Pub Date : 2020-11-04DOI: 10.1101/2020.11.02.20224824
S. Lumley, Jia Wei, D. O’Donnell, N. Stoesser, P. Matthews, A. Howarth, S. Hatch, B. Marsden, S. Cox, T. James, Liam J. Peck, Thomas G Ritter, Z. de Toledo, R. Cornall, E. Jones, D. Stuart, G. Screaton, Daniela Ebner, S. Hoosdally, D. Crook, C. Conlon, K. Pouwels, A. Walker, T. Peto, T. Walker, K. Jeffery, D. Eyre
Background SARS-CoV-2 IgG antibody measurements can be used to estimate the proportion of a population exposed or infected and may be informative about the risk of future infection. Previous estimates of the duration of antibody responses vary. Methods We present 6 months of data from a longitudinal seroprevalence study of 3217 UK healthcare workers (HCWs). Serial measurements of IgG antibodies to SARS-CoV-2 nucleocapsid were obtained. Bayesian mixed linear models were used to investigate antibody waning and associations with age, gender, ethnicity, previous symptoms and PCR results. Results In this cohort of working age HCWs, antibody levels rose to a peak at 24 (95% credibility interval, CrI 19-31) days post-first positive PCR test, before beginning to fall. Considering 452 IgG seropositive HCWs over a median of 121 days (maximum 171 days) from their maximum positive IgG titre, the mean estimated antibody half-life was 85 (95%CrI, 81-90) days. The estimated mean time to loss of a positive antibody result was 137 (95%CrI 127-148) days. We observed variation between individuals; higher maximum observed IgG titres were associated with longer estimated antibody half-lives. Increasing age, Asian ethnicity and prior self-reported symptoms were independently associated with higher maximum antibody levels, and increasing age and a positive PCR test undertaken for symptoms with longer antibody half-lives. Conclusion IgG antibody levels to SARS-CoV-2 nucleocapsid wane within months, and faster in younger adults and those without symptoms. Ongoing longitudinal studies are required to track the long-term duration of antibody levels and their association with immunity to SARS-CoV-2 reinfection.
{"title":"The duration, dynamics and determinants of SARS-CoV-2 antibody responses in individual healthcare workers","authors":"S. Lumley, Jia Wei, D. O’Donnell, N. Stoesser, P. Matthews, A. Howarth, S. Hatch, B. Marsden, S. Cox, T. James, Liam J. Peck, Thomas G Ritter, Z. de Toledo, R. Cornall, E. Jones, D. Stuart, G. Screaton, Daniela Ebner, S. Hoosdally, D. Crook, C. Conlon, K. Pouwels, A. Walker, T. Peto, T. Walker, K. Jeffery, D. Eyre","doi":"10.1101/2020.11.02.20224824","DOIUrl":"https://doi.org/10.1101/2020.11.02.20224824","url":null,"abstract":"Background SARS-CoV-2 IgG antibody measurements can be used to estimate the proportion of a population exposed or infected and may be informative about the risk of future infection. Previous estimates of the duration of antibody responses vary. Methods We present 6 months of data from a longitudinal seroprevalence study of 3217 UK healthcare workers (HCWs). Serial measurements of IgG antibodies to SARS-CoV-2 nucleocapsid were obtained. Bayesian mixed linear models were used to investigate antibody waning and associations with age, gender, ethnicity, previous symptoms and PCR results. Results In this cohort of working age HCWs, antibody levels rose to a peak at 24 (95% credibility interval, CrI 19-31) days post-first positive PCR test, before beginning to fall. Considering 452 IgG seropositive HCWs over a median of 121 days (maximum 171 days) from their maximum positive IgG titre, the mean estimated antibody half-life was 85 (95%CrI, 81-90) days. The estimated mean time to loss of a positive antibody result was 137 (95%CrI 127-148) days. We observed variation between individuals; higher maximum observed