Andre C Kalil

University of Nebraska Medical Center, Omaha, Nebraska, United States

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Publications (136)789.84 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. Patient medical records. Not applicable. Not applicable. Not applicable. Safe and effective care of patients with Ebola virus disease requires significant communication and planning. Adherence to a predetermined isolation protocol is essential, including proper donning and doffing of personal protective equipment. Location of the patient care area and the logistics of laboratory testing, diagnostic imaging, and the removal of waste must be considered. Patients with Ebola virus disease are often dehydrated and need adequate vascular access for fluid resuscitation, nutrition, and phlebotomy for laboratory sampling. Advanced planning for acute life-threatening events and code status must be considered. Intensivist scheduling should account for the significant amount of time required for the care of patients with Ebola virus disease. With appropriate precautions and resources, designated hospitals in the United States can safely provide care for patients with Ebola virus disease.
  • Andre C Kalil, Mark E Rupp, Diana F Florescu
  • Andre C Kalil
  • Andre C Kalil, Uriel S Sandkovsky
    Annals of internal medicine 02/2015; 162(4):JC7. DOI:10.7326/ACPJC-2015-162-4-007 · 16.10 Impact Factor
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    ABSTRACT: Staphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health.
    JAMA The Journal of the American Medical Association 10/2014; 312(15):1552-1564. DOI:10.1001/jama.2014.6364 · 30.39 Impact Factor
  • Clinical Infectious Diseases 10/2014; DOI:10.1093/cid/ciu789 · 9.42 Impact Factor
  • Antimicrobial Agents and Chemotherapy 10/2014; 58(10):6342. DOI:10.1128/AAC.04097-14 · 4.45 Impact Factor
  • Andre C Kalil, Junfeng Sun
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    ABSTRACT: Objectives: To review Bayesian methodology and its utility to clinical decision making and research in the critical care field. Data Source and Study Selection: Clinical, epidemiological, and biostatistical studies on Bayesian methods in PubMed and Embase from their inception to December 2013. Data Synthesis: Bayesian methods have been extensively used by a wide range of scientific fields, including astronomy, engineering, chemistry, genetics, physics, geology, paleontology, climatology, cryptography, linguistics, ecology, and computational sciences. The application of medical knowledge in clinical research is analogous to the application of medical knowledge in clinical practice. Bedside physicians have to make most diagnostic and treatment decisions on critically ill patients every day without clear-cut evidence-based medicine (more subjective than objective evidence). Similarly, clinical researchers have to make most decisions about trial design with limited available data. Bayesian methodology allows both subjective and objective aspects of knowledge to be formally measured and transparently incorporated into the design, execution, and interpretation of clinical trials. In addition, various degrees of knowledge and several hypotheses can be tested at the same time in a single clinical trial without the risk of multiplicity. Notably, the Bayesian technology is naturally suited for the interpretation of clinical trial findings for the individualized care of critically ill patients and for the optimization of public health policies. Conclusions: We propose that the application of the versatile Bayesian methodology in conjunction with the conventional statistical methods is not only ripe for actual use in critical care clinical research but it is also a necessary step to maximize the performance of clinical trials and its translation to the practice of critical care medicine.
    Critical Care Medicine 10/2014; 42(10):2267-2277. DOI:10.1097/CCM.0000000000000576 · 6.15 Impact Factor
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    ABSTRACT: Background Severe hypogammaglobulinemia (IgG<400 mg/dL) has adverse impact on mortality during the first year post-transplantation. The aim of the study was to determine whether increasing IgG levels to >400mg/dl improved outcomes.Methods Kaplan-Meier analyses were performed to estimate survival, log-rank test to compare survival distributions between groups and Fisher's exact test to determine the association between hypogammaglobulinemia and rejection or graft loss.Results37 solid organ transplant (SOT) recipients were included. Hypogammaglobulinemia was diagnosed at median of 5.6months (range:0-291.8months) post-transplantation. Types of transplants: liver-small bowel (17); liver-small bowel-kidney (2); liver (5); small bowel (4); liver-kidney (1); kidney/kidney-pancreas (3); heart (3); heart-kidney (1); heart-lung (1). The 3-year survival after the diagnosis of hypogammaglobulinemia was 49.5% (95%CI:32.2-64.6%). Patients were dichotomized based upon IgG level at last follow-up: IgG>400mg/dL (23patients) and IgG<400mg/dL (14patients). There was no evidence of a difference in survival (p=0.44), rejection rate (p=0.44) and graft loss censored for death (p=0.99) at one year between these 2 groups. There was no difference in survival between patients receiving or not immunoglobulin (p=0.99) or cytomegalovirus hyperimmunoglobulin (p=0.14).Conclusion Severe hypogammaglobulinemia after SOT is associated with high mortality rates, but increasing IgG levels to >400mg/dL did not seem to translate in better patient or graft survival in this cohort.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 09/2014; 28(11). DOI:10.1111/ctr.12458 · 1.49 Impact Factor
