Kimberly E Hanson

University of Utah, Salt Lake City, Utah, United States

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Publications (36)129.12 Total impact

  • Angela M. Caliendo · Kimberly E. Hanson
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    ABSTRACT: Since the Food and Drug Administration (FDA) released its draft guidance on the regulation of laboratory-developed tests (LDTs) in October 2014, there has been a flurry of responses from commercial and hospital based laboratory directors, clinicians, professional organizations and diagnostic companies. The FDA defines an LDT as an “ in vitro diagnostic device that is intended for clinical use and is designed, manufactured, and used within a single laboratory”. The draft guidance outlines a risk-based approach, with oversight of high risk and moderate risk tests being phased in over nine years. High risk tests would be regulated first and require a premarket approval. Subsequently, moderate risk tests would require a 510(k) and low risk tests would need only to be registered. Oversight discretion will be exercised for LDTs focused on rare diseases (defined as fewer than 4,000 tests, not cases, per year nationally) and unmet clinical needs (defined as those tests for which there is no alternative FDA cleared or approved test). There was an open comment period followed by a public hearing in early January of 2015 and we are currently awaiting the final decision regarding the regulation of LDTs. Given that LDTs have been developed by many laboratories and are essential for the diagnosis and monitoring of an array of infectious diseases, changes in their regulation with have far reaching implications for clinical microbiology laboratories. In this point-counterpoint Dr. Angela Caliendo discusses the potential benefits of the FDA guidance for LDTs while Dr. Kim Hanson discusses the concerns associated with implementing the guidance and why these regulations may not improve clinical care.
    No preview · Article · Jan 2016 · Journal of Clinical Microbiology
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    ABSTRACT: Candida bloodstream infections (BSI) are associated with significant morbidity, mortality and increased healthcare costs. Early treatment is essential because delayed therapy detrimentally impacts clinical outcomes. The FDA recently approved the first culture-independent, direct molecular detection method for Candida BSIs (T2Candida®). The speed and sensitivity of this assay have the potential to improve patient care but the reagents and instrumentation are expensive. We used an analytic decision tree model to compare the cost-effectiveness of T2Candida®-directed antifungal therapy (T2DT) to that of either empiric therapy (ET) or blood culture-directed therapy (BCDT). Costs included that of T2Candida® testing, antifungal treatment and hospital length of stay. The effectiveness measure was survival status at hospital discharge. T2DT was less costly and more effective than BCDT, but was less costly and less effective than ET with an echinocandin (incremental cost effectiveness ratio $111,084 per additional survivor). One-way sensitivity analyses demonstrated that the cost effectiveness of T2DT was highly dependent on Candida BSI prevalence and the cost of antifungal therapy as well as T2Candida® test reagents. Use of T2DT reduced the number of unnecessarily treated patients by 98% relative to ET. Reduced drug exposure could lessen the possibility of drug-related adverse events and may also prevent the development of antifungal resistance or emergence of drug resistant Candida species. The greatest benefit of T2Candida® appears to be the ability to confidently withhold or stop empiric antifungal therapy in low to moderate-risk patients who are unlikely to benefit from treatment.
