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Tamara D. Simon - One of the best experts on this subject based on the ideXlab platform.
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characterization of cerebrospinal fluid csf microbiota from patients with csf shunt infection and Reinfection using high throughput sequencing of 16s ribosomal rnagenes
PLOS ONE, 2021Co-Authors: Kathryn B. Whitlock, David D Limbrick, Christopher E Pope, Paul Hodor, Lucas R Hoffman, Patrick J Mcdonald, Jason S Hauptman, Jeffrey G Ojemann, Tamara D. SimonAbstract:BACKGROUND Nearly 20% of patients with cerebrospinal fluid (CSF) shunt infection develop Reinfection. It is unclear whether Reinfections are caused by an organism previously present or are independent infection events. OBJECTIVE We used bacterial culture and high throughput sequencing (HTS) of 16S ribosomal RNA (rRNA) genes to identify bacteria present in serial CSF samples obtained from children who failed CSF shunt infection treatment. We hypothesized that organisms that persist in CSF despite treatment would be detected upon Reinfection. DESIGN/METHODS Serial CSF samples were obtained from 6 patients, 5 with 2 infections and 1 with 3 infections; the study was limited to those for which CSF samples were available from the end of infection and beginning of Reinfection. Amplicons of the 16S rRNA gene V4 region were sequenced. Taxonomic assignments of V4 sequences were compared with bacterial species identified in culture. RESULTS Seven infection dyads averaging 13.5 samples per infection were analyzed. A median of 8 taxa [interquartile range (IQR) 5-10] were observed in the first samples from Reinfection using HTS. Conventional culture correlated with high abundance of an organism by HTS in all but 1 infection. In 6 of 7 infection dyads, organisms identified by culture at Reinfection were detected by HTS of culture-negative samples at the end of the previous infection. The median Chao-Jaccard abundance-based similarity index for matched infection pairs at end of infection and beginning of Reinfection was 0.57 (IQR 0.07-0.87) compared to that for unmatched pairs of 0.40 (IQR 0.10-0.60) [p = 0.46]. CONCLUSION(S) HTS results were generally consistent with culture-based methods in CSF shunt infection and Reinfection, and may detect organisms missed by culture at the end of infection treatment but detected by culture at Reinfection. However, the CSF microbiota did not correlate more closely within patients at the end of infection and beginning of Reinfection than between any two unrelated infections. We cannot reject the hypothesis that sequential infections were independent.
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Reinfection rates following adherence to infectious diseases society of america guideline recommendations in first cerebrospinal fluid shunt infection treatment
Journal of Neurosurgery, 2019Co-Authors: Tamara D. Simon, Abhaya V. Kulkarni, John R W Kestle, Matthew P. Kronman, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, Marcie Langley, David D Limbrick, Thomas G. LuerssenAbstract:OBJECTIVECSF shunt infection treatment requires both surgical and antibiotic decisions. Using the Hydrocephalus Clinical Research Network (HCRN) Registry and 2004 Infectious Diseases Society of America (IDSA) guidelines that were not proactively distributed to HCRN providers, the authors previously found high adherence to surgical recommendations but poor adherence to intravenous (IV) antibiotic duration recommendations. In general, IV antibiotic duration was longer than recommended. In March 2017, new IDSA guidelines expanded upon the 2004 guidelines by including recommendations for selection of specific antibiotics. The objective of this study was to describe adherence to both 2004 and 2017 IDSA guideline recommendations for CSF shunt infection treatment, and to report Reinfection rates associated with adherence to guideline recommendations.METHODSThe authors investigated a prospective cohort of children younger than 18 years of age who underwent treatment for first CSF shunt infection at one of 7 hospitals from April 2008 to December 2012. CSF shunt infection was diagnosed by recovery of bacteria from CSF culture (CSF-positive infection). Adherence to 2004 and 2017 guideline recommendations was determined. Adherence to antibiotics was further classified as longer or shorter duration than guideline recommendations. Reinfection rates with 95% confidence intervals (CIs) were generated.RESULTSThere were 133 children with CSF-positive infections addressed by 2004 IDSA guideline recommendations, with 124 at risk for Reinfection. Zero Reinfections were observed among those whose treatment was fully adherent (0/14, 0% [95% CI 0%-20%]), and 15 Reinfections were observed among those whose infection treatment was nonadherent (15/110, 14% [95% CI 8%-21%]). Among the 110 first infections whose infection treatment was nonadherent, 74 first infections were treated for a longer duration than guidelines recommended and 9 developed Reinfection (9/74, 12% [95% CI 6%-22%]). There were 145 children with CSF-positive infections addressed by 2017 IDSA guideline recommendations, with 135 at risk for Reinfection. No Reinfections were observed among children whose treatment was fully adherent (0/3, 0% [95% CI 0%-64%]), and 18 Reinfections were observed among those whose infection treatment was nonadherent (18/132, 14% [95% CI 8%-21%]).CONCLUSIONSThere is no clear evidence that either adherence to IDSA guidelines or duration of treatment longer than recommended is associated with reduction in Reinfection rates. Because IDSA guidelines recommend shorter IV antibiotic durations than are typically used, improvement efforts to reduce IV antibiotic use in CSF shunt infection treatment can and should utilize IDSA guidelines.
