Antibiotic use may drive Clostridium difficile transmission within long-term care facilities, according to the results of a recent study published in Annals of Internal Medicine.

Dr. Kevin A. Brown of Public Health Ontario in Toronto, and his coauthors, assessed long-term care–onset C. difficile infection in the largest and most comprehensive study of its kind to date. The retrospective study included 86 Veterans Health Administration health care regions and examined long-term care residents from January 2006 through December 2012. Study results indicated large variations in regional rates of C. difficile infection, regional antibiotic use, and importation of cases of acute care C. difficile infection (Ann Intern Med. 2016 Apr 19. doi: 10.7326/M15-1754).

CDC/Jennifer Hulsey

The total study population included 6,012 cases with a C. difficile infection incidence of 3.7 cases per 10,000 resident days. The regional variability in the incidence of long-term care–onset C. difficile infection was found to be attributable in large part (75%) to antibiotic use and importation from acute care facilities. The data also showed that regional differences in both the prescription of antibiotics and the individual receipt of antibiotics contributed to resident risk, suggesting increased risk for both acquiring and spreading C. difficile.

A potential mechanism offered by the authors for the transmission of C. difficile in facilities with high antibiotic use may be the increased prevalence of residents with asymptomatic C. difficile colonization who become more effective at shedding C. difficile spores when exposed to antibiotics.

Dr. Brown and his colleagues said that efforts designed to reduce C. difficile infection in long-term care should focus on the reduction of total antibiotic use, and that infection control teams may need to take special measures in long-term care facilities that receive residents from hospitals with elevated rates of C. difficile infection.

This study was funded by the U.S. Department of Veterans Affairs and the Centers for Disease Control and Prevention. Dr. Brown reported grants from AstraZeneca outside the submitted work, and another coauthor disclosed grant support from the funding source during the conduct of the study. The remaining coauthors disclosed no conflicts of interest.

Antibiotic use may drive Clostridium difficile transmission within long-term care facilities, according to the results of a recent study published in Annals of Internal Medicine.

Dr. Kevin A. Brown of Public Health Ontario in Toronto, and his coauthors, assessed long-term care–onset C. difficile infection in the largest and most comprehensive study of its kind to date. The retrospective study included 86 Veterans Health Administration health care regions and examined long-term care residents from January 2006 through December 2012. Study results indicated large variations in regional rates of C. difficile infection, regional antibiotic use, and importation of cases of acute care C. difficile infection (Ann Intern Med. 2016 Apr 19. doi: 10.7326/M15-1754).

CDC/Jennifer Hulsey

The total study population included 6,012 cases with a C. difficile infection incidence of 3.7 cases per 10,000 resident days. The regional variability in the incidence of long-term care–onset C. difficile infection was found to be attributable in large part (75%) to antibiotic use and importation from acute care facilities. The data also showed that regional differences in both the prescription of antibiotics and the individual receipt of antibiotics contributed to resident risk, suggesting increased risk for both acquiring and spreading C. difficile.

A potential mechanism offered by the authors for the transmission of C. difficile in facilities with high antibiotic use may be the increased prevalence of residents with asymptomatic C. difficile colonization who become more effective at shedding C. difficile spores when exposed to antibiotics.

Dr. Brown and his colleagues said that efforts designed to reduce C. difficile infection in long-term care should focus on the reduction of total antibiotic use, and that infection control teams may need to take special measures in long-term care facilities that receive residents from hospitals with elevated rates of C. difficile infection.

This study was funded by the U.S. Department of Veterans Affairs and the Centers for Disease Control and Prevention. Dr. Brown reported grants from AstraZeneca outside the submitted work, and another coauthor disclosed grant support from the funding source during the conduct of the study. The remaining coauthors disclosed no conflicts of interest.

Antibiotic use may drive Clostridium difficile transmission within long-term care facilities, according to the results of a recent study published in Annals of Internal Medicine.

Dr. Kevin A. Brown of Public Health Ontario in Toronto, and his coauthors, assessed long-term care–onset C. difficile infection in the largest and most comprehensive study of its kind to date. The retrospective study included 86 Veterans Health Administration health care regions and examined long-term care residents from January 2006 through December 2012. Study results indicated large variations in regional rates of C. difficile infection, regional antibiotic use, and importation of cases of acute care C. difficile infection (Ann Intern Med. 2016 Apr 19. doi: 10.7326/M15-1754).

