Coronavirus disease 2019 vaccine skin testing and graded challenges in vaccine-hesitant patients
Challenging the Dogma of Beta-Lactam Allergies: Impact of an Antimicrobial Stewardship Program [Meeting Abstract]
Background. Penicillin allergies are reported in approximately 10% of patients in the US but ~90% of these allergies can be de-labeled. Consequences of inappropriate allergy labeling leads to use of alternative agents associated with increased adverse events and resistance rates, leading to worse outcomes. Though all betalactam agents share the core beta-lactam ring, the R1 side chain has been identified as the focus of cross-reactivity. Agents that do not share the same or similar R1 side chain are likely to have negligible risk of hypersensitivity reactions. The purpose of this study was to assess the incidence of hypersensitivity reactions in patients with a documented beta-lactam allergy that received a beta-lactam agent with a different side chain based on recommendation by an antimicrobial stewardship clinical pharmacist. Methods. This was a retrospective, single-center, observational study of patients admitted to NYU Langone Hospital - Long Island from October 2019 to February 2022. Data was collected by review of the electronic medical record and descriptive statistics were generated as appropriate. The primary outcome was the proportion of patients that experienced a hypersensitivity reaction to a beta-lactam agent with a different side chain. Secondary outcomes included impact of antimicrobial stewardship intervention by clinical pharmacists, avoidance of alternative antibiotics, and cost comparison between agents requested and recommended. Results. A total of 181 patients were included in the final analysis, including 37 patients with a history of anaphylaxis. No patients with a documented beta-lactam allergy experienced a hypersensitivity reaction upon receiving a beta-lactam agent with a different side chain. Within the cost comparison, meropenem accounted for 45.6% and 75.9% of the total minimum and maximum wholesale costs of requested agents, respectively. Conclusion. The results of this study suggest that receipt of a beta-lactam agent with a different side chain is safe in patients with a history of beta-lactam allergy, including anaphylaxis history, and supports 'in the moment' antimicrobial stewardship intervention to ensure patients receive optimal therapy when access to in-depth allergy history or detailed patient interview is not feasible
Comparative results of focal-cryoablation and stereotactic body radiotherapy in the treatment of unilateral, low-to-intermediate-risk prostate cancer
OBJECTIVE:The purpose of this study is to compare oncologic and functional outcomes of men with unilateral, localized PCa treated with stereotactic body radiotherapy (SBRT) versus focal cryoablation (FC). METHODS:Patients from our IRB-approved PCa database who underwent FC or SBRT and were eligible for both treatments were included. Patients with less than 1Â year of follow-up or prior PCa treatment were excluded. The primary outcome was treatment failure, defined as salvage treatment or a Gleason group (GG) ofâ€‰â‰¥â€‰2 on post-treatment biopsy. Biochemical recurrence (BCR) was evaluated with Phoenix. Functional outcomes were based on EPIC surveys. Complications were categorized with the CTCAE 5.0. Outcomes were compared using descriptive statistics, univariate analyses, and Kaplan-Meier curve for failure-free survival (FFS) and BCR-free survival. Pâ€‰<â€‰0.05 was significant. RESULTS:68 FC and 51 SBRT patients with a median age of 68Â years (48-86) and a median follow-up time of 84 (70-101) months were included in this analysis. There was no difference in tumor risk (pâ€‰=â€‰0.47), GG (pâ€‰=â€‰0.20), or PSA (pâ€‰=â€‰0.70) among the two cohorts at baseline. At 7-year follow-up, no difference in FFS was found between the two cohorts (pâ€‰=â€‰0.70); however, significantly more FC patients had BCR (pâ€‰<â€‰0.001). At 48Â months, no differences existed in urinary or bowel function; however, SBRT patients had significantly worse sexual function (pâ€‰=â€‰0.032). CONCLUSION/CONCLUSIONS:FC and SBRT are associated with similar oncologic and functional outcomes 7-year post-treatment. These results underscore the utility of FC and SBRT for the management of unilateral low-to-intermediate-risk PCa.
Outcomes of Breast Cancer Patients Treated with Chemotherapy, Biologic Therapy, Endocrine Therapy, or Active Surveillance During the COVID-19 Pandemic
PURPOSE:Provide real-world data regarding the risk for SARS-CoV-2 infection and mortality in breast cancer (BC) patients on active cancer treatment. METHODS:Clinical data were abstracted from the 3778 BC patients seen at a multisite cancer center in New York between February 1, 2020 and May 1, 2020, including patient demographics, tumor histology, cancer treatment, and SARS-CoV-2 testing results. Incidence of SARS-CoV-2 infection by treatment type (chemotherapy [CT] vs endocrine and/or HER2 directed therapy [E/H]) was compared by Inverse Probability of Treatment Weighting. In those diagnosed with SARS-CoV-2 infection, Mann-Whitney test was used to a assess risk factors for severe disease and mortality. RESULTS:Three thousand sixty-two patients met study inclusion criteria with 641 patients tested for SARS-COV-2 by RT-PCR or serology. Overall, 64 patients (2.1%) were diagnosed with SARS-CoV-2 infection by either serology, RT-PCR, or documented clinical diagnosis. Comparing matched patients who received chemotherapy (n = 379) with those who received non-cytotoxic therapies (n = 2343) the incidence of SARS-CoV-2 did not differ between treatment groups (weighted risk; 3.5% CT vs 2.7% E/H, P = .523). Twenty-seven patients (0.9%) expired over follow-up, with 10 deaths attributed to SARS-CoV-2 infection. Chemotherapy was not associated with increased risk for death following SARS-CoV-2 infection (weighted risk; 0.7% CT vs 0.1% E/H, P = .246). Advanced disease (stage IV), age, BMI, and Charlson's Comorbidity Index score were associated with increased mortality following SARS-CoV-2 infection (P â‰¤ .05). CONCLUSION:BC treatment, including chemotherapy, can be safely administered in the context of enhanced infectious precautions, and should not be withheld particularly when given for curative intent.
LESS IS MORE ... A STUDY ON OXYGEN SUPPLEMENTATION MODALITIES IN PEDIATRIC STATUS ASTHMATICUS [Meeting Abstract]