Infection In Cohort Research Articles

The Novel KSP Inhibitor ARRY-520 Is Active Both with and without Low-Dose Dexamethasone in Patients with Multiple Myeloma Refractory to Bortezomib and Lenalidomide: Results From a Phase 2 Study

The Novel KSP Inhibitor ARRY-520 Is Active Both with and without Low-Dose Dexamethasone in Patients with Multiple Myeloma Refractory to Bortezomib and Lenalidomide: Results From a Phase 2 Study

Epidemiology of infection in critically ill patients with acute renal failure

Critically ill patients with infection are at increased risk for developing acute renal failure (ARF), and ARF is associated with an increased risk for infection. Both conditions are associated with prolonged length of stay (LOS) and worse outcome; however, little data exist on the epidemiology of infection in this specific cohort. Therefore, we investigated the occurrence of infection in a cohort of critically ill patients with ARF treated with renal replacement therapy (RRT). In addition, we assessed whether this infection worsened outcome. Retrospective cohort study. General intensive care unit (ICU) in an academic tertiary care center comprising a 22-bed surgical ICU, eight-bed cardiac surgery ICU, 14-bed medical ICU, and six-bed burn center. Six hundred forty-seven consecutive critically ill patients with ARF treated with RRT, admitted between 2000 and 2004. None. total of 519 (80.2%), 193 (29.8%), 66 (10.2%), and ten (1.5%) patients developed one, two, three, and four episodes of infection, respectively. Of 788 episodes of infection observed, 364 (46.2%) occurred before, 318 (40.3%) during, and 106 (13.4%) after discontinuation of RRT. Pneumonia (54.3%) was most frequent, followed by intra-abdominal (11.9%) and urinary tract infections (9.7%). Infections were caused by Gram-negative organisms in 33.7%, Gram-positive organisms in 21.6%, and yeasts in 9.8%. Patients with infection had higher mortality (p = 0.04) and longer ICU and hospital LOS. They needed more vasoactive therapy and spent more time on mechanical ventilation and RRT (all p < 0.001) than patients without infection. After adjustment for potential confounders, Acute Physiology and Chronic Health Evaluation II score, age, mechanical ventilation, and vasoactive therapy were associated with worse outcome, but infection was not. Infection occurred in four fifths of critically ill patients with ARF treated with RRT and was in an unadjusted analysis associated with longer LOS and higher mortality. After correction for other covariates, infection was no longer associated with in-hospital mortality.

PATHOGENESIS AND EPIDEMIOLOGY OF BRUCELLOSIS IN YELLOWSTONE BISON: SEROLOGIC AND CULTURE RESULTS FROM ADULT FEMALES AND THEIR PROGENY

Our objective in this prospective study was to determine the natural course of Brucella abortus infection in cohorts of seropositive and seronegative, female bison (Bison bison) and their offspring in Yellowstone National Park (YNP) for 5 yr. We collected specimens from 53 adult females and 25 calves at least once and from 45 adults and 22 calves more than once. Annual seroconversion rates (negative to positive) were relatively high (23% for calves and juvenile bison, 6% in the total sample of adult female bison in our study, and 11% in the adult females that began the study as seronegatives). Antibody was not protective against infection, even for calves that passively received antibody from an infected mother's colostrum. Antibody levels stayed remarkably constant, with only a slow decline over time. We found only two seroconversions from a weak positive status to negative. Infected bison aborted and shed viable bacteria. Risk of shedding infective Brucella was highest for bison in the 2 yr following seroconversion from negative to positive. In one bison, we detected shedding for 3 yr following seroconversion. Regardless of serostatus of dams and neonates, most calves were seronegative by 5 mo of age. There was no relationship between the antibody status of the dam and the tendency of a calf to seroconvert to positive during the duration of the study.