    Preview · Article · Jan 2016 · Journal of clinical microbiology
  • Kimberly E Hanson · Sankar Swaminathan

    No preview · Article · Oct 2015 · Future Microbiology
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    ABSTRACT: Neither breakpoints (BPs) nor epidemiological cutoff values (ECVs) have been established for Candida spp. with anidulafungin, caspofungin and micafungin when using the Sensititre YeastOne ®: (SYO) broth dilution colorimetric method. In addition, reference caspofungin MICs have so far proven to be unreliable. Candida species wild-type (WT) MIC distributions (microorganisms in a species-drug combination with no detectable phenotypic resistance) were established for 6,007 Candida albicans, 186 C. dubliniensis, 3,188 C. glabrata complex, 119 C. guilliermondii, 493 C. krusei, 205 C. lusitaniae, 3,136 C. parapsilosis complex, and 1,016 C. tropicalis isolates. SYO MIC data gathered from 38 laboratories in Australia, Canada, Europe, Mexico, New Zealand, South Africa, and the United States were pooled to statistically define SYO-ECVs. ECVs of anidulafungin, caspofungin and micafungin encompassing ≥97.5% of the statistically-modeled population were, respectively, 0.12, 0.25, 0.06 μg/ml for C. albicans, 0.12, 0.25, 0.03 μg/mL for C. glabrata complex, 4, 2, 4 μg/ml for C. parapsilosis complex, 0.5, 0.25, 0.06 μg/ml for C. tropicalis, 0.25, 1, 0.25 μg/ml for C. krusei, 0.25, 1, 0.12 μg/ml for C. lusitaniae, 4, 2, 2 μg/ml for C. guilliermondii, and 0.25, 0.25, 0.12 μg/ml for C. dubliniensis. Species-specific SYO-ECVs of anidulafungin, caspofungin and micafungin correctly classified 72 (88.9%), 74 (91.4%), 76 (93.8%), respectively, of 81 Candida isolates with identified fks mutations. SYO-ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin, micafungin and especially to caspofungin, since testing the susceptibilities of Candida spp. to caspofungin by reference methodologies is not recommended. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Full-text · Article · Aug 2015 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: Invasive fungal diseases (IFDs) are an important cause of morbidity and mortality, especially in immunocompromised patients. Prompt antifungal therapy is essential for favorable outcomes, but clinical signs and symptoms are nonspecific and mycologic confirmation is often not possible. Radiographic testing is an important adjunct to the diagnosis and management of IFDs. Early imaging has been associated with improved survival, particularly in neutropenic patients with fungal pneumonia or acute invasive fungal sinusitis. This review summarizes common radiologic appearances of IFDs of the lung, sinus, and brain. The advantages and limitations of computed tomography (CT) and magnetic resonance (MR) imaging are discussed as are recent developments in nuclear medicine and proton MR spectroscopy technology.
    No preview · Article · Jun 2015 · Current Fungal Infection Reports
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    ABSTRACT: Macrolide resistance has been linked to the presence of a functional erythromycin ribosomal methylase (erm) gene in most species of pathogenic rapidly growing mycobacteria (RGM). For these isolates, extended incubation in clarithromycin is necessary to determine macrolide susceptibility. In contrast, the absence of a detectable erm gene in isolates of M. chelonae, M. senegalense, M. peregrinum, and a non-functional erm gene in M. abscessus subspecies massiliense and 15-20% in subspecies M. abscessus renders these species intrinsically macrolide susceptible. Not all RGM species have been screened for the presence of an erm gene including the Mycobacterium mucogenicum group (M. mucogenicum, Mycobacterium phocaicum, and Mycobacterium aubagnense) and Mycobacterium immunogenum. A total of 356 isolates of these two pathogenic RGM taxa, from two reference laboratories underwent clarithromycin susceptibility testing with readings at 3-5 days and 14 days. Only 13 of the 356 isolates had resistant clarithromycin MICs at initial extended MIC readings and repeat values on all available isolates were ≤2 μg/mL. These studies suggest that these two additional RGM groups do not harbor functional erm genes and like M. chelonae, do not require extended clarithromycin susceptibility testing. We propose to the Clinical Laboratory and Standards Institute that isolates belonging to these six rapidly growing mycobacteria groups based on molecular identification with no known functional erm genes undergo only 3-5 days susceptibility testing (to exclude mutational resistance). Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Preview · Article · Jan 2015 · Journal of Clinical Microbiology
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    ABSTRACT: Accurate diagnosis is critical to providing appropriate care in infectious diseases (ID). New technologies for infectious disease diagnostics are emerging, but gaps remain in test development and availability. The Emerging Infections Network surveyed ID physicians to assess unmet diagnostic needs. Responses reflected the urgent need to identify drug-resistant infections and highlighted the potential for early diagnosis to improve antibiotic stewardship. Information gained from this survey can help inform recommendations for new diagnostic test development in the future.