CDC/Jennifer Hulsey

The total study population included 6,012 cases with a C. difficile infection incidence of 3.7 cases per 10,000 resident days. The regional variability in the incidence of long-term care–onset C. difficile infection was found to be attributable in large part (75%) to antibiotic use and importation from acute care facilities. The data also showed that regional differences in both the prescription of antibiotics and the individual receipt of antibiotics contributed to resident risk, suggesting increased risk for both acquiring and spreading C. difficile.

A potential mechanism offered by the authors for the transmission of C. difficile in facilities with high antibiotic use may be the increased prevalence of residents with asymptomatic C. difficile colonization who become more effective at shedding C. difficile spores when exposed to antibiotics.

Dr. Brown and his colleagues said that efforts designed to reduce C. difficile infection in long-term care should focus on the reduction of total antibiotic use, and that infection control teams may need to take special measures in long-term care facilities that receive residents from hospitals with elevated rates of C. difficile infection.

This study was funded by the U.S. Department of Veterans Affairs and the Centers for Disease Control and Prevention. Dr. Brown reported grants from AstraZeneca outside the submitted work, and another coauthor disclosed grant support from the funding source during the conduct of the study. The remaining coauthors disclosed no conflicts of interest.

Clinical question: What is the risk of acute kidney injury after orthopedic surgery, and does it impact mortality?

Background: Current studies show that acute kidney injury is associated with increased long-term mortality, future development of chronic kidney disease, and increased healthcare costs. However, no externally validated models are available to predict patients undergoing non-cardiac surgery at risk of postoperative acute kidney injury.

Study design: Observational, cohort study.

Setting: Teaching and private hospitals in the National Health Service (NHS) in the Tayside region of Scotland.

Synopsis: Investigators enrolled 10,615 adults >18 years of age undergoing orthopedic surgery into two groups: development cohort (6,220 patients) and validation cohort (4,395 patients). Using the development cohort, seven predictors were identified in the risk model: age at operation, male sex, diabetes, lower estimated glomerular filtration rate (GFR), use of ACE inhibitor/ARB, number of prescribing drugs, and American Society of Anesthesiologists (ASA) grade.

The model’s predictive performance for discrimination was good in the development cohort (C statistic 0.74; 95% CI, 0.72–0.76) and validation cohort (C statistic 0.7). Calibration was good in the development cohort but overestimated the risk in the validation cohort. Postoperative acute kidney injury developed in 672 (10.8%) patients in the development cohort and 295 (6.7%) in the validation cohort. Thirty percent (3,166) of the 10,615 patients enrolled in this study died over the median follow-up of 4.58 years. Survival was worse in the patients with acute kidney injury (adjusted hazard ratio 1.53; 95% CI, 1.38–1.70), worse in the short term (90-day adjusted hazard ratio 2.36; 95% CI, 1.94–2.87), and diminished over time.

Bottom line: A predictive model using age, male sex, diabetes, lower GFR, use of ACE inhibitor/ARB, multiple medications, and ASA grades might predict risk of postoperative acute kidney injury in orthopedic patients.

Citation: Bell S, Dekker FW, Vadiveloo T, et al. Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery—development and validation of a risk score and effect of acute kidney injury on survival: observational cohort study. BMJ 2015; 351:h5639.

Clinical question: What is the risk of acute kidney injury after orthopedic surgery, and does it impact mortality?

Background: Current studies show that acute kidney injury is associated with increased long-term mortality, future development of chronic kidney disease, and increased healthcare costs. However, no externally validated models are available to predict patients undergoing non-cardiac surgery at risk of postoperative acute kidney injury.

Study design: Observational, cohort study.

Setting: Teaching and private hospitals in the National Health Service (NHS) in the Tayside region of Scotland.

Synopsis: Investigators enrolled 10,615 adults >18 years of age undergoing orthopedic surgery into two groups: development cohort (6,220 patients) and validation cohort (4,395 patients). Using the development cohort, seven predictors were identified in the risk model: age at operation, male sex, diabetes, lower estimated glomerular filtration rate (GFR), use of ACE inhibitor/ARB, number of prescribing drugs, and American Society of Anesthesiologists (ASA) grade.

The model’s predictive performance for discrimination was good in the development cohort (C statistic 0.74; 95% CI, 0.72–0.76) and validation cohort (C statistic 0.7). Calibration was good in the development cohort but overestimated the risk in the validation cohort. Postoperative acute kidney injury developed in 672 (10.8%) patients in the development cohort and 295 (6.7%) in the validation cohort. Thirty percent (3,166) of the 10,615 patients enrolled in this study died over the median follow-up of 4.58 years. Survival was worse in the patients with acute kidney injury (adjusted hazard ratio 1.53; 95% CI, 1.38–1.70), worse in the short term (90-day adjusted hazard ratio 2.36; 95% CI, 1.94–2.87), and diminished over time.