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few patient treatment and diagnostic or microbiological factors except complications and intermittent negative cerebrospinal fluid csf cultures during first csf shunt infection are associated with Reinfection
Journal of the Pediatric Infectious Diseases Society, 2014Co-Authors: Tamara D. Simon, John R W Kestle, Kathryn B. Whitlock, Marcie Langley, Margaret Rosenfeld, Jay Rivacambrin, Nicole Mayerhamblett, Emily A ThorellAbstract:BACKGROUND The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of Reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt Reinfection. METHODS A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt Reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without Reinfection. RESULTS Of 118 children with first infection, 31 (26%) developed a Reinfection during the study period (overall median follow-up, 2096 days). Factors associated with Reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. CONCLUSIONS Few patient or treatment factors were associated with Reinfection. Factors associated with difficult-to-treat first CSF shunt infection, including complications after first CSF shunt infection and intermittent negative CSF cultures, were associated with Reinfection. Clinicians who treat patients with unusual CSF shunts or more difficult first infections should have a high index of suspicion for Reinfection after treatment is completed.
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Few Patient, Treatment, and Diagnostic or Microbiological Factors, Except Complications and Intermittent Negative Cerebrospinal Fluid (CSF) Cultures During First CSF Shunt Infection, Are Associated With Reinfection
2012Co-Authors: Tamara D. Simon, John R W Kestle, Kathryn B. Whitlock, Marcie Langley, Margaret Rosenfeld, Nicole Mayer-hamblett, Jay Riva-cambrin, Emily A ThorellAbstract:Background. The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of Reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt Reinfection. Methods. A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt Reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without Reinfection. Results. Of 118 children with first infection, 31 (26%) developed a Reinfection during the study period (overall median follow-up, 2096 days). Factors associated with Reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. Conclusions. Few patient or treatment factors were associated with Reinfection. Factors associated wit
Kathryn B. Whitlock - One of the best experts on this subject based on the ideXlab platform.