    Full-text · Article · Oct 2014 · Diagnostic Microbiology and Infectious Disease
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    ABSTRACT: Background: Meningitis is a severe infection that causes significant morbidity and mortality. Rapid etiologic diagnosis is critical to initiation of appropriate therapy. A molecular system to rapidly identify bacteria, viruses, and fungi causing meningitis could improve the medical management of this infection in children. Methods: The FilmArray® Meningitis / Encephalitis Panel (FA ME; BioFire Diagnostics, Inc., Salt Lake City, UT) performs automated nucleic acid purification and multiplex PCR to identify 17 bacterial, viral and fungal pathogens directly from CSF. We performed a retrospective study of 120 children < = 18 presenting to our children’s hospital with concern for meningitis. Conventional CSF testing (culture and/or viral testing) was ordered at the discretion of the treating physician. FA studies on archived CSF, using a research use only version of the panel, were performed at the University of Utah. FA ME results were compared to conventional testing. Results: The median age of children in the study was 6 months (range 0-237 months). 18 children had positive CSF cultures, of which 11 grew true pathogens. Nine were included on the FA ME panel. FA detected 8/9 cultured panel bacteria, and also detected bacteria in 6 additional specimens (see Table). The median CSF WBC count in children with positive cultures was 391; median WBC for children with positive FA ME testing was 1749. This difference is related to low CSF WBC in samples culture-positive for presumed contaminants. Only 4 children had viruses detected by conventional methods, including PCR of blood or CSF. FA ME detected viruses in 16 samples, including 4 also positive for bacteria. Conclusion: The FilmArray ME panel is a sensitive tool for the rapid identification of pathogens from CSF and may identify causative pathogens not detected by conventional testing. Improved detection of pathogens from CSF using FilmArray has the potential to improve treatment and outcomes for children with meningitis. Pathogen Identified by Conventional Testing (n) Identified by FilmArray (n) S. pneumoniae 3 4 S. agalactiae 1 2 N. meningitidis 1 1 H. influenzae 3 4 E. coli 1 3 K. pneumoniae/C. koseri 1/1 0/0 Presumed contaminants (skin flora) 7 0 HSV/HHV6/EBV/CMV/VZV 0/1/1/0/0 1/8/5/0/0 Enterovirus/Parechovirus 2/0 2/1
    No preview · Conference Paper · Oct 2014
  • J. H. Kim · C. Goulston · M. Zangari · G. Tricot · M. W. Boyer · K. E. Hanson
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    ABSTRACT: Background Levofloxacin is routinely used for the prevention of invasive bacterial infections during autologous peripheral blood stem cell transplantation (APBSCT). However, increasing rates of bacterial sepsis were noted at our institution among multiple myeloma (MM) patients undergoing outpatient APBSCT with melphalan-based chemotherapy and levofloxacin prophylaxis. We assessed the impact of a change in antibacterial prophylaxis from oral levofloxacin (Period 1) to sequential oral levofloxacin followed by ertapenem (Period 2).Methods Electronic medical records were reviewed to identify MM patients who underwent APBSCT in the outpatient clinic between October 2007 and April 2012.ResultsOver a 4.5-year period, 165 outpatient APBSCTs were eligible for the analysis. Fewer overall bacteremias occurred during Period 2 as compared with Period 1 (0.5 cases per 100 person-days vs. 2.4 cases per 100 person-days, P < 0.001). In addition, fewer patients were hospitalized for neutropenic fever while receiving sequential prophylaxis (45.7% vs. 75.7% of outpatient APBSCT recipients during Periods 2 and 1, respectively; P < 0.001). In Kaplan–Meier analysis, receipt of sequential prophylaxis (Period 2) was significantly associated with overall bacteremia-free survival within 30 days after the APBSCT (P < 0.001). No significant differences were seen in the number of patients developing Clostridium difficile infection or ertapenem-resistant gram-negative bacteremia between study periods.Conclusion In conclusion, sequential prophylaxis may effectively prevent episodes of bacteremia and hospitalizations in neutropenic MM outpatient APBSCT recipients. Prospective studies that involve larger numbers of MM patients with extended periods of follow-up are ultimately required to define the safety and efficacy of sequential antibacterial prophylaxis.