Bottom line: A predictive model using age, male sex, diabetes, lower GFR, use of ACE inhibitor/ARB, multiple medications, and ASA grades might predict risk of postoperative acute kidney injury in orthopedic patients.

Citation: Bell S, Dekker FW, Vadiveloo T, et al. Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery—development and validation of a risk score and effect of acute kidney injury on survival: observational cohort study. BMJ 2015; 351:h5639.

Clinical question: What is the risk of acute kidney injury after orthopedic surgery, and does it impact mortality?

Background: Current studies show that acute kidney injury is associated with increased long-term mortality, future development of chronic kidney disease, and increased healthcare costs. However, no externally validated models are available to predict patients undergoing non-cardiac surgery at risk of postoperative acute kidney injury.

Study design: Observational, cohort study.

Setting: Teaching and private hospitals in the National Health Service (NHS) in the Tayside region of Scotland.

Synopsis: Investigators enrolled 10,615 adults >18 years of age undergoing orthopedic surgery into two groups: development cohort (6,220 patients) and validation cohort (4,395 patients). Using the development cohort, seven predictors were identified in the risk model: age at operation, male sex, diabetes, lower estimated glomerular filtration rate (GFR), use of ACE inhibitor/ARB, number of prescribing drugs, and American Society of Anesthesiologists (ASA) grade.

The model’s predictive performance for discrimination was good in the development cohort (C statistic 0.74; 95% CI, 0.72–0.76) and validation cohort (C statistic 0.7). Calibration was good in the development cohort but overestimated the risk in the validation cohort. Postoperative acute kidney injury developed in 672 (10.8%) patients in the development cohort and 295 (6.7%) in the validation cohort. Thirty percent (3,166) of the 10,615 patients enrolled in this study died over the median follow-up of 4.58 years. Survival was worse in the patients with acute kidney injury (adjusted hazard ratio 1.53; 95% CI, 1.38–1.70), worse in the short term (90-day adjusted hazard ratio 2.36; 95% CI, 1.94–2.87), and diminished over time.

Bottom line: A predictive model using age, male sex, diabetes, lower GFR, use of ACE inhibitor/ARB, multiple medications, and ASA grades might predict risk of postoperative acute kidney injury in orthopedic patients.

Citation: Bell S, Dekker FW, Vadiveloo T, et al. Risk of postoperative acute kidney injury in patients undergoing orthopaedic surgery—development and validation of a risk score and effect of acute kidney injury on survival: observational cohort study. BMJ 2015; 351:h5639.

Clinical question: Does treating asymptomatic bacteriuria (AB) cause harm in women?

Background: In women with recurrent UTIs, AB is often treated, increasing the risk of multi-drug-resistant bacteria. At the same time, little data exist on the relationship between AB treatment and risk of higher antibiotic resistance in women with recurrent UTIs.

Study design: Follow-up observational, analytical, longitudinal study on a previously randomized clinical trial (RCT).

Setting: Sexually transmitted disease (STD) center in Florence, Italy.

Synopsis: Using the patients from the authors’ previous RCT, the study followed 550 women with recurrent UTIs and AB for a mean of 38.8 months in parallel groups: One group had AB treated, and the other group did not. In the group of women treated with antibiotics, the recurrence rate was 69.6% versus 37.7% in the group not treated (P<0.001). In addition, E. coli isolates showed more resistance to amoxicillin/clavulanic acid (P=0.03), trimethoprim/sulfamethazole (P=0.01), and ciprofloxacin (P=0.03) in the group previously treated with antibiotics.

Given the observational design of the study, data must be interpreted with caution in determining a causal relationship. However, prior studies have shown this relationship, and current Infectious Diseases Society of America guidelines support neither screening nor treating AB.

Bottom line: In women with recurrent UTIs, previous treatment of AB is associated with higher rates of antibiotic-resistant bacteria, causing symptomatic UTIs.

Citation: Cai T, Nsei G, Mazzoli S, et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infection. Clin Infect Dis. 2015;61(11):1655-1661.

Short Take

National Healthcare Spending Increased in 2014

Led by expansions under the Affordable Care Act, healthcare spending increased 5.3% from the previous year and now totals $3 trillion, which represents 17.5% of the gross domestic product.

Citation: Martin AB, Hartman M, Benson J, Catlin A. National health spending in 2014: faster growth drive by coverage expansion and prescription drug spending. Health Aff. 2016;35(1):150-160.

