased risk for severe infections, and empiric antibiotic choice may be driven anecdotally by single patient experiences in addition to local antibiograms. Knowledge of recent infection patterns may be insufficient to adjust prescribing practices. We report the results of a synchronized collaborative effort between Infectious Diseases and HSCT attendings to decrease meropenem (MERO) use on an HSCT unit. Methods: Antibiotics prescription practice on HSCT unit before, during and after interventions. Results: MERO use peaked at 392 days of therapy (DOT) per 1000 pt-days in October 2011 and remained greater than 300 DOT per 1000 patient days through 2012. Twice yearly reporting of microbiology data directly to the HSCT team identified an increasing incidence of candidemia in 2012. Interventions included data sharing of recently recovered pathogens, recommendations use MERO then de-escalate to piperacillin-tazobactam (PTZ) with negative cultures, daily huddles between ID and HSCT to de-escalate antibiotics when indicated, and visual display of MERO prescribing patterns in the HSCT unit. Over the following 8 months, MERO use declined to 72 DOT per 1000 pt-days after which ID/HSCT huddles were decreased in frequency to twice weekly (FIG1). MERO use has remained stable over the ensuing 6 months, averaging 100 DOT per 1000 pt-days. PTZ use increased modestly from 203 DOT per 1000 pt-days in October 2011 to a mean of 227 DOT per 1000 pt-days during the last 6 months. Overall usage of the two antibiotics in the HSCT unit remains lower (peak of 619 in October 2011 to 307 DOT per 1000 pt-days currently, FIG2). Conclusion: Multi-prong intervention including education, data sharing, concentrated antibiotic prescribing practices and improved communication resulted in decreased MERO use in the high-risk HSCT population.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background Infections with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) remain important in solid organ transplantation. Quantitative viral nucleic acid testing is a major advance to patient management. These assays are limited by a lack of standardization, resulting in viral load measurements that differ among clinical laboratories. The variability in viral load measurements makes interpretation of multicenter clinical trials data difficult. This study compares the current practices in CMV and EBV viral load testing at four large transplant centers participating in multicenter Clinical Trials in Organ Transplantation and the Clinical Trials in Organ Transplantation in Children (CTOT and CTOTC).Methods Viral load testing was performed on well-defined viral preparations according to standard operating procedures at each site.ResultsAmong centers, CMV viral load testing was accurate compared to WHO International Standards and within acceptable variation for this testing method. Epstein-Barr virus viral load data were more variable and less accurate despite the use of international standards.Conclusions These data suggest that comparison of CMV, but not EBV, viral load measurements at these sites is possible using current assays and control standards. Standardization of these assays is facilitated using the WHO International Standards and will allow comparison of viral load results among transplant centers. Assay standardization must be performed prior to initiation of multicenter trials.
    Clinical Transplantation 10/2014; 28(12). DOI:10.1111/ctr.12473 · 1.49 Impact Factor
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    8th International Pediatric Intestinal Failure and Rehabilitation Symposium, 2014, Atlanta, GA; 09/2014
  • L Danziger-Isakov, J Bucavalas
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    ABSTRACT: Cytomegalovirus (CMV) continues to be a significant posttransplant infectious complication after pediatric liver transplant (PLT). The optimal prevention strategy is not currently known. To assess current CMV prevention practices, a web-based survey was conducted within the North American Studies in Pediatric Liver Transplantation (SPLIT) network. Twenty-nine of the 31 centers (94%) surveyed responded. Only seven centers reported evidence-based development of protocols. For most at-risk (donor or recipient CMV seropositive) PLT recipients, a prophylactic strategy predominates current practice. For high-risk (D+/R-), only three centers used nonprophylaxis-based protocols: one preemptive and two sequential/hybrid. Duration of prophylaxis ranged from 84 to 730 days with 14 centers using around 100 days and nine centers using around 200 days. Initial therapy with ganciclovir followed by valganciclovir was the most common strategy. For lower-risk recipients (CMV D-/R-), more centers (10/29) employed a preemptive strategy while the remainder described prophylaxis (15) and sequential/hybrid (3) strategies. Prophylaxis predominates current CMV prevention strategies for at-risk recipients within SPLIT. The variation in duration of therapy provides the opportunity to perform comparative effectiveness studies within SPLIT.
    American Journal of Transplantation 06/2014; 14(8). DOI:10.1111/ajt.12755 · 6.19 Impact Factor
  • Lara Danziger-Isakov
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    ABSTRACT: Recipients of both solid organ transplant and hematopoietic stem cell transplantation are at increased risk for infectious morbidity and mortality after transplantation due to on-going immunosuppression. Gastrointestinal infections have been increasingly reported in these populations. Increased reports of gastrointestinal infections including bacterial infection with Clostridium difficile, viral infection with norovirus and parasitic pathogens like cryptosporidium are emerging. Risk factors identified have focused on type of transplant, transplant immunosuppression regimens and exposures. Although many events are self-limiting, significant morbidity and rare mortality are reported. Improved diagnostic techniques have increased the reporting of several gastrointestinal infections after transplantation, affording improved understanding of the epidemiology of these diseases. Armed with this emerging data, prevention, recognition of infection and treatment strategies can be more thoroughly assessed in these at-risk populations.
    Current opinion in gastroenterology 11/2013; DOI:10.1097/MOG.0000000000000016 · 3.66 Impact Factor
  • Dana Hawkinson, Daniel Hinthorn, Lara Danziger-Isakov