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characterization of cerebrospinal fluid csf microbiota from patients with csf shunt infection and Reinfection using high throughput sequencing of 16s ribosomal rnagenes
PLOS ONE, 2021Co-Authors: Kathryn B. Whitlock, David D Limbrick, Christopher E Pope, Paul Hodor, Lucas R Hoffman, Patrick J Mcdonald, Jason S Hauptman, Jeffrey G Ojemann, Tamara D. SimonAbstract:BACKGROUND Nearly 20% of patients with cerebrospinal fluid (CSF) shunt infection develop Reinfection. It is unclear whether Reinfections are caused by an organism previously present or are independent infection events. OBJECTIVE We used bacterial culture and high throughput sequencing (HTS) of 16S ribosomal RNA (rRNA) genes to identify bacteria present in serial CSF samples obtained from children who failed CSF shunt infection treatment. We hypothesized that organisms that persist in CSF despite treatment would be detected upon Reinfection. DESIGN/METHODS Serial CSF samples were obtained from 6 patients, 5 with 2 infections and 1 with 3 infections; the study was limited to those for which CSF samples were available from the end of infection and beginning of Reinfection. Amplicons of the 16S rRNA gene V4 region were sequenced. Taxonomic assignments of V4 sequences were compared with bacterial species identified in culture. RESULTS Seven infection dyads averaging 13.5 samples per infection were analyzed. A median of 8 taxa [interquartile range (IQR) 5-10] were observed in the first samples from Reinfection using HTS. Conventional culture correlated with high abundance of an organism by HTS in all but 1 infection. In 6 of 7 infection dyads, organisms identified by culture at Reinfection were detected by HTS of culture-negative samples at the end of the previous infection. The median Chao-Jaccard abundance-based similarity index for matched infection pairs at end of infection and beginning of Reinfection was 0.57 (IQR 0.07-0.87) compared to that for unmatched pairs of 0.40 (IQR 0.10-0.60) [p = 0.46]. CONCLUSION(S) HTS results were generally consistent with culture-based methods in CSF shunt infection and Reinfection, and may detect organisms missed by culture at the end of infection treatment but detected by culture at Reinfection. However, the CSF microbiota did not correlate more closely within patients at the end of infection and beginning of Reinfection than between any two unrelated infections. We cannot reject the hypothesis that sequential infections were independent.
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Reinfection rates following adherence to infectious diseases society of america guideline recommendations in first cerebrospinal fluid shunt infection treatment
Journal of Neurosurgery, 2019Co-Authors: Tamara D. Simon, Abhaya V. Kulkarni, John R W Kestle, Matthew P. Kronman, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, Marcie Langley, David D Limbrick, Thomas G. LuerssenAbstract:OBJECTIVECSF shunt infection treatment requires both surgical and antibiotic decisions. Using the Hydrocephalus Clinical Research Network (HCRN) Registry and 2004 Infectious Diseases Society of America (IDSA) guidelines that were not proactively distributed to HCRN providers, the authors previously found high adherence to surgical recommendations but poor adherence to intravenous (IV) antibiotic duration recommendations. In general, IV antibiotic duration was longer than recommended. In March 2017, new IDSA guidelines expanded upon the 2004 guidelines by including recommendations for selection of specific antibiotics. The objective of this study was to describe adherence to both 2004 and 2017 IDSA guideline recommendations for CSF shunt infection treatment, and to report Reinfection rates associated with adherence to guideline recommendations.METHODSThe authors investigated a prospective cohort of children younger than 18 years of age who underwent treatment for first CSF shunt infection at one of 7 hospitals from April 2008 to December 2012. CSF shunt infection was diagnosed by recovery of bacteria from CSF culture (CSF-positive infection). Adherence to 2004 and 2017 guideline recommendations was determined. Adherence to antibiotics was further classified as longer or shorter duration than guideline recommendations. Reinfection rates with 95% confidence intervals (CIs) were generated.RESULTSThere were 133 children with CSF-positive infections addressed by 2004 IDSA guideline recommendations, with 124 at risk for Reinfection. Zero Reinfections were observed among those whose treatment was fully adherent (0/14, 0% [95% CI 0%-20%]), and 15 Reinfections were observed among those whose infection treatment was nonadherent (15/110, 14% [95% CI 8%-21%]). Among the 110 first infections whose infection treatment was nonadherent, 74 first infections were treated for a longer duration than guidelines recommended and 9 developed Reinfection (9/74, 12% [95% CI 6%-22%]). There were 145 children with CSF-positive infections addressed by 2017 IDSA guideline recommendations, with 135 at risk for Reinfection. No Reinfections were observed among children whose treatment was fully adherent (0/3, 0% [95% CI 0%-64%]), and 18 Reinfections were observed among those whose infection treatment was nonadherent (18/132, 14% [95% CI 8%-21%]).CONCLUSIONSThere is no clear evidence that either adherence to IDSA guidelines or duration of treatment longer than recommended is associated with reduction in Reinfection rates. Because IDSA guidelines recommend shorter IV antibiotic durations than are typically used, improvement efforts to reduce IV antibiotic use in CSF shunt infection treatment can and should utilize IDSA guidelines.