Clinical question: Does treating asymptomatic bacteriuria (AB) cause harm in women?

Background: In women with recurrent UTIs, AB is often treated, increasing the risk of multi-drug-resistant bacteria. At the same time, little data exist on the relationship between AB treatment and risk of higher antibiotic resistance in women with recurrent UTIs.

Study design: Follow-up observational, analytical, longitudinal study on a previously randomized clinical trial (RCT).

Setting: Sexually transmitted disease (STD) center in Florence, Italy.

Synopsis: Using the patients from the authors’ previous RCT, the study followed 550 women with recurrent UTIs and AB for a mean of 38.8 months in parallel groups: One group had AB treated, and the other group did not. In the group of women treated with antibiotics, the recurrence rate was 69.6% versus 37.7% in the group not treated (P<0.001). In addition, E. coli isolates showed more resistance to amoxicillin/clavulanic acid (P=0.03), trimethoprim/sulfamethazole (P=0.01), and ciprofloxacin (P=0.03) in the group previously treated with antibiotics.

Given the observational design of the study, data must be interpreted with caution in determining a causal relationship. However, prior studies have shown this relationship, and current Infectious Diseases Society of America guidelines support neither screening nor treating AB.

Bottom line: In women with recurrent UTIs, previous treatment of AB is associated with higher rates of antibiotic-resistant bacteria, causing symptomatic UTIs.

Citation: Cai T, Nsei G, Mazzoli S, et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infection. Clin Infect Dis. 2015;61(11):1655-1661.

Short Take

National Healthcare Spending Increased in 2014

Led by expansions under the Affordable Care Act, healthcare spending increased 5.3% from the previous year and now totals $3 trillion, which represents 17.5% of the gross domestic product.

Citation: Martin AB, Hartman M, Benson J, Catlin A. National health spending in 2014: faster growth drive by coverage expansion and prescription drug spending. Health Aff. 2016;35(1):150-160.

Clinical question: Does treating asymptomatic bacteriuria (AB) cause harm in women?

Background: In women with recurrent UTIs, AB is often treated, increasing the risk of multi-drug-resistant bacteria. At the same time, little data exist on the relationship between AB treatment and risk of higher antibiotic resistance in women with recurrent UTIs.

Study design: Follow-up observational, analytical, longitudinal study on a previously randomized clinical trial (RCT).

Setting: Sexually transmitted disease (STD) center in Florence, Italy.

Synopsis: Using the patients from the authors’ previous RCT, the study followed 550 women with recurrent UTIs and AB for a mean of 38.8 months in parallel groups: One group had AB treated, and the other group did not. In the group of women treated with antibiotics, the recurrence rate was 69.6% versus 37.7% in the group not treated (P<0.001). In addition, E. coli isolates showed more resistance to amoxicillin/clavulanic acid (P=0.03), trimethoprim/sulfamethazole (P=0.01), and ciprofloxacin (P=0.03) in the group previously treated with antibiotics.

Given the observational design of the study, data must be interpreted with caution in determining a causal relationship. However, prior studies have shown this relationship, and current Infectious Diseases Society of America guidelines support neither screening nor treating AB.

Bottom line: In women with recurrent UTIs, previous treatment of AB is associated with higher rates of antibiotic-resistant bacteria, causing symptomatic UTIs.

Citation: Cai T, Nsei G, Mazzoli S, et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infection. Clin Infect Dis. 2015;61(11):1655-1661.

Short Take

National Healthcare Spending Increased in 2014

Led by expansions under the Affordable Care Act, healthcare spending increased 5.3% from the previous year and now totals $3 trillion, which represents 17.5% of the gross domestic product.

Citation: Martin AB, Hartman M, Benson J, Catlin A. National health spending in 2014: faster growth drive by coverage expansion and prescription drug spending. Health Aff. 2016;35(1):150-160.

Short-term low-dose corticosteroid prophylaxis reduces the incidence of graft-vs.-host disease in patients who undergo allogeneic haploidentical stem-cell transplantation to treat hematologic neoplasms, according to a report published online April 18 in the Journal of Clinical Oncology.

The key to selecting patients most likely to benefit from the corticosteroid therapy is to identify those at high risk for graft-vs.-host disease (GVHD) using two biomarkers: high levels of CD56bright natural killer cells in allogeneic grafts or high CD4:CD8 ratios in bone marrow grafts, according to Dr. Ying-Jun Chang of Peking University People’s Hospital, Beijing, and associates.