    No preview · Article · May 2014 · Transplant Infectious Disease

  • No preview · Article · May 2014 · Clinical Infectious Diseases
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    ABSTRACT: Paecilomyces species are emerging fungal pathogens. Morphological identifications are complicated by similarities among the members of the P. variotii complex as well as to some Rasamsonia and Hamigera species. The purpose of this study was to compare matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI–TOF MS) with molecular diagnostic standards (i.e., multilocus DNA sequencing of the internal transcribed spacer regions 1 and 2, D1/D2 regions, and part of the β-tubulin gene) for the identification of Paecilomyces spp. encountered in two clinical mycology laboratories. A total of 77 clinical isolates identified morphologically as P. variotii (n = 21), P. lilacinus (n = 52), and Paecilomyces spp. not otherwise specified (n = 4) were included. In accord with the most recent taxonomy, all P. lilacinus isolates were confirmed as Purpureocillium lilacinum by both sequencing and MALDI–TOF MS. Fungi phenotypically resembling P. variotii or Paecilomyces spp. were identified by molecular techniques as P. variotii sensu stricto (n = 12), P. formosus (n = 3), P. dactylethromorphus (n = 3), Rasamsonia argillacea (n = 4), or R. piperina (n = 1) and at the genus level as an isolate of a Hamigera sp. and a Paecilomyces sp. There was 92.2% (71/77) agreement between the molecular and proteomic methods only after supplementation of the MALDI–TOF MS database with type strains. Paecilomyces variotii–like organisms required multilocus DNA interrogations for differentiation and account for all of the fungi whose identification was missed by MALDI–TOF MS. Overall, MALDI–TOF MS was a rapid and reliable alternative to multilocus sequencing. However, significant augmentation of the commercially available database was required to reproducibly identify this group of important human pathogens.
    Preview · Article · Mar 2014 · Medical mycology: official publication of the International Society for Human and Animal Mycology
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    Kimberly E Hanson · E Susan Slechta · Haleina Muir · Adam P. Barker
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    ABSTRACT: The erm(41) gene causes inducible macrolide resistance in Mycobacterium abscessus but not Mycobacterium chelonae. erm(41) sequencing of 285 M. abscessus and 45 M. chelonae isolates was compared to 14-day susceptibility; agreement percentages were 98.9% and 100%, respectively. Extended incubation may not be necessary for M. chelonae, and the erm(41) genotype is a useful adjunct for M. abscessus.