Serological evidence of an antibody response in farmed southern bluefin tuna naturally infected with the blood fluke Cardicola forsteri

In this study, adaptive immune response was investigated in farmed southern bluefin tuna, Thunnus maccoyii, infected with a sanguinicolid Cardicola forsteri. A cohort (Cohort 2005) of southern bluefin tuna was sampled between March 2005 and August 2006. Samples were taken at the transfer of wild caught tuna to sea cages and then at regular intervals. Parasite intensity, abundance and prevalence data were recorded. An ELISA was developed to detect and quantify an antibody response against the blood fluke in southern bluefin tuna serum. Intensity and prevalence of the blood fluke were shown to peak in May 2005 at 10.9 flukes per infected fish (SE = 1.72) and 97.5% prevalence and then decreased to low prevalence (10%) and intensity (1.0). There were no significant changes in prevalence or intensity in 2006. Antibody titres and seroprevalence increased from 1.37 U μl −1 and 10% at transfer in March 2005 to reach a peak in December 2005 of 25.86 U μl −1 (SE = 6.26 U μl −1) and 66.66%. No significant changes were observed in antibody titres for the same cohort of fish during 2006. Parasitological and serological values from Cohort 2005 were compared to a 2006 cohort (Cohort 2006) in March 2006 and August 2006 to determine if prior infection in Cohort 2005 elicited any protection against infection in 2006. Although significant differences were not observed in intensities between cohorts it was shown that Cohort 2005 had significantly lower abundances and prevalences of blood fluke infection than Cohort 2006. Although there was no significant difference in mean antibody titres between cohorts in March 2006, the mean antibody titre of Cohort 2006 was significantly greater than that of Cohort 2005 in August 2006. No significant differences were observed in seroprevalence. This is one of the few studies to demonstrate the development of acquired resistance in fish against a parasite in an aquaculture environment under natural infection conditions.

Incidence of and Risk Factors for Clinically Significant Methicillin-Resistant Staphylococcus aureus Infection in a Cohort of HIV-Infected Adults

Outbreaks of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have been noted in multiple sites in the United States. This study's purpose was to estimate trends in the incidence of and risk factors for clinically significant MRSA (CS-MRSA) infection in a cohort of HIV-infected adults. A retrospective clinic-based cohort (January 1, 2000-December 31, 2003) study. We ascertained all initial episodes of CS-MRSA and categorized them by primary site. Incidence rates were estimated by half year. Risk factors for CA-MRSA infection were identified using Cox modeling. Of 126 potential events, 94 were CS. Their primary sources were 83% skin or soft tissue, 10% blood, 6% respiratory, and 1.0% other sites. Among these, 60% were CA and 40% were nosocomial. Of antibiotics tested, only cotrimoxazole resistance was associated with nosocomial acquisition. The 3455 patients contributed 7003 person-years at risk. The incidence of CS-MRSA infection increased 6.2-fold from the first to the last half year. In multivariate analysis, independent predictors of CA-MRSA infection included HIV transmission by men who have sex with men or by injection drug use, CD4 count <50 cells/muL, log10 HIV plasma viral load, and absence of cotrimoxazole prophylaxis. The incidence of initial CS-MRSA events increased more than 6-fold in a 4-year period. The associations between CA-MRSA infection and HIV severity indicators merit examination in other cohorts.

Fabrication of Three-Dimensional Porous Scaffolds of Complicated Shape for Tissue Engineering. I. Compression Molding Based on Flexible–Rigid Combined Mold

A novel method for the fabrication of complexly shaped three-dimensional porous scaffolds has been developed by combining modified compression molding and conventional particulate leaching. The resultant scaffolds of various shapes, including some shaped like auricles, were made of hydrophobic biodegradable and bioresorbable poly(D,L-lactic acid) (PDLLA) and poly(D,L-lactic-co-glycolic acid) (PLGA). A polymer-particulate mixture was first prepared by the conventional solvent casting method and then compressively molded in a specially designed flexible-rigid combined mold which facilitates shaping and mold release during the fabrication process. The molding was carried out at a moderate temperature, above the glass transition temperature and below the flow temperature of these amorphous polymers. A porous scaffold was then obtained after particulate leaching. The pores are highly interconnected and uniformly distributed both in the bulk and on the external surface of the scaffolds, and the porosity can exceed 90%. The mechanical properties of the resultant porous scaffolds are satisfactory as determined by measurements of compressive modulus and compressive stress at 10% strain. Good viability of cells seeded in the porous scaffolds was confirmed. This novel fabrication method is promising in tissue engineering because of its ability to produce precise and complexly (anatomically) shaped porous scaffolds.