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    ABSTRACT: Respiratory viruses cause significant morbidity and mortality in immunocompromised populations such as stem cell transplant and solid organ transplant patients. Few viruses causing respiratory tract infection have an approved therapy, and many of the viruses have no therapeutic options at all. In this article, we describe novel agents under development for treatment options against several respiratory viruses.
    Current Infectious Disease Reports 10/2013; 15(6). DOI:10.1007/s11908-013-0370-0
  • Lara Danziger-Isakov
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • Lara Danziger-Isakov, Infectious Disease
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Background: Human herpesvirus 6 (HHV-6) is a ubiquitous virus, most children acquire by primary infection by age 2 years. HHV-6 has been associated with serious illness after immune suppression associated with organ transplantation, and is prospectively screened in some institutions after organ transplantation. HHV-6 and the other human betaherpesviruses (cytomegalovirus and HHV-7) have not been well studied in children undergoing cancer chemotherapy. Because these viruses can become latent, finding one during acute illness does not prove a pathogenic role. Our objective was to longitudinally evaluate for the presence of the human betaherpesviruses and EBV from the onset of chemotherapy through the first 2 years after diagnosis of a malignancy in children treated at the CCCH. Methods: We enrolled 77 children with newly diagnosed malignancy requiring chemotherapy and followed prospectively for 2 years. Blood specimens were collected every 2 weeks for the first 6 months, every month for the next 6 months, and then every 3 months. Specimens were also collected during acute illness. DNA was extracted for PCR of HHV-6, HHV-7, CMV and EBV. Samples from each child were run together after all were collected. Analysis was complete-case based and tests were two tailed and performed with SAS 9.2 software. Results: Seventy-three children had evaluable data: 39M/34F with a mean age of 10.1 years (range 6m to 21 y) at enrollment. Deaths: 14; lost to follow up: 3(transferred care). Diagnoses included leukemia/lymphoma (29), histocytosis (3), brain tumor (4), and other (38). There were 159 acute visits in 48 of the children and 907 routine visits in the first year. Of the 48 with acute visits, 31 had +PCR for HHV-6. HHV-6 PCR was + in 10% of both acute and routine visits. HHV-6 was not more likly positive during acute than during a routine visit. HHV-6 viremia was significantly associated with younger age, chemotherapy, and marginally with steroids, but not with acute visits. It was not associated with CMV or EBV reactivation or infection. Conclusion: HHV-6 PCR positivity occurred in a significant proportion of pediatric cancer patients over the course of the first year (51%) of treatment. However it occurred with similar frequency during acute and routine visits. If HHV-6 is not assessed longitudinally clinical events may be misattributed to the virus.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Infection is common complication associated with significant morbidity and mortality after implantation of mechanical circulatory support (MCS) devices. Standardized infection prevention practices have not been established.Methods and MaterialsAn international survey to investigate the current infection prevention (IP) practices with MCS was conducted through an electronic survey. Through an ISHLT mailing, 210 centers identified a representative to complete the survey managed by the Research Survey Center at Mayo Clinic. Data regarding pre, peri, and post-implantation practices was collected.ResultsRepresentatives from 56 centers have completed the survey by November 2012. 37 (66.1%) centers routinely evaluate for pre-implant bacterial colonization; 35 for MRSA by nasal swab, 14 for MSSA and 7 for resistant gram-negatives. Pre-implant IP included antiseptics (94.6%) and pre-op chlorhexidine bath (62.6%). Pre-implant antibiotics given within 1 hour (60%) included vancomycin (82.1%), rifampin (32.1%), ciprofloxacin (21.4%) and antifungal (47.3%). The majority report antimicrobials duration for 24-48h (56%). Operative techniques reported included placing velour driveline portion subcutaneously (78.2%) and contralateral placement of driveline exit from device (61.5%). In addition, most centers reported willingness to participate in future IP trials.Conclusions Common IP practices were reported in the majority of MCS centers though subtle differences exist. Future consensus building and design of multi-center intervention studies in MCS may be developed based on this survey.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S182. DOI:10.1016/j.healun.2013.01.437 · 5.61 Impact Factor
  • American Journal of Transplantation 03/2013; 13(s4):1-2. DOI:10.1111/ajt.12129 · 6.19 Impact Factor
  • L Danziger-Isakov, D Kumar
    American Journal of Transplantation 03/2013; 13(s4):311-317. DOI:10.1111/ajt.12122 · 6.19 Impact Factor
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    ABSTRACT: A working group representing the American Society of Transplantation, Pediatric Infectious Diseases Society, and International Pediatric Transplant Association has developed a collaborative effort to identify and develop core knowledge in pediatric transplant infectious diseases. Guidance for patient care environments for training and core competencies is included to help facilitate training directed at improving the experience for pediatric infectious diseases trainees and practitioners in the area of pediatric transplant infectious diseases.
    02/2013; 4(1). DOI:10.1093/jpids/pit079

Publication Stats

797 Citations
292.41 Total Impact Points

Institutions

  • 2012–2015
    • Cincinnati Children's Hospital Medical Center
      Cincinnati, Ohio, United States
  • 2006–2013
    • Cleveland Clinic
      • • Transplant Center
      • • Department of Urology at Children's Hospital
      Cleveland, Ohio, United States
  • 2010–2012
    • Case Western Reserve University
      Cleveland, Ohio, United States
  • 2011
    • Pediatric Associates
      Tampa, Florida, United States
  • 2009
    • The Children's Hospital of Philadelphia
      Filadelfia, Pennsylvania, United States
    • Medical University of Vienna
      Wien, Vienna, Austria
  • 2008
    • B.P. Koirala Institute of Health Sciences
      Dharan, Eastern Region, Nepal
  • 2003–2005
    • Washington University in St. Louis
      • Department of Pediatrics
      San Luis, Missouri, United States