Harper University Hospital

Introduction: Stenotrophomonas maltophilia has a high mortality risk, with rates estimated to be between 23-77%. Trimethoprim/sulfamethoxazole (TMP/SMX) or minocycline (MIN) are the mainstay treatment of S. maltophilia. However, there is a lack of comparative clinical data comparing the two antibiotics. The objective of this study was to assess clinical outcomes between patients treated with TMP/SMX or MIN for pneumonia due to S. maltophilia. Methods: This was a retrospective cohort study of patients admitted to an ICU at the Detroit Medical Center from August 20th, 2019 to February 19th, 2024. Adult patients with clinical signs of pneumonia; a culture growing S. maltophilia; and who received TMP/SMX or MIN ≥ 48 hours were included. Patients were excluded if they received combination therapy; had a non-susceptible S. maltophilia isolate; or died or were transferred to hospice within 48 hours of treatment. The primary outcome was 28-day all-cause mortality. Secondary outcomes included 28-day ventilator free days, ICU length of stay, in-hospital mortality, clinical response at EOT, and rates of adverse effects including hyperkalemia and hepatotoxicity. Results: A total of 71 patients were included (TMP/SMX, n=37; MIN, n=34). A majority of patients were male (62%) and African American (66%). Baseline characteristics were similar, though more patients in the MIN group had recent surgery (26.4% vs. 8.1%, p=0.01) and a higher Charlson Comorbidity Index (4.3 vs. 3.1, p=0.03); more patients in the TMP/SMX group had COPD (14.7% vs. 32.4%, p=0.04). Baseline SOFA scores (MIN=4.9 vs. TMP/SMX=5.7, p=0.15) were similar between the two groups. A majority of cultures were polymicrobial (82.5%). The primary outcome of 28-day all-cause mortality occurred in 29% of MIN patients and 32% of TMP/SMX patients (p=0.39). Mean 28-day ventilator free days (10.5 vs. 10.1, p=0.46), ICU length of stay (24 vs. 20, p=0.39), in-hospital mortality (41% vs. 40%, p=0.47), and clinical response at EOT (55% vs. 56%, p=0.47) were similar for TMP/SMX and MIN, respectively. Rates of adverse effects were similar between groups. Conclusions: TMP/SMX had similar rates of mortality and clinical outcomes when compared to MIN for the treatment of S. maltophilia. Future prospective trials should be conducted to confirm the results of this study.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of procedure-related, skin, and soft-tissue infections. Hospitalized patients who are colonized with MRSA are at a higher risk of developing invasive infections after discharge. Chlorhexidine, an antiseptic/disinfectant, has been used to reduce carriage and prevent infections in these patients. Studies have shown chlorhexidine resistance among MRSA strains. Chlorhexidine resistance is associated with qac genes, which encode multidrug efflux pumps that increase bacterial tolerance to disinfectant agents. The global distribution and prevalence of qacA and qacB genes are highly variable. One study reported that qacA and qacB genes could be found in 0.9% - 83.3% of clinical MRSA isolates worldwide. The goal of this study was to determine the prevalence of chlorhexidine resistance and identify the resistance-associated genes from our MRSA samples using whole genome sequencing (WGS). Methods: 474 MRSA samples were obtained from hospitals in Detroit, MI (287) and Cleveland, OH (187). Whole genome sequencing was performed using the NextSeq (Illumina Inc., CA) platform. The sequencing data was analyzed using ResFinder 4.1, a publicly available database that can be used to identify acquired genes and chromosomal mutations mediating antimicrobial resistance. The output was organized into a data sheet to visualize the presence of the genes of interest. Results: The qacA gene was present in only one MRSA sample from the Cleveland area hospital. In the samples from Detroit, 14 out of 287 showed disinfectant resistance genes. The qacA, qacB, and qacD were present in 1, 6, and 7 samples, respectively. The prevalence of any qac gene in the Cleveland area samples was 0.5%. Meanwhile, the prevalence of any qac gene in Detroit area samples was 4.9%. Among the 7 samples that have qacD gene, 6 samples have more than one copy of qacD. Conclusions: The prevalence of the “qac” gene varied widely based on the origin of the samples. Detroit area samples had more qac genes prevalence than Cleveland area samples. Chlorhexidine is a widely used antiseptic/disinfectant, and it plays a vital role in reducing carriage and preventing infection among hospitalized patients colonized with MRSA. Monitoring and addressing MRSA-reduced susceptibility to chlorhexidine is imperative for maintaining the effectiveness of infection control practices such as decolonization.

Journal Article Accepted manuscript "The nodes always know"! Get access Frank A Baciewicz, Jr Frank A Baciewicz, Jr Chief, Department of Cardiothoracic Surgery, Professor of Cardiothoracic Surgery, Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Harper Hospital, 3990 John R, Detroit, MI, 48201 (313) 549-5906 fbaciewi@dmc.org Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezae102, https://doi.org/10.1093/ejcts/ezae102 Published: 15 March 2024 Article history Received: 07 March 2024 Accepted: 13 March 2024 Published: 15 March 2024

BackgroundIn-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI.MethodsBaseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient.ResultsIn-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 ​years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P ​< ​.001), and the model demonstrated good discriminative power (c-statistic ​= ​0.81) and calibration (Hosmer-Lemeshow, P ​= ​.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high–risk score categories, respectively).ConclusionsThe risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

BackgroundThis study profiles ceramides extracted from visceral and subcutaneous adipose tissue of human subjects by liquid chromatography‐mass spectrometry to determine a correlation with status of diabetes and gender.MethodsSamples of visceral and abdominal wall subcutaneous adipose tissue (n = 36 and n = 31, respectively) were taken during laparoscopic surgery from 36 patients (14 nondiabetic, 22 diabetic and prediabetic) undergoing bariatric surgery with a body mass index (BMI) >35 kg/m2 with ≥1 existing comorbidity or BMI ≥40 kg/m2. Sphingolipids were extracted and analyzed using liquid chromatography‐mass spectrometry.ResultsAfter logarithm 2 conversion, paired analysis of visceral to subcutaneous tissue showed differential accumulation of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in visceral tissue of prediabetic/diabetic female subjects, but not in males. Within‐tissue analysis showed higher mean levels of ceramide species linked to insulin resistance, such as Cer(d18:1/18:0) and Cer(d18:1/16:0), in visceral tissue of prediabetic/diabetic patients compared with nondiabetic subjects and higher content of Cer(d18:1/14:0) in subcutaneous tissue of insulin‐resistant female patients compared with prediabetic/diabetic males. Statistically significant differences in mean levels of ceramide species between insulin‐resistant African American and insulin‐resistant Caucasian patients were not evident in visceral or subcutaneous tissue.ConclusionsAnalysis of ceramides is important for developing a better understanding of biological processes underlying type 2 diabetes, metabolic syndrome, and obesity. Knowledge of the accumulated ceramides/dihydroceramides may reflect on the prelipolytic state that leads the lipotoxic phase of insulin resistance and may shed light on the predisposition to insulin resistance by gender.