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few patient treatment and diagnostic or microbiological factors except complications and intermittent negative cerebrospinal fluid csf cultures during first csf shunt infection are associated with Reinfection
Journal of the Pediatric Infectious Diseases Society, 2014Co-Authors: Tamara D. Simon, John R W Kestle, Kathryn B. Whitlock, Marcie Langley, Margaret Rosenfeld, Jay Rivacambrin, Nicole Mayerhamblett, Emily A ThorellAbstract:BACKGROUND The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of Reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt Reinfection. METHODS A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt Reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without Reinfection. RESULTS Of 118 children with first infection, 31 (26%) developed a Reinfection during the study period (overall median follow-up, 2096 days). Factors associated with Reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. CONCLUSIONS Few patient or treatment factors were associated with Reinfection. Factors associated with difficult-to-treat first CSF shunt infection, including complications after first CSF shunt infection and intermittent negative CSF cultures, were associated with Reinfection. Clinicians who treat patients with unusual CSF shunts or more difficult first infections should have a high index of suspicion for Reinfection after treatment is completed.
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Few Patient, Treatment, and Diagnostic or Microbiological Factors, Except Complications and Intermittent Negative Cerebrospinal Fluid (CSF) Cultures During First CSF Shunt Infection, Are Associated With Reinfection
2012Co-Authors: Tamara D. Simon, John R W Kestle, Kathryn B. Whitlock, Marcie Langley, Margaret Rosenfeld, Nicole Mayer-hamblett, Jay Riva-cambrin, Emily A ThorellAbstract:Background. The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of Reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt Reinfection. Methods. A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt Reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without Reinfection. Results. Of 118 children with first infection, 31 (26%) developed a Reinfection during the study period (overall median follow-up, 2096 days). Factors associated with Reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. Conclusions. Few patient or treatment factors were associated with Reinfection. Factors associated wit
Havard Midgard - One of the best experts on this subject based on the ideXlab platform.
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hepatitis c Reinfection after successful antiviral treatment among people who inject drugs a meta analysis
Journal of Hepatology, 2020Co-Authors: Behzad Hajarizadeh, Olav Dalgard, Havard Midgard, Evan B Cunningham, Heather Valerio, Marianne Martinello, Matthew Law, Naveed Z Janjua, John F Dillon, Matthew HickmanAbstract:Background & Aims HCV Reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV Reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). Methods We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV Reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate Reinfection rates and meta-regression was used to explore heterogeneity across studies. Results Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV Reinfection was 5.9/100 person-years (95% CI 4.1–8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3–9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5–5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1–9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5–5.9) therapy. In stratified analysis, Reinfection rates were 1.4/100 person-years (95% CI 0.8–2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0–8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4–12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower Reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69–0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62–7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82–8.59) had higher Reinfection rates. Conclusion HCV Reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of Reinfection observed in studies with longer follow-up suggested higher Reinfection risk early post-treatment. Lay summary Our findings demonstrate that although Reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C Reinfection is lower than the rates of primary infection reported in the literature for this population – Reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C Reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the Reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
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hcv epidemiology in high risk groups and the risk of Reinfection
Journal of Hepatology, 2016Co-Authors: Havard Midgard, Amanda Weir, Norah Palmateer, Juan A Pineda, Juan Macias, Olav DalgardAbstract:Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV Reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of Reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of Reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent Reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of Reinfections.