IgG titres were associated with longer estimated antibody half-lives. Increasing age, Asian ethnicity and prior self-reported symptoms were independently associated with higher maximum antibody levels, and increasing age and a positive PCR test undertaken for symptoms with longer antibody half-lives. Conclusion IgG antibody levels to SARS-CoV-2 nucleocapsid wane within months, and faster in younger adults and those without symptoms. Ongoing longitudinal studies are required to track the long-term duration of antibody levels and their association with immunity to SARS-CoV-2 reinfection.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81547785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monica L. Bianchini, Rachel M. Kenney, Robyn Lentz, M. Zervos, Manu Malhotra, S. Davis
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) is a widely-used safe and cost-effective treatment strategies. Most public and private insurance providers require prior authorization (PA) for OPAT, yet impact of the inpatient PA process is not known. This study aimed to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics. METHODS IRB-approved study of adult patients discharged with high-priced OPAT antibiotics from January to December 2017. Antibiotics included: daptomycin, ceftaroline, ertapenem, and the novel beta-lactam beta-lactam inhibitor combinations. Patients with an OPAT PA delay were compared to patients without. Primary endpoint: total direct hospital costs from the start of treatment. Secondary outcomes: discharge delay and 30-day readmission or mortality. RESULTS Two-hundred patients included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a sub-acute care facility compared to an outpatient setting: 37 (63%) vs 52 (37%), p=0.001. Discharge delays and median total direct hospital costs were higher in patients with OPAT delays: 31 (53%) vs 21 (15%), p<0.001; and $19,576 vs (IQR 10,056-37,038) vs $7,770 (IQR 3,031-13,974), p<0.001. In a multiple variable regression, discharge to a sub-acute care facility was associated with an increased odds of discharge delay while age over 64 years was associated with a decreased odds of discharge delay. CONCLUSIONS OPAT with high-priced antibiotics requires significant care coordination. PA delays for these antibiotics are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient are and address access barriers.
背景门诊肠外抗菌药物治疗(OPAT)是一种广泛使用的安全和具有成本效益的治疗策略。大多数公共和私人保险提供商需要OPAT的事先授权(PA)，但住院患者PA流程的影响尚不清楚。本研究旨在表征与高价OPAT抗生素相关的出院障碍和PA延迟。方法对2017年1月至12月使用高价OPAT抗生素出院的成人患者进行sirb批准的研究。抗生素包括:达托霉素，头孢他林，厄他培南，和新的-内酰胺-内酰胺抑制剂组合。将OPAT PA延迟的患者与未延迟的患者进行比较。主要终点:从治疗开始的直接住院总费用。次要结局:延迟出院，30天再入院或死亡。结果200例患者:无OPAT延迟141例(71%)，OPAT延迟59例(30%)。与门诊相比，更多的PA延迟患者出院到亚急性护理机构:37人(63%)对52人(37%)，p=0.001。OPAT延迟患者的出院延迟和直接住院总费用中位数较高:31例(53%)vs 21例(15%)，p<0.001;$19,576 vs (IQR 10,056-37,038) vs $7,770 (IQR 3,031-13,974)， p<0.001。在多变量回归中，出院到亚急性护理机构与出院延迟的几率增加有关，而年龄超过64岁与出院延迟的几率降低有关。结论sopat与高价抗菌药物需加强护理配合。这些抗生素的PA延迟是常见的，并导致出院延迟。OPAT的护理过渡是改善患者状况和解决获取障碍的一个机会。
{"title":"Discharge Delays and Costs Associated with Outpatient Parenteral Antimicrobial Therapy for High priced Antibiotics.","authors":"Monica L. Bianchini, Rachel M. Kenney, Robyn Lentz, M. Zervos, Manu Malhotra, S. Davis","doi":"10.1093/cid/ciz1076","DOIUrl":"https://doi.org/10.1093/cid/ciz1076","url":null,"abstract":"BACKGROUND\u0000Outpatient parenteral antimicrobial therapy (OPAT) is a widely-used safe and cost-effective treatment strategies. Most public and private insurance providers require prior authorization (PA) for OPAT, yet impact of the inpatient PA process is not known. This study aimed to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics.\u0000\u0000\u0000METHODS\u0000IRB-approved study of adult patients discharged with high-priced OPAT antibiotics from January to December 2017. Antibiotics included: daptomycin, ceftaroline, ertapenem, and the novel beta-lactam beta-lactam inhibitor combinations. Patients with an OPAT PA delay were compared to patients without. Primary endpoint: total direct hospital costs from the start of treatment. Secondary outcomes: discharge delay and 30-day readmission or mortality.\u0000\u0000\u0000RESULTS\u0000Two-hundred patients included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a sub-acute care facility compared to an outpatient setting: 37 (63%) vs 52 (37%), p=0.001. Discharge delays and median total direct hospital costs were higher in patients with OPAT delays: 31 (53%) vs 21 (15%), p<0.001; and $19,576 vs (IQR 10,056-37,038) vs $7,770 (IQR 3,031-13,974), p<0.001. In a multiple variable regression, discharge to a sub-acute care facility was associated with an increased odds of discharge delay while age over 64 years was associated with a decreased odds of discharge delay.\u0000\u0000\u0000CONCLUSIONS\u0000OPAT with high-priced antibiotics requires significant care coordination. PA delays for these antibiotics are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient are and address access barriers.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79271504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thibaut Davy-Mendez, S. Napravnik, D. Wohl, A. Durr, Oksana Zakharova, Claire E Farel, J. Eron
BACKGROUND Advances in antiretroviral therapy, aging, and comorbidities impact hospitalization rates in HIV-infected populations. We examined temporal trends and patient characteristics associated with hospitalization rates and outcomes. METHODS Study population included patients in the University of North Carolina Center for AIDS Research HIV Clinical Cohort receiving clinical care 1996-2016. We estimated annual hospitalization rates, time to inpatient mortality or live discharge, and 30-day readmission risk using bivariable Poisson, Fine and Gray, and log-binomial regression models. RESULTS 4323 patients (29% women, 60% African-American) contributed 30 007 person-years. Overall, the hospitalization rate per 100 person-years was 34.3 (95% confidence interval [CI] 32.4, 36.4) with a mean change of -3% per year (95% CI -4%, -2%). Thirty-day readmission risk was 18.9% (95% CI 17.7%, 20.2%) and stable over time (P=0.21 and P=0.44 for 2010-2016 and 2003-2009, respectively, compared to 1996-2002). Patients who were Black (compared to White), older, had HIV RNA >400 copies/mL, or had CD4 count <200 cells/µL had higher hospitalization rates (all P<0.05). Higher inpatient mortality was associated with older age and lower CD4 (both P<0.05). Thirty-day readmission risk was higher among Black patients, those with detectable HIV RNA, and with lower CD4 cell counts (all P<0.05). CONCLUSIONS Hospitalization rates decreased from 1996 to 2016, but readmissions remained unchanged and high. Older patients, of minority race/ethnicity, and with uncontrolled HIV experienced higher rates and worse hospitalization outcomes. These findings underscore the importance of early diagnosis and treatment, linkage and retention in care, and care engagement at the time of hospital discharge.
背景:抗逆转录病毒治疗的进展、老龄化和合并症影响hiv感染者的住院率。我们研究了与住院率和结果相关的时间趋势和患者特征。方法研究人群为1996-2016年接受临床护理的北卡罗来纳大学艾滋病研究中心HIV临床队列患者。我们使用双变量泊松模型、Fine and Gray模型和对数二项回归模型估计了年住院率、住院死亡率或活出院时间和30天再入院风险。结果4323例患者(29%为女性，60%为非裔美国人)贡献了300007人年。总体而言，每100人年住院率为34.3(95%可信区间[CI] 32.4, 36.4)，平均每年变化-3% (95% CI -4%， -2%)。30天再入院风险为18.9% (95% CI 17.7%， 20.2%)，且随时间稳定(与1996-2002年相比，2010-2016年和2003-2009年分别P=0.21和P=0.44)。黑人(与白人相比)、年龄较大、HIV RNA >400拷贝/mL或CD4计数<200细胞/µL的患者住院率较高(均P<0.05)。较高的住院死亡率与年龄和较低的CD4相关(P<0.05)。黑人患者、检测到HIV RNA的患者和CD4细胞计数较低的患者30天再入院风险较高(均P<0.05)。结论1996 - 2016年住院率下降，但再入院率保持不变且较高。老年患者，少数种族/民族，和不受控制的艾滋病毒有更高的发病率和更差的住院结果。这些发现强调了早期诊断和治疗、护理中的联系和保留以及出院时护理参与的重要性。