The investigators performed an open-label trial involving 228 patients aged 15-60 years treated at a single medical center during an 18-month period for acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, myelodysplastic syndrome, or other hematologic neoplasms. Using the two biomarkers, the patients were categorized as either high or low risk for developing GVHD. They were randomly assigned to three study groups: 72 high-risk patients who received short-term low-dose corticosteroids, 73 high-risk patients who received usual care, and 83 low-risk patients who received usual care.

The cumulative 100-day incidence of acute grade-II to grade-IV GVHD was significantly lower in the high-risk patients who received prophylaxis (21%) than in the high-risk patients who did not receive prophylaxis (48%). In fact, corticosteroids decreased the rate of GVHD so that it was comparable with that in the low-risk patients (26%), Dr. Chang and associates said (J Clin Oncol. 2016 Apr 18. doi: 10.1200/JCO.2015.63l.8817).

Moreover, in the high-risk patients the median interval until GVHD developed was 25 days for those who took corticosteroids, compared with only 15 days for those who did not. Median times to myeloid recovery and platelet recovery were significantly shorter for high-risk patients who received corticosteroids than for either of the other study groups. However, 3-year overall survival and leukemia-free survival were comparable among the three study groups.

The short-term low-dose regimen of corticosteroids did not raise the rate of adverse events, including infection, which suggests that it is preferable to standard corticosteroid regimens in this patient population. The incidences of cytomegalovirus or Epstein-Barr virus reactivation, post-transplantation lymphoproliferative disorder, hemorrhagic cystitis, bacteremia, and invasive fungal infections were comparable among the three study groups. Of note, the incidences of osteonecrosis of the femoral head and secondary hypertension were significantly lower among high-risk patients who received corticosteroid prophylaxis than among those who did not.

“These results provide the first test, to our knowledge, of a novel risk-stratification-directed prophylaxis strategy that effectively prevented acute GVHD among patients who were at high risk for GVHD, without unnecessarily exposing patients who were at low risk to excessive toxicity from additional immunosuppressive agents,” Dr. Chang and associates said.

Short-term low-dose corticosteroid prophylaxis reduces the incidence of graft-vs.-host disease in patients who undergo allogeneic haploidentical stem-cell transplantation to treat hematologic neoplasms, according to a report published online April 18 in the Journal of Clinical Oncology.

The key to selecting patients most likely to benefit from the corticosteroid therapy is to identify those at high risk for graft-vs.-host disease (GVHD) using two biomarkers: high levels of CD56bright natural killer cells in allogeneic grafts or high CD4:CD8 ratios in bone marrow grafts, according to Dr. Ying-Jun Chang of Peking University People’s Hospital, Beijing, and associates.

The investigators performed an open-label trial involving 228 patients aged 15-60 years treated at a single medical center during an 18-month period for acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, myelodysplastic syndrome, or other hematologic neoplasms. Using the two biomarkers, the patients were categorized as either high or low risk for developing GVHD. They were randomly assigned to three study groups: 72 high-risk patients who received short-term low-dose corticosteroids, 73 high-risk patients who received usual care, and 83 low-risk patients who received usual care.

The cumulative 100-day incidence of acute grade-II to grade-IV GVHD was significantly lower in the high-risk patients who received prophylaxis (21%) than in the high-risk patients who did not receive prophylaxis (48%). In fact, corticosteroids decreased the rate of GVHD so that it was comparable with that in the low-risk patients (26%), Dr. Chang and associates said (J Clin Oncol. 2016 Apr 18. doi: 10.1200/JCO.2015.63l.8817).

Moreover, in the high-risk patients the median interval until GVHD developed was 25 days for those who took corticosteroids, compared with only 15 days for those who did not. Median times to myeloid recovery and platelet recovery were significantly shorter for high-risk patients who received corticosteroids than for either of the other study groups. However, 3-year overall survival and leukemia-free survival were comparable among the three study groups.

The short-term low-dose regimen of corticosteroids did not raise the rate of adverse events, including infection, which suggests that it is preferable to standard corticosteroid regimens in this patient population. The incidences of cytomegalovirus or Epstein-Barr virus reactivation, post-transplantation lymphoproliferative disorder, hemorrhagic cystitis, bacteremia, and invasive fungal infections were comparable among the three study groups. Of note, the incidences of osteonecrosis of the femoral head and secondary hypertension were significantly lower among high-risk patients who received corticosteroid prophylaxis than among those who did not.