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hepatitis c Reinfection after sustained virological response
Journal of Hepatology, 2016Co-Authors: Havard Midgard, Benedikte Bjoro, Arild Maeland, Zbigniew Konopski, Hege Kileng, Jan Kristian Damas, Jorn Paulsen, Lars Heggelund, Per SandveiAbstract:Background & Aims On-going risk behaviour can lead to hepatitis C virus (HCV) Reinfection following successful treatment. We aimed to assess the incidence of persistent HCV Reinfection in a population of people who inject drugs (PWID) who had achieved sustained virological response (SVR) seven years earlier. Methods In 2004–2006 we conducted a multicentre treatment trial comprising HCV genotype 2 or 3 patients in Sweden, Norway and Denmark (NORTH-C). Six months of abstinence from injecting drug use (IDU) was required before treatment. All Norwegian patients who had obtained SVR (n=161) were eligible for participation in this long-term follow-up study assessing virological and behavioural characteristics. Results Follow-up data were available in 138 of 161 (86%) individuals. Persistent Reinfection was identified in 10 of 94 (11%) individuals with a history of IDU prior to treatment (incidence rate 1.7/100 person-years (PY); 95% CI 0.8–3.1) and in 10 of 37 (27%) individuals who had relapsed to IDU after treatment (incidence rate 4.9/100 PY; 95% CI 2.3–8.9). Although relapse to IDU perfectly predicted Reinfection, no baseline factor was associated with Reinfection. Relapse to IDU was associated with age vs. ⩾40years) at treatment (adjusted odds ratio [aOR] 7.03; 95% CI 1.78–27.8) and low education level (aOR 3.64; 95% CI 1.44–9.18). Conclusions Over time, persistent HCV Reinfection was common among individuals who had relapsed to IDU after treatment. Reinfection should be systematically addressed and prevented when providing HCV care for PWID.
Emily A Thorell - One of the best experts on this subject based on the ideXlab platform.
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few patient treatment and diagnostic or microbiological factors except complications and intermittent negative cerebrospinal fluid csf cultures during first csf shunt infection are associated with Reinfection
Journal of the Pediatric Infectious Diseases Society, 2014Co-Authors: Tamara D. Simon, John R W Kestle, Kathryn B. Whitlock, Marcie Langley, Margaret Rosenfeld, Jay Rivacambrin, Nicole Mayerhamblett, Emily A ThorellAbstract:BACKGROUND The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of Reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt Reinfection. METHODS A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt Reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without Reinfection. RESULTS Of 118 children with first infection, 31 (26%) developed a Reinfection during the study period (overall median follow-up, 2096 days). Factors associated with Reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. CONCLUSIONS Few patient or treatment factors were associated with Reinfection. Factors associated with difficult-to-treat first CSF shunt infection, including complications after first CSF shunt infection and intermittent negative CSF cultures, were associated with Reinfection. Clinicians who treat patients with unusual CSF shunts or more difficult first infections should have a high index of suspicion for Reinfection after treatment is completed.
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Few Patient, Treatment, and Diagnostic or Microbiological Factors, Except Complications and Intermittent Negative Cerebrospinal Fluid (CSF) Cultures During First CSF Shunt Infection, Are Associated With Reinfection
2012Co-Authors: Tamara D. Simon, John R W Kestle, Kathryn B. Whitlock, Marcie Langley, Margaret Rosenfeld, Nicole Mayer-hamblett, Jay Riva-cambrin, Emily A ThorellAbstract:Background. The relationship between first and subsequent cerebrospinal fluid (CSF) shunt infections is poorly understood. By understanding the factors associated with increased risk of Reinfection, researchers may provide optimal treatment strategies at the time of first infection. The objective of this study was to describe and compare children with and without CSF shunt Reinfection. Methods. A retrospective cohort study was performed among 118 children who underwent initial CSF shunt placement and developed first CSF shunt infection. The primary outcome variable was CSF shunt Reinfection. Patient risk factors and medical and surgical management of initial CSF shunt placement and first CSF shunt infection were compared between children with and without Reinfection. Results. Of 118 children with first infection, 31 (26%) developed a Reinfection during the study period (overall median follow-up, 2096 days). Factors associated with Reinfection in this cohort included ventriculoatrial or complex shunt at initial CSF shunt placement, complications after first CSF shunt infection, and intermittent negative CSF cultures. Conclusions. Few patient or treatment factors were associated with Reinfection. Factors associated wit
Laith J Aburaddad - One of the best experts on this subject based on the ideXlab platform.