{"title":"Hospitalization Rates and Outcomes among Persons Living with HIV in the Southeastern United States, 1996-2016.","authors":"Thibaut Davy-Mendez, S. Napravnik, D. Wohl, A. Durr, Oksana Zakharova, Claire E Farel, J. Eron","doi":"10.1093/cid/ciz1043","DOIUrl":"https://doi.org/10.1093/cid/ciz1043","url":null,"abstract":"BACKGROUND\u0000Advances in antiretroviral therapy, aging, and comorbidities impact hospitalization rates in HIV-infected populations. We examined temporal trends and patient characteristics associated with hospitalization rates and outcomes.\u0000\u0000\u0000METHODS\u0000Study population included patients in the University of North Carolina Center for AIDS Research HIV Clinical Cohort receiving clinical care 1996-2016. We estimated annual hospitalization rates, time to inpatient mortality or live discharge, and 30-day readmission risk using bivariable Poisson, Fine and Gray, and log-binomial regression models.\u0000\u0000\u0000RESULTS\u00004323 patients (29% women, 60% African-American) contributed 30 007 person-years. Overall, the hospitalization rate per 100 person-years was 34.3 (95% confidence interval [CI] 32.4, 36.4) with a mean change of -3% per year (95% CI -4%, -2%). Thirty-day readmission risk was 18.9% (95% CI 17.7%, 20.2%) and stable over time (P=0.21 and P=0.44 for 2010-2016 and 2003-2009, respectively, compared to 1996-2002). Patients who were Black (compared to White), older, had HIV RNA >400 copies/mL, or had CD4 count <200 cells/µL had higher hospitalization rates (all P<0.05). Higher inpatient mortality was associated with older age and lower CD4 (both P<0.05). Thirty-day readmission risk was higher among Black patients, those with detectable HIV RNA, and with lower CD4 cell counts (all P<0.05).\u0000\u0000\u0000CONCLUSIONS\u0000Hospitalization rates decreased from 1996 to 2016, but readmissions remained unchanged and high. Older patients, of minority race/ethnicity, and with uncontrolled HIV experienced higher rates and worse hospitalization outcomes. These findings underscore the importance of early diagnosis and treatment, linkage and retention in care, and care engagement at the time of hospital discharge.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85963990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Morgan, M. Zhan, Michihiko Goto, C. Franciscus, Bruce H. Alexander, M. Vaughan-Sarrazin, M. Roghmann, Lisa Pineles
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections in long-term care facilities (LTCF). The Centers for Disease Control and Prevention (CDC) recommends Contact Precautions for prevention of MRSA within acute care facilities and are being used within the United States Department of Veterans Affairs (VA) for LTCF in a modified fashion. The impact of Contact Precautions in long-term care is unknown. METHODS To evaluate if Contact Precautions decreased MRSA acquisition in LTCF compared to Standard Precautions we performed a retrospective effectiveness study (pre-post with concurrent controls) using data from the VA healthcare system from 1/1/2011 until 12/31/2015, two years before and after a 2013 policy recommending a more aggressive form of Contact Precautions. RESULTS Across 75,414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using Standard Precautions vs. Contact Precautions in multivariable discrete-time survival analysis, controlling for patient demographics, risk factors, and year of admission (Odds Ratio (OR) 0.97, 95% confidence interval (CI), 0.85-1.12, p=0.71). CONCLUSIONS MRSA acquisition and infections were not impacted by use of active surveillance and Contact Precautions in LTCF in the VA.