“These results provide the first test, to our knowledge, of a novel risk-stratification-directed prophylaxis strategy that effectively prevented acute GVHD among patients who were at high risk for GVHD, without unnecessarily exposing patients who were at low risk to excessive toxicity from additional immunosuppressive agents,” Dr. Chang and associates said.

Short-term low-dose corticosteroid prophylaxis reduces the incidence of graft-vs.-host disease in patients who undergo allogeneic haploidentical stem-cell transplantation to treat hematologic neoplasms, according to a report published online April 18 in the Journal of Clinical Oncology.

The key to selecting patients most likely to benefit from the corticosteroid therapy is to identify those at high risk for graft-vs.-host disease (GVHD) using two biomarkers: high levels of CD56bright natural killer cells in allogeneic grafts or high CD4:CD8 ratios in bone marrow grafts, according to Dr. Ying-Jun Chang of Peking University People’s Hospital, Beijing, and associates.

The investigators performed an open-label trial involving 228 patients aged 15-60 years treated at a single medical center during an 18-month period for acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, myelodysplastic syndrome, or other hematologic neoplasms. Using the two biomarkers, the patients were categorized as either high or low risk for developing GVHD. They were randomly assigned to three study groups: 72 high-risk patients who received short-term low-dose corticosteroids, 73 high-risk patients who received usual care, and 83 low-risk patients who received usual care.

The cumulative 100-day incidence of acute grade-II to grade-IV GVHD was significantly lower in the high-risk patients who received prophylaxis (21%) than in the high-risk patients who did not receive prophylaxis (48%). In fact, corticosteroids decreased the rate of GVHD so that it was comparable with that in the low-risk patients (26%), Dr. Chang and associates said (J Clin Oncol. 2016 Apr 18. doi: 10.1200/JCO.2015.63l.8817).

Moreover, in the high-risk patients the median interval until GVHD developed was 25 days for those who took corticosteroids, compared with only 15 days for those who did not. Median times to myeloid recovery and platelet recovery were significantly shorter for high-risk patients who received corticosteroids than for either of the other study groups. However, 3-year overall survival and leukemia-free survival were comparable among the three study groups.

The short-term low-dose regimen of corticosteroids did not raise the rate of adverse events, including infection, which suggests that it is preferable to standard corticosteroid regimens in this patient population. The incidences of cytomegalovirus or Epstein-Barr virus reactivation, post-transplantation lymphoproliferative disorder, hemorrhagic cystitis, bacteremia, and invasive fungal infections were comparable among the three study groups. Of note, the incidences of osteonecrosis of the femoral head and secondary hypertension were significantly lower among high-risk patients who received corticosteroid prophylaxis than among those who did not.

“These results provide the first test, to our knowledge, of a novel risk-stratification-directed prophylaxis strategy that effectively prevented acute GVHD among patients who were at high risk for GVHD, without unnecessarily exposing patients who were at low risk to excessive toxicity from additional immunosuppressive agents,” Dr. Chang and associates said.

In allogeneic hematopoietic stem-cell transplantation, the donor’s status regarding Epstein-Barr virus affects the recipient’s risk of developing graft-vs-host disease – a “completely new and striking” finding, according to a report published online April 18 in the Journal of Clinical Oncology.

Approximately 80% of the general population has been infected with EBV and carries persistent virus in memory B cells. When viral material is transmitted to stem-cell recipients, it is known to cause posttransplantation lymphoproliferative disorder. Until now, however, no data were available to examine EBV serology’s effect on other posttransplantation outcomes, said Dr. Jan Styczynski of the department of pediatric hematology and oncology at Nicolaus Copernicus University, Bydgoszcz, Poland, and his associates.

They analyzed information in the European Society of Blood and Marrow Transplantation database for 11,364 patients with acute lymphoblastic leukemia or acute myeloblastic leukemia who underwent stem-cell transplantation between 1997 and 2012 and who were followed for approximately 5 years. Most of the donors (82%) were seropositive for EBV. Acute graft-vs-host disease (GVHD) developed in 32% and chronic GVHD developed in 40% of these stem cell–transplant recipients.

The incidence of chronic GVHD was significantly higher when the donor was EBV-seropositive (41%) than when the donor was EBV-seronegative (31%). Similarly, the incidence of acute GVHD was significantly higher when the donor was EBV-seropositive (32% vs 30%), but the magnitude of the difference between the two groups was smaller. The risk for GVHD increased even though patients receiving transplants from EBV-seropositive donors underwent more intensive GVHD prophylaxis than did those who had seronegative donors, the investigators said (J Clin Oncol. 2016 Apr 18. doi: 10.1200/JCO.2015.64.2405).