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sars cov 2 antibody positivity protects against Reinfection for at least seven months with 95 efficacy
EClinicalMedicine, 2021Co-Authors: Laith J Aburaddad, Hiam Chemaitelly, Peter Coyle, Joel A Malek, Ayeda A Ahmed, Yasmin A Mohamoud, Shameem Younuskunju, Houssein H AyoubAbstract:Abstract Background Reinfection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been documented, raising public health concerns. SARS-CoV-2 Reinfections were assessed in a cohort of antibody-positive persons in Qatar. Methods All SARS-CoV-2 antibody-positive persons from April 16 to December 31, 2020 with a PCR-positive swab ≥14 days after the first-positive antibody test were investigated for evidence of Reinfection. Viral genome sequencing was conducted for paired viral specimens to confirm Reinfection. Incidence of Reinfection was compared to incidence of infection in the complement cohort of those who were antibody-negative. Findings Among 43,044 antibody-positive persons who were followed for a median of 16.3 weeks (range: 0–34.6), 314 individuals (0.7%) had at least one PCR positive swab ≥14 days after the first-positive antibody test. Of these individuals, 129 (41.1%) had supporting epidemiological evidence for Reinfection. Reinfection was next investigated using viral genome sequencing. Applying the viral-genome-sequencing confirmation rate, the incidence rate of Reinfection was estimated at 0.66 per 10,000 person-weeks (95% CI: 0.56–0.78). Incidence rate of Reinfection versus month of follow-up did not show any evidence of waning of immunity for over seven months of follow-up. Meanwhile, in the complement cohort of 149,923 antibody-negative persons followed for a median of 17.0 weeks (range: 0–45.6), incidence rate of infection was estimated at 13.69 per 10,000 person-weeks (95% CI: 13.22–14.14). Efficacy of natural infection against Reinfection was estimated at 95.2% (95% CI: 94.1–96.0%). Reinfections were less severe than primary infections. Only one Reinfection was severe, two were moderate, and none were critical or fatal. Most Reinfections (66.7%) were diagnosed incidentally through random or routine testing, or through contact tracing. Interpretation Reinfection is rare in the young and international population of Qatar. Natural infection appears to elicit strong protection against Reinfection with an efficacy ~95% for at least seven months. Funding Biomedical Research Program, the Biostatistics, Epidemiology, and Biomathematics Research Core, and the Genomics Core, all at Weill Cornell Medicine-Qatar, the Ministry of Public Health, Hamad Medical Corporation, and the Qatar Genome Programme.
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sars cov 2 Reinfection in a cohort of 43 000 antibody positive individuals followed for up to 35 weeks
medRxiv, 2021Co-Authors: Laith J Aburaddad, Hiam Chemaitelly, Peter Coyle, Joel A Malek, Ayeda A Ahmed, Yasmin A Mohamoud, Shameem Younuskunju, Houssein H AyoubAbstract:ABSTRACT Background Reinfection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been documented, raising public health concerns. Risk and incidence rate of SARS-CoV-2 Reinfection were assessed in a large cohort of antibody-positive persons in Qatar. Methods All SARS-CoV-2 antibody-positive persons with a PCR-positive swab ≥14 days after the first-positive antibody test were individually investigated for evidence of Reinfection. Viral genome sequencing was conducted for paired viral specimens to confirm Reinfection. Results Among 43,044 anti-SARS-CoV-2 positive persons who were followed for a median of 16.3 weeks (range: 0-34.6), 314 individuals (0.7%) had at least one PCR positive swab ≥14 days after the first-positive antibody test. Of these individuals, 129 (41.1%) had supporting epidemiological evidence for Reinfection. Reinfection was next investigated using viral genome sequencing. Applying the viral-genome-sequencing confirmation rate, the risk of Reinfection was estimated at 0.10% (95% CI: 0.08-0.11%). The incidence rate of Reinfection was estimated at 0.66 per 10,000 person-weeks (95% CI: 0.56-0.78). Incidence rate of Reinfection versus month of follow-up did not show any evidence of waning of immunity for over seven months of follow-up. Efficacy of natural infection against Reinfection was estimated at >90%. Reinfections were less severe than primary infections. Only one Reinfection was severe, two were moderate, and none were critical or fatal. Most Reinfections (66.7%) were diagnosed incidentally through random or routine testing, or through contact tracing. Conclusions Reinfection is rare. Natural infection appears to elicit strong protection against Reinfection with an efficacy >90% for at least seven months.