    Preview · Article · Feb 2014 · Journal of clinical microbiology
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    ABSTRACT: Reference broth microdilution methods of Candida echinocandin susceptibility testing are limited by interlaboratory variability in caspofungin MICs. Recently revised Clinical and Laboratory Standards Institute (CLSI) breakpoint MICs for echinocandin nonsusceptibility may not be valid for commercial tests employed in hospital laboratories. Indeed, there are limited echinocandin susceptibility testing data from hospital laboratories. We conducted a multicenter retrospective study of 9 U.S., Australian, and New Zealand hospitals that routinely tested Candida bloodstream isolates for echinocandin susceptibility from 2005 to 2013. Eight hospitals used Sensititre YeastOne assays. The Candida spp. were C. albicans (n = 1,067), C. glabrata (n = 911), C. parapsilosis (n = 476), C. tropicalis (n = 185), C. krusei (n = 104), and others (n = 154). Resistance and intermediate rates were ≤1.4% and ≤3%, respectively, for each echinocandin against C. albicans, C. parapsilosis, and C. tropicalis. Resistance rates among C. glabrata and C. krusei isolates were ≤7.5% and ≤5.6%, respectively. Caspofungin intermediate rates among C. glabrata and C. krusei isolates were 17.8% and 46.5%, respectively, compared to ≤4.3% and ≤4.4% for other echinocandins. Using CLSI breakpoints, 18% and 19% of C. glabrata isolates were anidulafungin susceptible/caspofungin nonsusceptible and micafungin susceptible/caspofungin nonsusceptible, respectively; similar discrepancies were observed for 38% and 39% of C. krusei isolates. If only YeastOne data were considered, interhospital modal MIC variability was low (within 2 doubling dilutions for each agent). In conclusion, YeastOne assays employed in hospitals may reduce the interlaboratory variability in caspofungin MICs against Candida species that are observed between reference laboratories using CLSI broth microdilution methods. The significance of classifying isolates as caspofungin intermediate and anidulafungin/micafungin susceptible will require clarification in future studies.
    Full-text · Article · Jan 2014 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians.
    Preview · Article · Dec 2013 · Clinical Infectious Diseases
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    ABSTRACT: Background: Broad-range amplification and sequencing of conserved housekeeping genes provides a culture-independent method to detect infectious pathogens in clinical specimens. The Emerging Infections Network (EIN) surveyed ID physicians to assess use of this novel technology. Methods: 1572 EIN members were surveyed in 03/13. Respondents who reported having performed broad-range PCR were asked about frequencies of submitted specimen types, positive results and their clinical usefulness. Results: Of the 700 (44.5%) respondents to the survey, 297 (42%) had used broad-range PCR. The most common reason for not using these tests was lack of availability (76%), followed by a lack of knowledge about the test (28%). 201 respondents answered questions about their use of broad-range PCR. 60/201 (30%) had used it more than 10 times; the majority (50%) had used it 1-5 times. The most commonly submitted specimens were osteoarticular, CSF, and endovascular samples, including blood, each submitted by more than 50% of respondents. Most specimens were submitted in the setting of inflammation on histopathology with negative pathogen stains and culture. A majority of respondents (65%) could submit specimens with no laboratory utilization review. Most respondents reported only rare (36%) to occasional (38%) positive results. 89% of respondents who had used broad-range PCR more than 10 times and 80% of respondents who used it less than 10 times reported test results to be helpful (not significant). Contaminant results were reported by similar proportions of respondents regardless of how frequently the test was ordered. Conclusion: Increasing the use of broad-range PCR for diagnosis of suspected infections will depend on increased availability and awareness of the test as well as increased specificity and decreased frequency of contamination. Positive results need to be interpreted with caution due to risk of contamination. Studies that help physicians correlate test results with clinical decision-making and treatment strategies can help develop guidelines for use of this test.
    No preview · Conference Paper · Oct 2013
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    Eugene V Ravkov · Igor Y Pavlov · Kimberly E Hanson · Julio C Delgado
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    ABSTRACT: Cytomegalovirus (CMV) infection is one of the most important infectious complications of transplantation. Monitoring CMV-specific CD8 T cell immunity is useful for predicting active CMV infection and for directing targeted antiviral therapy. In this study, we examined four basic parameters for validation of CMV-specific tetramer staining and peptide stimulation assays that cover five most frequent HLA class I alleles. We also examined the potential use of CMV-specific CD8(+) T cell numbers and functional and cytolytic responses in two autologous HSCT recipients treated for multiple myeloma. The coefficient of variation (CV %) of the precision within assays was 3.1-24% for HLA-tetramer staining, 2.5-47% for IFN-γ, and 3.4-59.7% for CD107a/b production upon peptide stimulation. The precision between assays was 5-26% for tetramer staining, 4-24% for IFN-γ, and 5-48% for CD107a/b. The limit of detection was 0.1-0.23 cells/μL of blood for tetramer staining, 0-0.23 cell/μL for IFN-γ, and 0.11-0.98 cells/μL for CD107a/b. The assays were linear and specific. The reference interval with 95% confidence level was 0-18 cells/μL for tetramer staining, 0-2 cells/μL for IFN-γ, and 0-3 cells/μL for CD107a/b. Our results provide acceptable measures of test performance for CMV immune competence assays for the characterization of CD8(+) T cell responses posttransplant measured in the absolute cell count per μL of blood.