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    ABSTRACT: BackgroundAcute flaccid paralysis surveillance (AFP) is an essential strategy of the WHO’s Polio Eradication Initiative. This is the first study conducted to estimate the incidence, etiology, distribution, and surveillance performance of AFP in Iraq.MethodsSurveillance data about the AFP cases under the age of 15 years reported from Iraq during January 1997 to December 2011 were depended in the current study.ResultsA total of 4974 cases of AFP were reported from Iraq during the study period, with an annual incidence of 2.5/100,000 population. Guillain-Barré syndrome represented more than half of the reported cases (N = 2611, 52.5%), followed by traumatic neuritis (N = 715, 14.4%), and other CNS infections (N = 292, 5.9%). Poliomyelitis accounted for 166 (3.3%) of cases, the last reported case being in January 2000. Surveillance performance showed that all, but two, indicators were below the required WHO recommended levels.ConclusionsAFP surveillance remains the gold standard method for poliomyelitis detection. It witnessed dramatic changes over the last two decades. This has raised people’s and clinicians’ awareness to the importance of promptness in notifying suspected cases and timely transportation of stool specimens to the National Poliovirus Laboratory in Baghdad, or alternatively having more than one laboratory for poliovirus detection in the country, all of which are very useful measures to increase the surveillance performance in the country.
    BMC Infectious Diseases 08/2014; 14(1):448. DOI:10.1186/1471-2334-14-448 · 2.56 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    Andre C Kalil
    The Lancet Infectious Diseases 08/2014; 14(8):674–675. DOI:10.1016/S1473-3099(14)70836-9 · 19.45 Impact Factor
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    ABSTRACT: The lungs are a major target for infection and a key battleground in the fight against the development of antimicrobial drug-resistant pathogens. Ventilator-associated pneumonia (VAP) is associated with mortality rates of 24-50%. The optimal duration of antibiotic therapy against VAP is unknown, but prolonged courses are associated with the emergence of bacterial resistance. De-escalation strategies in which treatment is discontinued based on signs of clinical resolution, fixed durations of therapy (generally 7-8 d), or serum procalcitonin responses have been shown to decrease antibiotic consumption. Outcomes are comparable to longer treatment courses, with the possible exception of VAP due to nonfermenting, gram-negative bacilli such as Pseudomonas aeruginosa. Staphylococcus aureus is a leading cause of VAP and other infections. Outcomes after S. aureus infection are shaped by the interplay between environmental, bacterial, and host genetic factors. It is increasingly clear that mechanisms of pathogenesis vary in different types of S. aureus infections. Genome-scale studies of S. aureus strains, host responses, and host genetics are redefining our understanding of the pathogenic mechanisms underlying VAP. Genome-sequencing technologies are also revolutionizing our understanding of the molecular epidemiology, evolution, and transmission of influenza. Deep sequencing using next-generation technology platforms is defining the remarkable genetic diversity of influenza strains within infected hosts. Investigators have demonstrated that antiviral drug-resistant influenza may be present prior to the initiation of treatment. Moreover, drug-resistant minor variant influenza strains can be transmitted from person to person in the absence of selection pressure. Studies of lung infections and the causative pathogens will remain at the cutting edge of clinical and basic medical research.
    08/2014; 11(Supplement 4):S193-S200. DOI:10.1513/AnnalsATS.201402-069PL
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    ABSTRACT: We conducted a randomized and unblinded 2×2 sequential-factorial trial, composed of an induction arm (part 1) comparing single-dose (SD) versus divided-dose rabbit antithymocyte globulin (rATG), and a maintenance arm (part 2) comparing tacrolimus minimization versus withdrawal. We report the long-term safety and efficacy of SD-rATG induction in the context of early steroid withdrawal and tacrolimus minimization or withdrawal.
