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The Utility of Scoring Systems in Determining the Need for Echocardiography in Patients with Staphylococcus aureus Bacteremia

Zervou, Fainareti N; Zacharioudakis, Ioannis M
PMID: 33972992
ISSN: 1537-6591
CID: 4867272

Leveraging Rapid Diagnostics and Electronic Health Records to Decrease Antimicrobial Utilization: a Step in the Right Direction

Zacharioudakis, Ioannis M; Zervou, Fainareti N; Decano, Arnold; Ahmed, Nabeela
PMID: 33319227
ISSN: 1537-6591
CID: 4717742

SARS-CoV-2 antibody responses in solid organ transplant recipients

Zervou, Fainareti N; Ali, Nicole M; Neumann, Henry J; Madan, Rebecca Pellett; Mehta, Sapna A
Antibody responses among immunocompromised solid organ transplant recipients (SOT) infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) may be diminished compared to the general population and have not been fully characterized. We conducted a cohort study at our transplant center to investigate the rate of seroconversion for SARS-CoV-2 IgG antibodies among SOT recipients who were diagnosed with Coronavirus disease 2019 (COVID-19) and underwent serum SARS-CoV-2 IgG enzyme-linked immunosorbent assay (ELISA) testing. The 61 patients who were included in the final analysis underwent initial SARS-CoV-2 IgG testing at a median of 62 days (Interquartile range 55.0-75.0) from symptom onset. Note that, 51 of 61 patients (83.6%) had positive SARS-CoV-2 IgG results, whereas 10 (16.4%) had negative IgG results. Six (60%) out of 10 seronegative patients underwent serial IgG testing and remained seronegative up to 17 weeks post-diagnosis. Use of belatacept in maintenance immunosuppression was significantly associated with negative IgG antibodies to SARS-CoV-2 both in univariate and multivariate analyses (Odds ratio 0.04, p = .01). In conclusion, the majority of organ transplant recipients with COVID-19 in our study developed SARS-CoV-2 antibodies. Further longitudinal studies of the durability and immunologic role of these IgG responses and the factors associated with lack of seroconversion are needed.
PMID: 34505324
ISSN: 1399-3062
CID: 5012082

SARS-CoV-2 antibodies: IgA correlates with severity of disease in early COVID-19 infection

Zervou, Fainareti N; Louie, Ping; Stachel, Anna; Zacharioudakis, Ioannis M; Ortiz-Mendez, Yadira; Thomas, Kristen; Aguero-Rosenfeld, Maria E
Timing of detection of immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and their use to support the diagnosis are of increasing interest. We used the Gold Standard Diagnostics ELISA to evaluate the kinetics of SARS-CoV-2 IgG, IgA, and IgM antibodies in sera of 82 hospitalized patients with polymerase chain reaction (PCR)-confirmed coronavirus disease 2019 (COVID-19). Serum samples were collected 1-59 days post-onset of symptoms (PoS) and we examined the association of age, sex, disease severity, and symptoms' duration with antibody levels. We also tested sera of 100 ambulatory hospital employees with PCR-confirmed COVID-19 and samples collected during convalescence, 35-57 days PoS. All but four of the admitted patients (95.1%) developed antibodies to SARS-CoV-2. Antibodies were detected within 7 days PoS; IgA in 60.0%, IgM in 53.3%, and IgG in 46.7% of samples. IgG positivity increased to 100% on Day 21. We did not observe significant differences in the rate of antibody development in regard to age and sex. IgA levels were highest in patients with a severe and critical illness. In multiple regression analyses, only IgA levels were statistically significantly correlated with critical disease (p = .05) regardless of age, sex, and duration of symptoms. Among 100 ambulatory hospital employees who had antibody testing after 4 weeks PoS only 10% had positive IgA antibodies. The most frequently isolated isotype in sera of employees after 30 days PoS was IgG (88%). IgA was the predominant immunoglobulin in early disease and correlated independently with a critical illness. IgG antibodies remained detectable in almost 90% of samples collected up to two months after infection.
PMID: 33932299
ISSN: 1096-9071
CID: 4865782

Association of SARS-CoV-2 Genomic Load with COVID-19 Patient Outcomes

Zacharioudakis, Ioannis M; Prasad, Prithiv J; Zervou, Fainareti N; Basu, Atreyee; Inglima, Kenneth; Weisenberg, Scott A; Aguero-Rosenfeld, Maria E
PMID: 33119425
ISSN: 2325-6621
CID: 4646792