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assessment of the risk of sars cov 2 Reinfection in an intense re exposure setting
Clinical Infectious Diseases, 2020Co-Authors: Laith J Aburaddad, Hiam Chemaitelly, Joel A Malek, Ayeda A Ahmed, Yasmin A Mohamoud, Shameem Younuskunju, Houssein H Ayoub, Zaina Al KanaaniAbstract:Background Risk of Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We assessed risk and incidence rate of documented SARS-CoV-2 Reinfection in a cohort of laboratory-confirmed cases in Qatar. Methods All SARS-CoV-2 laboratory-confirmed cases with at least one PCR positive swab that is ≥45 days after a first-positive swab were individually investigated for evidence of Reinfection, and classified as showing strong, good, some, or weak/no evidence for Reinfection. Viral genome sequencing of the paired first-positive and Reinfection viral specimens was conducted to confirm Reinfection. Risk and incidence rate of Reinfection were estimated. Results Out of 133,266 laboratory-confirmed SARS-CoV-2 cases, 243 persons (0.18%) had at least one subsequent positive swab ≥45 days after the first-positive swab. Of these, 54 cases (22.2%) had strong or good evidence for Reinfection. Median time between first and Reinfection swab was 64.5 days (range: 45-129). Twenty-three of the 54 cases (42.6%) were diagnosed at a health facility suggesting presence of symptoms, while 31 (57.4%) were identified incidentally through random testing campaigns/surveys or contact tracing. Only one person was hospitalized at time of Reinfection, but was discharged the next day. No deaths were recorded. Viral genome sequencing confirmed four Reinfections out of 12 cases with available genetic evidence. Reinfection risk was estimated at 0.02% (95% CI: 0.01-0.02%) and Reinfection incidence rate at 0.36 (95% CI: 0.28-0.47) per 10,000 person-weeks. Conclusions SARS-CoV-2 Reinfection can occur but is a rare phenomenon suggestive of protective immunity against Reinfection that lasts for at least a few months post primary infection.
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assessment of the risk of sars cov 2 Reinfection in an intense re exposure setting
medRxiv, 2020Co-Authors: Laith J Aburaddad, Hiam Chemaitelly, Peter Coyle, Houssein H Ayoub, Zaina Al Kanaani, Abdullatif Al Khal, Einas Al Kuwari, Adeel A Butt, Andrew Jeremijenko, Anvar Hassan KaleeckalAbstract:Background: Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a subject of debate. We aimed to assess the risk and incidence rate of documented SARS-CoV-2 Reinfection in a large cohort of laboratory-confirmed cases in Qatar. Methods: All SARS-CoV-2 laboratory-confirmed cases with at least one PCR positive swab that is ≥45 days after a first positive swab were individually investigated for evidence of Reinfection, and classified as showing strong, good, some, or weak/no evidence for Reinfection. Risk and incidence rate of Reinfection were estimated. Results: Out of 133,266 laboratory-confirmed SARS-CoV-2 cases, 243 persons (0.18%) had at least one subsequent positive swab ≥45 days after the first positive swab. Of these, 54 cases (22.2%) had strong or good evidence for Reinfection. Median time between first and Reinfection swab was 64.5 days (range: 45-129). Twenty-three of the 54 cases (42.6%) were diagnosed at a health facility suggesting presence of symptoms, while 31 (57.4%) were identified incidentally through random testing campaigns/surveys or contact tracing. Only one person was hospitalized at or following time of Reinfection swab, but still had relatively mild infection. No deaths were recorded. Risk of Reinfection was estimated at 0.04% (95% CI: 0.03-0.05%) and incidence rate of Reinfection was estimated at 1.09 (95% CI: 0.84-1.42) per 10,000 person-weeks. Conclusions: SARS-CoV-2 Reinfection appears to be a rare phenomenon suggestive of a strong protective immunity against Reinfection that lasts for at least a few months post primary infection.