    Transplantation 07/2014; DOI:10.1097/TP.0000000000000250 · 3.78 Impact Factor
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    ABSTRACT: There are limited U.S. data describing the risk factors for multidrug-resistant organism (MDRO) isolation in community-acquired (CAP) and healthcare-associated pneumonia (HCAP). However, concern for the presence of these pathogens drives the prescribing of empiric broad-spectrum antibiotics for CAP and HCAP. A retrospective study of all adults hospitalized with community-onset pneumonia (CAP and HCAP) at a large U.S. medical center from 1/2010-12/2011 was conducted. The objective was to ascertain the rate of pneumonia caused by MDROs and to evaluate if HCAP is a risk factor for MDRO pneumonia. Univariate and propensity score adjusted multivariate analyses were performed. 521 patients (50.5% CAP, 49.5% HCAP) were included. The most common etiologies of pneumonia were primary viral and Streptococcus pneumoniae. MDRO were isolated in 20 (3.8%) patients overall, and MDRO occurred in 5.9% and 1.9% of HCAP and CAP patients, respectively. MDRO was not associated with HCAP classification (OR=1.95;95%CI 0.66-5.80;P=0.23) or with most of its individual components (hemodialysis, home infusion, home wound care, and ≥48h hospitalization in last 90 days). Independent predictors of MDRO included: P. aeruginosa colonization/infection in the previous year (OR=7.43;95%CI 2.24-24.61;P<0.001), antimicrobial use in the previous 90 days (OR=2.90;95%CI 1.13-7.45;P=0.027), admission from nursing home (OR=4.19;95%CI 1.55-11.31;P=0.005), and duration of hospitalization in the previous 90 or 180 days (P=0.013 and P=0.002, respectively). MDROs were uncommon in HCAP and CAP. HCAP did not predict MDRO isolation. Local etiology of community-onset pneumonia and specific MDRO risk factors should be integrated into therapeutic decisions to prevent empiric overprescribing of antibiotics for MRSA and P. aeruginosa.
    Antimicrobial Agents and Chemotherapy 06/2014; 58(9). DOI:10.1128/AAC.02582-14 · 4.57 Impact Factor
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    ABSTRACT: Background: We aimed to evaluate and quantify the risk of serious opportunistic infections after induction with polyclonal antibodies versus IL-2 receptor antagonists (IL-2RAs) in randomized clinical trials. Methods: PRISMA guidelines were followed and random-effects models were performed. Results: 70 randomized clinical trials (10,106 patients) were selected: 36 polyclonal antibodies (n = 3377), and 34 IL-2RAs (n = 6729). Compared to controls, polyclonal antibodies showed higher risk of serious opportunistic infections (OR: 1.93, 95% CI: 1.34-2.80; p < 0.0001); IL-2RAs were associated with lower risk of serious opportunistic infections (OR: 0.80, 95% CI: 0.68-0.94; p = 0.009). Polyclonal antibodies were associated with higher risk of bacterial (OR: 1.58, 95% CI: 1.00-2.50; p = 0.049) and viral infections (OR: 2.37, 95% CI: 1.60-3.49; p < 0.0001), while IL-2RAs were associated with lower risk of cytomegalovirus (CMV) disease (OR: 0.73, 95% CI: 0.56-0.97; p = 0.032). Adjusted indirect comparison: compared to polyclonal antibodies, IL-2RAs were associated with lower risk of serious opportunistic infections (OR: 0.41, 95% CI: 0.34-0.49; p < 0.0001), bacterial infections (OR: 0.51, 95% CI: 0.39-0.67; p < 0.0001) and CMV disease (OR: 0.58, 95% CI: 0.34-0.98; p = 0.043). Results remained consistent across allografts.Conclusion The risk of serious opportunistic infections, bacterial infections and CMV disease were all significantly decreased with IL-2RAs compared to polyclonal antibodies.
    Expert Review of Anti-infective Therapy 05/2014; DOI:10.1586/14787210.2014.917046 · 3.06 Impact Factor
  • Michael Klompas, Andre C Kalil
    Critical care medicine 03/2014; 42(3):722-3. DOI:10.1097/CCM.0000436119.32758.69 · 6.15 Impact Factor
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    ABSTRACT: Aims: The aims of this study were to determine a mechanism and general timeline forstatin related anti-inflammatory activity. Methods: Healthy male subjects received rosuvastatin (20 mg daily) for 3 weeks. Blood samples before and after treatment were collected forclinical laboratories and research procedures.Toll-like receptor-4 (tlr-4) expression on blood monocytes was measured using flow cytometry before and after rosuvastatin treatment. Inflammatory molecules were measured before and after rosuvastatin and after blood samples were incubated for 3 hours with or without lipopolysaccharide. Plasma was collected and analyzed for IL-6, TNF, IL-8, IGF-1, and sCD14. Comparisons were made using Mann-Whitney rank sum test and paired Student's t-test with significance defined as p.