In contrast, the transplant recipients’ EBV status did not affect their risk of developing GVHD.

“Despite the effect of donor EBV serostatus on GVHD, we did not observe a corresponding GVHD-related death rate, and as a result, there was no effect on overall survival, relapse-free survival, relapse incidence, and nonrelapse mortality. However, it should be kept in mind that many other pre- and posttransplantation factors play a role in contributing to final transplantation outcomes,” Dr. Styczynski and his associates noted.

The current recommendation to monitor transplantation recipients for EBV and to give them “preemptive” rituximab to stave off the development of posttransplantation lymphoproliferative disorder might prove useful in also preventing GVHD, they added.

In allogeneic hematopoietic stem-cell transplantation, the donor’s status regarding Epstein-Barr virus affects the recipient’s risk of developing graft-vs-host disease – a “completely new and striking” finding, according to a report published online April 18 in the Journal of Clinical Oncology.

Approximately 80% of the general population has been infected with EBV and carries persistent virus in memory B cells. When viral material is transmitted to stem-cell recipients, it is known to cause posttransplantation lymphoproliferative disorder. Until now, however, no data were available to examine EBV serology’s effect on other posttransplantation outcomes, said Dr. Jan Styczynski of the department of pediatric hematology and oncology at Nicolaus Copernicus University, Bydgoszcz, Poland, and his associates.

They analyzed information in the European Society of Blood and Marrow Transplantation database for 11,364 patients with acute lymphoblastic leukemia or acute myeloblastic leukemia who underwent stem-cell transplantation between 1997 and 2012 and who were followed for approximately 5 years. Most of the donors (82%) were seropositive for EBV. Acute graft-vs-host disease (GVHD) developed in 32% and chronic GVHD developed in 40% of these stem cell–transplant recipients.

The incidence of chronic GVHD was significantly higher when the donor was EBV-seropositive (41%) than when the donor was EBV-seronegative (31%). Similarly, the incidence of acute GVHD was significantly higher when the donor was EBV-seropositive (32% vs 30%), but the magnitude of the difference between the two groups was smaller. The risk for GVHD increased even though patients receiving transplants from EBV-seropositive donors underwent more intensive GVHD prophylaxis than did those who had seronegative donors, the investigators said (J Clin Oncol. 2016 Apr 18. doi: 10.1200/JCO.2015.64.2405).

In contrast, the transplant recipients’ EBV status did not affect their risk of developing GVHD.

“Despite the effect of donor EBV serostatus on GVHD, we did not observe a corresponding GVHD-related death rate, and as a result, there was no effect on overall survival, relapse-free survival, relapse incidence, and nonrelapse mortality. However, it should be kept in mind that many other pre- and posttransplantation factors play a role in contributing to final transplantation outcomes,” Dr. Styczynski and his associates noted.

The current recommendation to monitor transplantation recipients for EBV and to give them “preemptive” rituximab to stave off the development of posttransplantation lymphoproliferative disorder might prove useful in also preventing GVHD, they added.

In allogeneic hematopoietic stem-cell transplantation, the donor’s status regarding Epstein-Barr virus affects the recipient’s risk of developing graft-vs-host disease – a “completely new and striking” finding, according to a report published online April 18 in the Journal of Clinical Oncology.

Approximately 80% of the general population has been infected with EBV and carries persistent virus in memory B cells. When viral material is transmitted to stem-cell recipients, it is known to cause posttransplantation lymphoproliferative disorder. Until now, however, no data were available to examine EBV serology’s effect on other posttransplantation outcomes, said Dr. Jan Styczynski of the department of pediatric hematology and oncology at Nicolaus Copernicus University, Bydgoszcz, Poland, and his associates.

They analyzed information in the European Society of Blood and Marrow Transplantation database for 11,364 patients with acute lymphoblastic leukemia or acute myeloblastic leukemia who underwent stem-cell transplantation between 1997 and 2012 and who were followed for approximately 5 years. Most of the donors (82%) were seropositive for EBV. Acute graft-vs-host disease (GVHD) developed in 32% and chronic GVHD developed in 40% of these stem cell–transplant recipients.

The incidence of chronic GVHD was significantly higher when the donor was EBV-seropositive (41%) than when the donor was EBV-seronegative (31%). Similarly, the incidence of acute GVHD was significantly higher when the donor was EBV-seropositive (32% vs 30%), but the magnitude of the difference between the two groups was smaller. The risk for GVHD increased even though patients receiving transplants from EBV-seropositive donors underwent more intensive GVHD prophylaxis than did those who had seronegative donors, the investigators said (J Clin Oncol. 2016 Apr 18. doi: 10.1200/JCO.2015.64.2405).

