Archive for July 15, 2016

Suspected Female-to-Male Sexual Transmission of Zika Virus — New York City, 2016

MMWR Morb Mortal Wkly Rep. Published online July 15, 2016

Alexander Davidson, MPH1; Sally Slavinski, DVM1; Kendra Komoto1; Jennifer Rakeman, PhD1; Don Weiss, MD1

1New York City Department of Health and Mental Hygiene, New York.

A routine investigation by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) identified a nonpregnant woman in her twenties who reported she had engaged in a single event of condomless vaginal intercourse with a male partner the day she returned to NYC (day 0) from travel to an area with ongoing Zika virus transmission. She had headache and abdominal cramping while in the airport awaiting return to NYC. The following day (day 1) she developed fever, fatigue, a maculopapular rash, myalgia, arthralgia, back pain, swelling of the extremities, and numbness and tingling in her hands and feet. In addition, on day 1, the woman began menses that she described as heavier than usual. On day 3 she visited her primary care provider who obtained blood and urine specimens. Zika virus RNA was detected in both serum and urine by real-time reverse transcription–polymerase chain reaction (rRT-PCR) performed at the DOHMH Public Health Laboratory using a test based on an assay developed at CDC (1). The results of serum testing for anti-Zika virus immunoglobulin M (IgM) antibody performed by the New York State Department of Health Wadsworth Center laboratory was negative using the CDC Zika IgM antibody capture enzyme-linked immunosorbent assay (Zika MAC-ELISA) (2).



July 15, 2016 at 3:17 pm

Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis.

J Am Heart Assoc. 2016 Apr 18;5(4).

Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, Tattevin P, Habib G, Tan R, Gonzalez J, Altclas J, Edathodu J, Fortes CQ, Siciliano RF, Pachirat O, Kanj S, Wang A; International Collaboration on Endocarditis (ICE) Investigators.

Collaborators (306)

Clara L, Sanchez M, Casabé J, Cortes C, Nacinovich F, Fernandez Oses P, Ronderos R, Sucari A, Thierer J, Kogan S, Spelman D, Athan E, Harris O, Kennedy K, Gordon D, Papanicolas L, Korman T, Kotsanas D, Dever R, Jones P, Konecny P, Lawrence R, Rees D, Ryan S, Feneley MP, Harkness J, Jones P, Ryan S, Jones P, Ryan S, Jones P, Post J, Reinbott P, Ryan S, Gattringer R, Wiesbauer F, Andrade AR, de Brito AC, Guimarães AC, Grinberg M, Mansur AJ, Strabelli TM, Vieira ML, de Medeiros Tranchesi RA, Paiva MG, de Oliveira Ramos A, Weksler C, Ferraiuoli G, Golebiovski W, Lamas C, Karlowsky JA, Keynan Y, Morris AM, Rubinstein E, Jones SB, Garcia P, Fica A, Mella RM, Fernandez R, Franco L, Jaramillo AN, Barsic B, Bukovski S, Krajinovic V, Pangercic A, Rudez I, Vincelj J, Freiberger T, Pol J, Zaloudikova B, Ashour Z, El Kholy A, Mishaal M, Osama D, Rizk H, Aissa N, Alauzet C, Alla F, Campagnac C, Doco-Lecompte T, Selton-Suty C, Casalta JP, Fournier PE, Raoult D, Thuny F, Delahaye F, Delahaye A, Vandenesch F, Donal E, Donnio PY, Flecher E, Michelet C, Revest M, Chevalier F, Jeu A, Rémadi JP, Rusinaru D, Tribouilloy C, Bernard Y, Chirouze C, Hoen B, Leroy J, Plesiat P, Naber C, Neuerburg C, Mazaheri B, Naber C, Neuerburg C, Athanasia S, Deliolanis I, Giamarellou H, Thomas T, Giannitsioti E, Mylona E, Paniara O, Papanicolaou K, Pyros J, Mylona E, Paniara O, Papanikolaou K, Pyros J, Sharma G, Francis J, Nair L, Thomas V, Venugopal K, Hannan MM, Hurley JP, Cahan A, Gilon D, Israel S, Korem M, Strahilevitz J, Rubinstein E, Strahilevitz J, Durante-Mangoni E, Mattucci I, Pinto D, Agrusta F, Senese A, Ragone E, Utili R, Cecchi E, De Rosa F, Forno D, Imazio M, Trinchero R, Grossi P, Lattanzio M, Toniolo A, Goglio A, Raglio A, Ravasio V, Rizzi M, Suter F, Carosi G, Magri S, Signorini L, Kanafani Z, Kanj SS, Sharif-Yakan A, Abidin I, Tamin SS, Martínez ER, Soto Nieto GI, van der Meer JT, Chambers S, Holland D, Morris A, Raymond N, Read K, Murdoch DR, Dragulescu S, Ionac A, Mornos C, Butkevich OM, Chipigina N, Kirill O, Vadim K, Vinogradova T, Halim M, Liew YY, Tan RS, Logar M, Mueller-Premru M, Commerford P, Commerford A, Deetlefs E, Hansa C, Ntsekhe M, Almela M, Armero Y, Azqueta M, Castañeda X, Cervera C, Falces C, Garcia-de-la-Maria C, Fita G, Gatell JM, Heras M, Llopis J, Marco F, Mestres CA, Miró JM, Moreno A, Ninot S, Paré C, Pericas JM, Ramirez J, Rovira I, Sitges M, Anguera I, Font B, Guma JR, Bermejo J, Garcia Fernández MA, Gonzalez-Ramallo V, Marín M, Muñoz P, Pedromingo M, Roda J, Rodríguez-Créixems M, Solis J, Almirante B, Fernandez-Hidalgo N, Tornos P, de Alarcón A, Parra R, Alestig E, Johansson M, Olaison L, Snygg-Martin U, Pachirat P, Pussadhamma B, Senthong V, Casey A, Elliott T, Lambert P, Watkin R, Eyton C, Klein JL, Bradley S, Kauffman C, Bedimo R, Corey GR, Crowley AL, Douglas P, Drew L, Fowler VG, Holland T, Lalani T, Mudrick D, Samad Z, Sexton D, Stryjewski M, Woods CW, Lerakis S, Cantey R, Steed L, Wray D, Dickerman SA, Bonilla H, DiPersio J, Salstrom SJ, Baddley J, Patel M, Stancoven A, Levine D, Riddle J, Rybak M, Cabell CH, Baloch K, Corey GR, Dixon CC, Fowler VG Jr, Harding T, Jones-Richmond M, Sanderford B, Sanderford B, Stafford J, Stafford J, Anstrom K, Athan E, Bayer AS, Cabell CH, Corey GR, Fowler VG Jr, Hoen B, Karchmer AW, Miró JM, Murdoch DR, Sexton DJ, Bayer AS, Cabell CH, Chu V, Corey GR, Durack DT, Eykyn S, Fowler VG Jr, Hoen B, Miró JM, Moreillon P, Olaison L, Raoult D, Rubinstein E, Sexton DJ.



Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE.


Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell’s C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell’s C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables.


Six-month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.


July 15, 2016 at 9:13 am

Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality.

Clin Infect Dis. 2015 Sep 15;61 Suppl 2:S87-93.

Lacy MK1, Stryjewski ME2, Wang W1, Hardin TC1, Nogid B1, Luke DR1, Shorr AF3, Corey GR4, Barriere SL1.

Author information

1Theravance Biopharma US, South San Francisco, California.

2Department of Medicine, Section of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Ciudad Autónoma de Buenos Aires, Argentina.

3Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington D.C.

4Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.



When hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP) is caused by gram-positive and gram-negative pathogens or both (mixed infections), the adequacy of gram-negative coverage (GNC) can confound the assessment of a gram-positive agent under study. This analysis examines the influence of gram-negative infections and the adequacy of GNC on clinical efficacy and all-cause mortality in the telavancin HABP/VABP phase 3 ATTAIN trials (Assessment of Telavancin for Treatment of Hospital-Acquired Pneumonia).


This post hoc analysis evaluated 3 patient groups from ATTAIN: (1) gram-positive-only infections, (2) gram-positive-only and mixed infections-adequate GNC, and (3) gram-negative-only infections and mixed infections with inadequate GNC. For each, clinical efficacy at test of cure and all-cause mortality at day 28 were compared for telavancin and vancomycin.


In the ATTAIN safety population there were 16 more deaths in the telavancin arms than in the vancomycin arms. Of these, 13 were in patients with gram-negative-only infections (n = 9) or with mixed infections and inadequate GNC (n = 4) and all had estimated baseline creatinine clearances of <30ml/min. Based on this analysis, clinical response and all-cause mortality could be confounded because there were more patients with gram-negative pathogens at baseline and more patients received inadequate treatment of these gram-negative infections in the telavancin groups.