    Current pharmaceutical design 01/2014; DOI:10.2174/1381612820666140127163313 · 4.41 Impact Factor
  • Andre C Kalil, Trevor C Schooneveld
    The Lancet 01/2014; 383(9911):29-30. DOI:10.1016/S0140-6736(13)62734-8 · 39.21 Impact Factor
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    ABSTRACT: Background. Prophylactic and preemptive strategies are used to prevent cytomegalovirus infections after solid organ transplantation. We assessed the safety and efficacy of both strategies for CMV prevention. Methods. DerSimonian and Laird random-effects model was used for pooling the data and Q statistic and I-squared methods were used to assess statistical heterogeneity. Results. Twenty studies (2744 patients) were selected for the direct analysis and 20 studies (2544 patients) for the indirect analysis. The odds of CMV syndrome (OR=1.10;95%CI:0.60-2.03;p=0.757;Q=18.55;I(2)=51.49%) and disease (OR=0.77;95%CI:0.41-1.47;p=0.432;Q=32.71;I(2)=44.97%.) were not significantly different between strategies. The odds of developing late-onset CMV infections were higher for the prophylactic compared to the preemptive strategy (OR=6.21;95%CI:2.55-15.20;p<0.0001;Q=9.66;I(2)=37.9%). The odds of CMV viremia were lower for prophylaxis (OR=0.42;95%CI:0.24-0.74;p=0.003;Q=48.10;I(2)=75.1%) than preemptive therapy. No differences between strategies were noted for: graft loss (OR=0.88;95%CI:0.37-2.13;p=0.779;Q=13.03,I(2)=38.62%), graft loss censored for death (OR=0.73;95%CI:0.17-3.21;p=0.679;Q=4.48;I(2)=55.32%), acute rejection (OR=0.93;95%CI:0.70-1.24;p=0.637;Q=12.99;I(2)=7.61%) and mortality (OR=0.80;95%CI:0.56-1.14;p=0.220;Q=8.76;I(2)=0%). Other infections (HSV, VZV, bacterial and fungal infections) were not significantly different between strategies. Leukopenia (OR=1.97;95%CI:1.39-2.79;p=0.0001;Q=7.10;I(2)=0%) and neutropenia (OR=2.07;95%CI:1.13-3.78;p=0.018;Q=6.77;I(2)=11.40%) were more frequent with prophylaxis than preemptive strategy. The results of direct and indirect comparisons were consistent. Conclusions. Prophylaxis was associated with less early post-transplant viremia, but with significantly more late-onset CMV infections and side effects - leukopenia and neutropenia, than the preemptive strategy. Both preventive strategies showed similar efficacy in preventing CMV syndrome and disease, with no differences regarding rejection, graft loss, death and opportunistic infections.
    Clinical Infectious Diseases 01/2014; 58(6). DOI:10.1093/cid/cit945 · 9.42 Impact Factor
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    ABSTRACT: Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis (AFP) in the post-poliomyelitis eradication era. This is the first study done to identify the epidemiology, clinical features, and outcome of GBS in Iraqi children over 15 years. The surveillance database about AFP cases < 15 years reported during January 1997-December 2011 was used. GBS represented 52.5% of AFP cases, with an incidence of 1.33 case/100,000 population < 15 years/year. There was a higher incidence in the Southern provinces, age group 1-4 years, males, and outside the capital city of province, with no significant seasonal variations (p = .22). Survival probability after the 1 year of onset for those with respiratory muscle involvement was .76 (95% CI: .60-.86), versus .97 (95% Cl:.96- .98) for those who did not develop it(p < .001); and .97 (95%CI: .96-.98) for those living inside the capital city, versus .94 (.93-.95) for those living outside (p = .001). ). Cumulative incidence of residual paralysis for patients living inside the capital city was .21 (95%CI: .18-.24), versus.27 (95%CI: .25-.29) for those living outside (p < .001). The incidence, age and gender distribution, and seasonality of GBS among Iraqi children is similar to those reported from other previous studies. It is the most important cause of AFP, especially in those between the age of 1 to 4 years living in rural areas.
    BMC Neurology 12/2013; 13(1):195. DOI:10.1186/1471-2377-13-195 · 2.49 Impact Factor
    This article is viewable in ResearchGate's enriched format

Publication Stats

2k Citations
789.84 Total Impact Points

Institutions

  • 2005–2015
    • University of Nebraska Medical Center
      • • Division of Infectious Diseases
      • • Department of Internal Medicine
      Omaha, Nebraska, United States
    • Baylor University
      Waco, Texas, United States
  • 2011–2014
    • The Nebraska Medical Center
      Omaha, Nebraska, United States
  • 2006–2013
    • University of Nebraska at Omaha
      • Department of Internal Medicine
      Omaha, Nebraska, United States
  • 2010
    • University at Buffalo, The State University of New York
      Buffalo, New York, United States
  • 2009
    • University of Illinois, Urbana-Champaign
      • Department of Food Science and Human Nutrition
      Urbana, Illinois, United States
  • 2007–2009
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2005–2006
    • National Institutes of Health
      • Critical Care Medicine Department
      Bethesda, MD, United States