Recognizing Cutibacterium acnes as a cause of infectious pericarditis: A case report and review of literature [Case Report]

Li-Geng, Tony; Geraci, Travis C; Narula, Navneet; Zervou, Fainareti N; Prasad, Prithiv J; Decano, Arnold G; Sterling, Stephanie; Zacharioudakis, Ioannis M
Cutibacterium acnes is an anaerobic bacterium commonly thought of as a culture contaminant rather than a pathogen. We present a case of Cutibacterium acnes pericarditis in a 22-year-old immunocompetent woman managed with surgical pericardial window and a 4-week course of penicillin G and review related literature on Cutibacterium acnes pericarditis.
PMID: 33771686
ISSN: 1095-8274
CID: 4830272

Rate and consequences of missed Clostridioides (Clostridium) difficile infection diagnosis from nonreporting of Clostridioides difficile results of the multiplex GI PCR panel: experience from two-hospitals

Zacharioudakis, Ioannis M; Zervou, Fainareti N; Phillips, Michael S; Aguero-Rosenfeld, Maria E
INTRODUCTION/BACKGROUND:It is common among microbiology laboratories to blind the Clostridioides difficile (C. difficile) BioFire FilmArray GI Panel result in fear of overdiagnosis. METHODS:We examined the rate of missed community-onset C. difficile infection (CDI) diagnosis and associated outcomes. Adult patients with FilmArray GI Panel positive for C. difficile on hospital admission who lacked dedicated C. difficile testing were included. RESULTS:Among 144 adults with a FilmArray Panel positive for C. difficile, 18 did not have concurrent dedicated C. difficile testing. Eight patients were categorized as possible, 5 as probable and 4 as definite cases of missed CDI diagnosis. We observed associated delays in initiation of appropriate therapy, intensive care unit admissions, hospital readmissions, colorectal surgery and death/discharge to hospice. Five out of 17 lacked risk factors for CDI. CONCLUSION/CONCLUSIONS:The practice of concealing C. difficile FilmArray GI Panel results needs to be reconsidered in patients presenting with community-onset colitis.
PMID: 33647544
ISSN: 1879-0070
CID: 4801232

Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes

Zacharioudakis, Ioannis M; Zervou, Fainareti N
PMID: 32300798
ISSN: 1537-6591
CID: 4506672

Evaluation of a Multiplex PCR Panel for the Microbiologic Diagnosis of Pneumonia in Hospitalized Patients: Experience from an Academic Medical Center

Zacharioudakis, Ioannis M; Zervou, Fainareti N; Yanina, Dubrovskaya; Inglima, Kenneth; See, Benjamin; Aguero-Rosenfeld, Maria
OBJECTIVES/OBJECTIVE:We evaluated the value of BioFire® FilmArray® pneumonia panel in establishing a microbiologic diagnosis of pneumonia. We evaluated opportunities for antimicrobial optimization from its use. METHODS:We included adult patients with pneumonia between May 2019-January 2020. The pneumonia panel was performed on high-quality sputum specimens and the results were prospectively compared with sputum cultures and other tests performed per standard of care. RESULTS:Seventy patients were included, sixty-nine of whom completed a 5-day antimicrobial course for pneumonia and 14.3% died during hospitalization. There was a trend of higher rate of microbiologic diagnosis among the patients with culture submitted before antimicrobial administration (9/15 vs. 20/55; p = 0.09). The panel increased the microbiologic diagnosis from 29/70 to 59/70 (p < 0.001) patients. The per isolate analysis revealed an increase in the isolation of Haemophilus influenzae (p = 0.002) and Streptococcus pneumoniae (p = 0.05). On review of empiric antimicrobials, there was potential for antimicrobial optimization in 56/70 patients, including 9 bacteria among 9 patients, not covered by empiric treatment and another 70 antimicrobials in 49 patients that could have been stopped. CONCLUSIONS:Incorporation of the pneumonia panel in the diagnostic work-up of pneumonia substantially increased the rate of microbiologic diagnosis and revealed abundant opportunities for antimicrobial optimization.
PMID: 33434669
ISSN: 1878-3511
CID: 4746732

Is Early Clearance of Blood Cultures the Be-All and End-All Outcome? [Letter]

Zacharioudakis, I M; Zervou, F N
ISSN: 1058-4838
CID: 4977972