July 15, 2016 at 9:12 am

Telavancin for Acute Bacterial Skin and Skin Structure Infections, a Post Hoc Analysis of the Phase 3 ATLAS Trials in Light of the 2013 FDA Guidance.

Antimicrob Agents Chemother. 2015 Oct;59(10):6170-4.

Pushkin R1, Barriere SL1, Wang W2, Corey GR3, Stryjewski ME4.

Author information

1Theravance Biopharma US, Inc., South San Francisco, California, USA.

2Theravance Biopharma US, Inc., South San Francisco, California, USA

3Duke Clinical Research Institute and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.

4Department of Medicine, Section of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.


Two phase 3 ATLAS trials demonstrated noninferiority of telavancin compared with vancomycin for complicated skin and skin structure infections. Data from these trials were retrospectively evaluated according to 2013 U.S. Food and Drug Administration (FDA) guidance on acute bacterial skin and skin structure infections. This post hoc analysis included patients with lesion sizes of ≥75 cm(2) and excluded patients with ulcers or burns (updated all-treated population; n = 1,127). Updated day 3 (early) clinical response was defined as a ≥20% reduction in lesion size from baseline and no rescue antibiotic. Updated test-of-cure (TOC) clinical response was defined as a ≥90% reduction in lesion size, no increase in lesion size since day 3, and no requirement for additional antibiotics or significant surgical procedures. Day 3 (early) clinical responses were achieved in 62.6% and 61.0% of patients receiving telavancin and vancomycin, respectively (difference, 1.7%, with a 95% confidence interval [CI] of -4.0% to 7.4%). Updated TOC visit cure rates were similar for telavancin (68.0%) and vancomycin (63.3%), with a difference of 4.8% (95% CI, -0.7% to 10.3%). Adopting current FDA guidance, this analysis corroborates previous noninferiority findings of the ATLAS trials of telavancin compared with vancomycin.


July 15, 2016 at 9:10 am

Potential role for telavancin in bacteremic infections due to gram-positive pathogens: focus on Staphylococcus aureus.

Clin Infect Dis. 2015 Mar 1;60(5):787-96.

Corey GR1, Rubinstein E2, Stryjewski ME3, Bassetti M4, Barriere SL5.

Author information

1Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.

2Section of Infectious Diseases, Department of Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada.

3Department of Medicine, Section of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas ‘Norberto Quirno’ (CEMIC), Ciudad Autónoma de Buenos Aires, Argentina.

4Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia, Udine, Italy.

5Theravance Biopharma US, Inc., South San Francisco, California.


Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections and the most frequent invasive infection due to methicillin-resistant S. aureus (MRSA). Treatment is challenging, particularly for MRSA, because of limited treatment options. Telavancin is a bactericidal lipoglycopeptide antibiotic that is active against a range of clinically relevant gram-positive pathogens including MRSA. In experimental animal models of sepsis telavancin was shown to be more effective than vancomycin. In clinically evaluable patients enrolled in a pilot study of uncomplicated SAB, cure rates were 88% for telavancin and 89% for standard therapy. Among patients with infection due to only gram-positive pathogens enrolled in the 2 phase 3 studies of telavancin for treatment of hospital-acquired pneumonia, cure rates for those with bacteremic S. aureus pneumonia were 41% (9/22, telavancin) and 40% (10/25, vancomycin) with identical mortality rates. These data support further evaluation of telavancin in larger, prospective studies of SAB


July 15, 2016 at 9:09 am

Methicillin-resistant Staphylococcus aureus: an evolving pathogen.

Clin Infect Dis. 2014 Jan;58 Suppl 1:S10-9.

Stryjewski ME1, Corey GR.

Author information

1Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Buenos Aires, Argentina.


The horizontal transmission of methicillin resistance to Staphylococcus aureus (MRSA) in hospital and community settings, and growing prevalence of these strains, presents a significant clinical challenge to the management of serious infections worldwide. While infection control initiatives have stemmed the rising prevalence, MRSA remains a significant pathogen. More recently, evidence that MRSA is becoming resistant to glycopeptides and newer therapies raises concern about the use of these therapies in clinical practice. Vancomycin resistance has become evident in select clinical settings through rising MICs, growing awareness of heteroresistance, and emergence of intermediate-resistant and fully resistant strains. While resistance to linezolid and daptomycin remains low overall, point mutations leading to resistance have been described for linezolid, and horizontal transmission of cfr-mediated resistance to linezolid has been reported in clinical isolates. These resistance trends for newer therapies highlight the ongoing need for new and more potent antimicrobial therapies.


July 15, 2016 at 9:07 am


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