{"title":"The effectiveness of Contact Precautions on methicillin-resistant Staphylococcus aureus (MRSA) in long-term care across the United States.","authors":"D. Morgan, M. Zhan, Michihiko Goto, C. Franciscus, Bruce H. Alexander, M. Vaughan-Sarrazin, M. Roghmann, Lisa Pineles","doi":"10.1093/cid/ciz1045","DOIUrl":"https://doi.org/10.1093/cid/ciz1045","url":null,"abstract":"BACKGROUND\u0000Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections in long-term care facilities (LTCF). The Centers for Disease Control and Prevention (CDC) recommends Contact Precautions for prevention of MRSA within acute care facilities and are being used within the United States Department of Veterans Affairs (VA) for LTCF in a modified fashion. The impact of Contact Precautions in long-term care is unknown.\u0000\u0000\u0000METHODS\u0000To evaluate if Contact Precautions decreased MRSA acquisition in LTCF compared to Standard Precautions we performed a retrospective effectiveness study (pre-post with concurrent controls) using data from the VA healthcare system from 1/1/2011 until 12/31/2015, two years before and after a 2013 policy recommending a more aggressive form of Contact Precautions.\u0000\u0000\u0000RESULTS\u0000Across 75,414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using Standard Precautions vs. Contact Precautions in multivariable discrete-time survival analysis, controlling for patient demographics, risk factors, and year of admission (Odds Ratio (OR) 0.97, 95% confidence interval (CI), 0.85-1.12, p=0.71).\u0000\u0000\u0000CONCLUSIONS\u0000MRSA acquisition and infections were not impacted by use of active surveillance and Contact Precautions in LTCF in the VA.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85125737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Carved in Stone with Consequences: Antibiotic Allergy Labels in Transplant Patients.","authors":"E. Shenoy, A. Ramsey","doi":"10.1093/cid/ciz1028","DOIUrl":"https://doi.org/10.1093/cid/ciz1028","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75369265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND To address the growing threat of multidrug resistant organisms, policymakers are seeking ideas to promote development of novel antibiotics. In 2018, the REVAMP Act was proposed in Congress to reward manufacturers of certain novel antibiotics with transferrable market exclusivity vouchers. METHODS We estimated the economic impact of this proposal by identifying antimicrobial drugs approved by the FDA from 2007 - 2016 that would likely have qualified for an exclusivity voucher and matching each drug to the highest-revenue fast-track drug facing generic entry within 4 years after the antibiotic was approved. Assuming a spending decrease of 75% after generic entry, we calculated the per-drug and total societal costs of these transferrable market exclusivity extensions over a decade. RESULTS We identified 10 antimicrobials that would have qualified for an exclusivity voucher, each of which was matched with one of 17 fast-track drugs facing generic entry through July 2019. These 10 drugs had a median annual revenue prior to generic entry of $249 million (range: $26 million - $2.7 billion). Accounting for a 75% spending reduction after generic entry, the median excess spending associated with 12 months of extended exclusivity was $187 million, for a total of $4.5 billion over 10 years. CONCLUSIONS While market exclusivity extensions are a politically appealing mechanism to encourage novel antibiotic development, this approach would cost public and private payers billions of dollars over the next decade.
{"title":"Transferrable Market Exclusivity Extensions to Promote Antibiotic Development: An Economic Analysis.","authors":"B. Rome, A. Kesselheim","doi":"10.1093/cid/ciz1039","DOIUrl":"https://doi.org/10.1093/cid/ciz1039","url":null,"abstract":"BACKGROUND\u0000To address the growing threat of multidrug resistant organisms, policymakers are seeking ideas to promote development of novel antibiotics. In 2018, the REVAMP Act was proposed in Congress to reward manufacturers of certain novel antibiotics with transferrable market exclusivity vouchers.\u0000\u0000\u0000METHODS\u0000We estimated the economic impact of this proposal by identifying antimicrobial drugs approved by the FDA from 2007 - 2016 that would likely have qualified for an exclusivity voucher and matching each drug to the highest-revenue fast-track drug facing generic entry within 4 years after the antibiotic was approved. Assuming a spending decrease of 75% after generic entry, we calculated the per-drug and total societal costs of these transferrable market exclusivity extensions over a decade.\u0000\u0000\u0000RESULTS\u0000We identified 10 antimicrobials that would have qualified for an exclusivity voucher, each of which was matched with one of 17 fast-track drugs facing generic entry through July 2019. These 10 drugs had a median annual revenue prior to generic entry of $249 million (range: $26 million - $2.7 billion). Accounting for a 75% spending reduction after generic entry, the median excess spending associated with 12 months of extended exclusivity was $187 million, for a total of $4.5 billion over 10 years.\u0000\u0000\u0000CONCLUSIONS\u0000While market exclusivity extensions are a politically appealing mechanism to encourage novel antibiotic development, this approach would cost public and private payers billions of dollars over the next decade.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90828763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wesley S Rogers, L. Westblade, R. Soave, S. Jenkins, K. van Besien, H. Singh, T. Walsh, C. Small, T. Shore, C. Crawford, M. Satlin
BACKGROUND Diarrhea is common and associated with substantial morbidity among hematopoietic cell transplant (HCT) recipients, but the etiology is often not identified. Multiplexed PCR assays increase the detection of diarrheal pathogens, but the impact of this technology in this population has not been evaluated. METHODS Our center replaced stool cultures and other conventional microbiological methods with the FilmArray® Gastrointestinal Panel (GI PCR) in June 2016. We reviewed all adult patients who received a HCT from June 2014-May 2015 (pre-GI PCR, n=163) and from June 2016-May 2017 (post-GI PCR, n=182) and followed them for one year after transplantation. Clostridioides difficile infection was diagnosed by an independent PCR test in both cohorts. RESULTS The proportion of patients with ≥1 identified infectious diarrheal pathogen increased from 25% to 37% after implementation of GI PCR (p=0.01). Eight patients (5%) in the pre-GI PCR cohort tested positive for a pathogen other than C. difficile, vs. 49 patients (27%) in the post-GI PCR cohort (p<0.001). The most common non-C. difficile diarrheal pathogens in the post-GI PCR cohort were enteropathogenic Escherichia coli (n=14, 8%), norovirus (n=14, 8%), and Yersinia enterocolitica (n=7, 4%). The percentage of diarrheal episodes with an identified infectious etiology increased from 14% to 23% (p=0.001). Median total costs of stool testing per patient did not increase (pre: $473; post: $425; p=0.25). CONCLUSIONS Infectious etiologies of diarrhea were identified in a higher proportion of HCT recipients after replacing conventional stool testing with a multiplexed PCR assay, without an increase in testing costs.