Rising incidence and prevalence of herpes simplex type 2 infection in a cohort of 26 year old New Zealanders

Objectives: To examine changes in the incidence and prevalence of herpes simplex type 2 (HSV-2) infection in a birth cohort of 26 year old New Zealanders in whom seroprevalence had...

Hepatitis C virus infection in a large cohort of homosexually active men: independent associations with HIV-1 infection and injecting drug use but not sexual behaviour.

To determine the prevalence and risk factors for hepatitis C virus (HCV) infection in a cohort of homosexually active men, with particular reference to assessing sexual transmission. Prevalence based on cross-sectional testing for HCV (c100 protein) antibody in a cohort using sera stored between 1984 and 1989, and assessment of risk factors using a case-control analysis based on questionnaire data from HCV positive and negative subjects. 1038 homosexually active men who were participating in a prospective study established to identify risk factors for AIDS. They had been recruited through private and public primary care and sexually transmissible disease (STD) services in central Sydney. Prevalence of HCV antibody and its association with human immunodeficiency virus type 1 (HIV-1) infection and other STDs, number of sexual partners, sexual practices and recreational drug use. Overall, 7.6% of subjects tested were seropositive for HCV antibody. In univariate analysis, HCV infection was significantly associated with injecting drug use (IDU) (OR = 8.18, p < 0.0001) and HIV infection (OR = 3.14, p < 0.0001) and with self reported history of syphilis (OR = 1.88, p = 0.016), anogenital herpes (OR = 1.93, p = 0.017), gonorrhoea (OR = 2.43, p = 0.009) and hepatitis B (OR = 1.92, p = 0.010). In case control analysis, similar sexual behaviours (partner numbers and practices) were reported by HCV positive and HCV negative subjects except that HCV negative subjects more frequently reported engaging than HCV positive subject in unprotected receptive anal intercourse without ejaculation (OR = 0.61, p = 0.034), unprotected insertive (OR = 0.59, p = 0.039) and receptive (OR = 0.56, p = 0.016) oro-anal intercourse (rimming) and insertive fisting (OR = 0.48, p = 0.034). In multiple logistic regression analyses, only HIV-1 infection (OR = 3.18, p < 0.0001) and IDU in the previous six months (OR = 7.24, p < 0.0001) remained significantly associated with the presence of HCV antibody. IDU was the major behavioural risk factor for HCV infection. If sexual or another from of transmission did occur, it may have been facilitated by concurrent HIV-1 infection.

Overt and latent HIV 1 and HTLV-I infection in cohorts of at high risk individuals in Argentina

We conducted a survey using serology and polymerase chain reaction assays to detect HIV 1 and/or HTLV-I antibodies and viral DNA, respectively, in 113 intravenous drug abusers and in 62 sexually active high risk individuals attending two Drug Addict Centres and a Centre for Venereal Diseases in Buenos Aires, Argentina. At the time of the survey 137 of these subjects were known to be HIV 1 seropositive but none of them was symptomatic. Serological tests for HTLV-I were found to be positive in 38 (21.7%) of the HIV 1 positive individuals, whereas all of the 38 HIV 1 seronegative subjects were also seronegative for HTLV-I antibodies. Gene amplification assays carried out in blood sample DNA from the 38 HIV 1/HTLV-I seronegative individuals, revealed HIV 1 DNA in six out of 28 intravenous drug abusers (21.5%). One subject (2.6%) was positive for both HIV 1 and HTLV-I DNA sequences, whereas four (10.5%) showed HTLV-I DNA only. To determine whether these individuals were infected with HTLV-I and/or HTLV-II, DNA samples were also amplified with HTLV-II specific primers and no evidence of HTLV-II infection was observed. None of the subjects seroconverted according to conventional serological tests during the 2 year follow-up period. The 10 seronegative subjects belonging to the sexual risk group were negative for both HIV 1 and HTLV-I in polymerase chain reaction assays. We conclude that not only HIV 1, but also HTLV-I is a widely spread infection in intravenous drug abusers and sexually active high risk individuals in Argentina.(ABSTRACT TRUNCATED AT 250 WORDS)