    Full-text · Article · Dec 2012 · Clinical and Developmental Immunology
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    ABSTRACT: Cryptococcosis is a systemic infection caused by the pathogenic yeasts Cryptococcus neoformans and C. gattii. Detection of cryptococcal capsular antigen (CrAg) in serum and cerebrospinal fluid (CSF) plays an important diagnostic role. We prospectively compared the new IMMY lateral flow assay (LFA) and enzyme immunoassay (EIA) to our current CrAg test (Premier EIA, Meridian Bioscience Inc.). Discordant samples were retested with the Latex-Cryptococcus antigen test (IMMY) and using serotype-specific monoclonal antibodies (mAbs). A total of 589 serum and 411 CSF specimens were tested in parallel. Qualitative agreement across assays was 97.7%. In all, 56 (41 serum and 15 CSF) were positive and 921 (527 serum and 394 CSF) were negative by all three assays. The 23 discrepant specimens were all Meridian EIA negative. Of 23 discordant specimens, 20 (87.0%) were positive by both the IMMY LFA and EIA, 2 were LFA positive only and 1 EIA positive only. Eleven discrepant specimens had adequate volume for latex agglutination (LA) testing; 8 were LA positive and 3 LA negative. LA negative samples (2 CSF and 1 serum) had low IMMY LFA/EIA titers (≤ 1:10). Serotype-specific mAb analysis of the LA positive samples suggested that these specimens contain CrAg epitopes similar to those of serotype C strains. In conclusion, the IMMY assays showed excellent overall concordance with the Meridian EIA. Assay performance differences were related to issues of analytic sensitivity and possible serotype bias. Incomplete access to patient-level data combined with low specimen volumes limited our ability to fully resolve discrepant results.
    Full-text · Article · Oct 2012 · Clinical and vaccine Immunology: CVI
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    ABSTRACT: Invasive candidiasis (IC) is a devastating disease. While prompt antifungal therapy improves outcomes, empiric treatment based on the presence of fever has little clinical impact. Β-D-Glucan (BDG) is a fungal cell wall component detectable in the serum of patients with early invasive fungal infection (IFI). We evaluated the utility of BDG surveillance as a guide for preemptive antifungal therapy in at-risk intensive care unit (ICU) patients. Patients admitted to the ICU for ≥ 3 days and expected to require at least 2 additional days of intensive care were enrolled. Subjects were randomized in 3:1 fashion to receive twice weekly BDG surveillance with preemptive anidulafungin in response to a positive test or empiric antifungal treatment based on physician preference. Sixty-four subjects were enrolled, with 1 proven and 5 probable cases of IC identified over a 2.5 year period. BDG levels were higher in subjects with proven/probable IC as compared to those without an IFI (117 pg/ml vs. 28 pg/ml; p<0.001). Optimal assay performance required 2 sequential BDG determinations of ≥ 80 pg/ml to define a positive test (sensitivity 100%, specificity 75%, positive predictive value 30%, negative predictive value 100%). In all, 21 preemptive and 5 empiric subjects received systemic antifungal therapy. Receipt of preemptive antifungal treatment had a significant effect on BDG concentrations (p< 0.001). Preemptive anidulafungin was safe and generally well tolerated with excellent outcome. BDG monitoring may be useful for identifying ICU patients at highest risk to develop an IFI as well as for monitoring treatment response. Preemptive strategies based on fungal biomarkers warrant further study. Clinical Trials.gov NCT00672841.