{"title":"Impact of a Multiplexed PCR Panel on Identifying Diarrheal Pathogens in Hematopoietic Cell Transplant Recipients.","authors":"Wesley S Rogers, L. Westblade, R. Soave, S. Jenkins, K. van Besien, H. Singh, T. Walsh, C. Small, T. Shore, C. Crawford, M. Satlin","doi":"10.1093/cid/ciz1068","DOIUrl":"https://doi.org/10.1093/cid/ciz1068","url":null,"abstract":"BACKGROUND\u0000Diarrhea is common and associated with substantial morbidity among hematopoietic cell transplant (HCT) recipients, but the etiology is often not identified. Multiplexed PCR assays increase the detection of diarrheal pathogens, but the impact of this technology in this population has not been evaluated.\u0000\u0000\u0000METHODS\u0000Our center replaced stool cultures and other conventional microbiological methods with the FilmArray® Gastrointestinal Panel (GI PCR) in June 2016. We reviewed all adult patients who received a HCT from June 2014-May 2015 (pre-GI PCR, n=163) and from June 2016-May 2017 (post-GI PCR, n=182) and followed them for one year after transplantation. Clostridioides difficile infection was diagnosed by an independent PCR test in both cohorts.\u0000\u0000\u0000RESULTS\u0000The proportion of patients with ≥1 identified infectious diarrheal pathogen increased from 25% to 37% after implementation of GI PCR (p=0.01). Eight patients (5%) in the pre-GI PCR cohort tested positive for a pathogen other than C. difficile, vs. 49 patients (27%) in the post-GI PCR cohort (p<0.001). The most common non-C. difficile diarrheal pathogens in the post-GI PCR cohort were enteropathogenic Escherichia coli (n=14, 8%), norovirus (n=14, 8%), and Yersinia enterocolitica (n=7, 4%). The percentage of diarrheal episodes with an identified infectious etiology increased from 14% to 23% (p=0.001). Median total costs of stool testing per patient did not increase (pre: $473; post: $425; p=0.25).\u0000\u0000\u0000CONCLUSIONS\u0000Infectious etiologies of diarrhea were identified in a higher proportion of HCT recipients after replacing conventional stool testing with a multiplexed PCR assay, without an increase in testing costs.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74464591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antimicrobial stewardship and implementation of rapid multiplex respiratory diagnostics: Is there method in the madness?","authors":"T. Timbrook","doi":"10.1093/cid/ciz1046","DOIUrl":"https://doi.org/10.1093/cid/ciz1046","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74798438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Declining Hospitalizations among Persons With HIV; Time to Leave no One Behind.","authors":"J. Colasanti, C. del Rio","doi":"10.1093/cid/ciz1047","DOIUrl":"https://doi.org/10.1093/cid/ciz1047","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84696818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Candidemia in the Growing Opioid Epidemic: A Distinct and Emerging Entity.","authors":"D. Andes","doi":"10.1093/cid/ciz1065","DOIUrl":"https://doi.org/10.1093/cid/ciz1065","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"27 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82837744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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