    Full-text · Article · Aug 2012 · PLoS ONE
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    ABSTRACT: Cytomegalovirus (CMV) is an important pathogen after allogeneic transplantation. However, few studies have examined CMV reactivation after autologous peripheral blood stem cell transplantation (APBSCT) to treat multiple myeloma (MM), especially in the setting of the newer chemotherapeutic agents and/or 2 sequential APBSCTs (ie, tandem transplantation). A retrospective chart review of patients with MM who underwent either single APBSCT or tandem transplantation was conducted to evaluate the incidence, risk factors, and outcomes of CMV infection at a single institution. A total of 104 patients with MM underwent transplantation during the study period, including 66 patients who received tandem transplantation. The majority of patients (66 of 104; 63.5%) were CMV-seropositive, and CMV viremia was frequently detected in this subgroup (32 of 66; 48.5%). No primary CMV infections were identified. CMV reactivation was more common in recipients of tandem transplantation than in recipients of single APBSCT (P < .001). In addition, patients who developed CMV viremia were more likely to have received conditioning therapy with melphalan, bortezomib, dexamethasone, and thalidomide compared with those without CMV reactivation (P = .015). However, on multiple logistic regression analysis, only receipt of tandem transplantation was significantly associated with CMV reactivation (odds ratio, 5.112; 95% confidence interval, 1.27-20.60; P = .022). Febrile episodes of CMV viremia were observed in 17 patients (17 of 32; 53.1%), and invasive CMV disease was diagnosed in 1 patient. Our data suggest that CMV reactivation after APBSCT for MM is relatively common, and that viremia is often associated with fever. CMV surveillance should be considered, especially when tandem transplantation is performed using combination chemotherapy with high-dose melphalan.
    Preview · Article · Jun 2012 · Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation
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    ABSTRACT: Leptotrichia spp. are anaerobic, pencil-shaped, Gram-negative rods that are part of the normal oral and intestinal human flora. Although not typically considered pathogenic, invasive Leptotrichia infections have been reported in immunosuppressed patients. A perceived rise in the identification of Leptotrichia spp. at our institution prompted a retrospective evaluation of these infections. Laboratory and clinical records were reviewed to identify Leptotrichia culture-positive patients. Over a 5-year period, 68 Leptotrichia-positive specimens were identified. Of these, 21% (14/68) were identified in original samples submitted from 13 different patients at our institution, and the remainder (79% [54/68]) were unknown isolates referred from outside hospitals for molecular identification. All in-house Leptotrichia were identified from blood cultures. Only 64% (9/14) of these grew on solid media, and 5 were a part of polymicrobial bacteremias containing other enteric pathogens. All local patients were receiving chemotherapy and a majority received hematopoietic stem cell transplant (HSCT) (11/13). All had neutropenic fever with symptoms of mucositis and/or enteritis. Most of the HSCT patients (73% [8/11]) were autologous recipients hospitalized after recent high-dose chemotherapy for multiple myeloma. L. hongkongensis, a novel species, was found in the majority of myeloma cases (63% [5/8]). In conclusion, we suggest that Leptotrichia spp. may be an underappreciated cause of bacteremia, particularly in multiple myeloma patients receiving cytotoxic chemotherapy for autologous HSCT. In our cohort, these infections were associated with neutropenic fever from an enteric source, and most isolates remained sensitive to standard antibiotics.
    Full-text · Article · Dec 2011 · Journal of clinical microbiology

Publication Stats

399 Citations
129.12 Total Impact Points

Institutions

  • 2009-2016
    • University of Utah
      • • Department of Pathology
      • • School of Medicine
      • • Division of Infectious Diseases
      • • Division of Pediatric Infectious Disease
      Salt Lake City, Utah, United States
  • 2015
    • Arup
      Londinium, England, United Kingdom
  • 2007-2008
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 2006-2007
    • Duke University Medical Center
      Durham, North Carolina, United States