In contrast, the transplant recipients’ EBV status did not affect their risk of developing GVHD.

“Despite the effect of donor EBV serostatus on GVHD, we did not observe a corresponding GVHD-related death rate, and as a result, there was no effect on overall survival, relapse-free survival, relapse incidence, and nonrelapse mortality. However, it should be kept in mind that many other pre- and posttransplantation factors play a role in contributing to final transplantation outcomes,” Dr. Styczynski and his associates noted.

The current recommendation to monitor transplantation recipients for EBV and to give them “preemptive” rituximab to stave off the development of posttransplantation lymphoproliferative disorder might prove useful in also preventing GVHD, they added.

Immunotherapies that target abnormally activated T and B cells may represent a unique combination and promising DMT strategy for patients with RRMS and have the greatest potential for long-term success. Targeting T cells in MS may help attenuate initiation and maintenance of inflammatory attacks by reducing the production of pro-inflammatory cytokines, recruitment of innate immune cells, stimulation of antibody production, and direct attack of myelin. Targeting B cells in MS may attenuate secretion of autoantibodies and pro-inflammatory cytokines, as well as presentation of self-antigen to T cells.

Click here to read the digital edition.

Immunotherapies that target abnormally activated T and B cells may represent a unique combination and promising DMT strategy for patients with RRMS and have the greatest potential for long-term success. Targeting T cells in MS may help attenuate initiation and maintenance of inflammatory attacks by reducing the production of pro-inflammatory cytokines, recruitment of innate immune cells, stimulation of antibody production, and direct attack of myelin. Targeting B cells in MS may attenuate secretion of autoantibodies and pro-inflammatory cytokines, as well as presentation of self-antigen to T cells.

Click here to read the digital edition.

Immunotherapies that target abnormally activated T and B cells may represent a unique combination and promising DMT strategy for patients with RRMS and have the greatest potential for long-term success. Targeting T cells in MS may help attenuate initiation and maintenance of inflammatory attacks by reducing the production of pro-inflammatory cytokines, recruitment of innate immune cells, stimulation of antibody production, and direct attack of myelin. Targeting B cells in MS may attenuate secretion of autoantibodies and pro-inflammatory cytokines, as well as presentation of self-antigen to T cells.

Click here to read the digital edition.

Overall activity of influenza-like illness (ILI) in the United States continued to fall, but New Jersey took a turn for the worse during the week ending April 9, 2016, according to the Centers for Disease Control and Prevention.

New Jersey’s ILI activity level went from 8 the previous week to 10 on the CDC’s 1-10 scale. For the week ending April 9, it was the only U.S. state in the “high” range, with Hawaii the next highest at level 6 – the only state in the “moderate” range, the CDC reported.

Nationwide, the proportion of outpatient visits for ILI was 2.1%, which is at the national baseline of 2.1% and down from 2.5% the week before. That number has now dropped for 4 consecutive weeks since hitting a season high of 3.7% for the week ending March 12. The CDC also reported a cumulative rate of 26.6 influenza-associated hospitalizations per 100,000 population.

Ten flu-related pediatric deaths were reported during the week, of which only one occurred during the week. A total of 50 flu-related pediatric deaths have been reported during the 2015-2016 season, the CDC said. The overall proportion of deaths attributed to pneumonia and influenza was below the system-specific threshold in the National Center for Health Statistics Mortality Surveillance System, but above the system-specific threshold in the 122 Cities Mortality Reporting System.

rfranki@frontlinemedcom.com

Overall activity of influenza-like illness (ILI) in the United States continued to fall, but New Jersey took a turn for the worse during the week ending April 9, 2016, according to the Centers for Disease Control and Prevention.

New Jersey’s ILI activity level went from 8 the previous week to 10 on the CDC’s 1-10 scale. For the week ending April 9, it was the only U.S. state in the “high” range, with Hawaii the next highest at level 6 – the only state in the “moderate” range, the CDC reported.

Nationwide, the proportion of outpatient visits for ILI was 2.1%, which is at the national baseline of 2.1% and down from 2.5% the week before. That number has now dropped for 4 consecutive weeks since hitting a season high of 3.7% for the week ending March 12. The CDC also reported a cumulative rate of 26.6 influenza-associated hospitalizations per 100,000 population.

Ten flu-related pediatric deaths were reported during the week, of which only one occurred during the week. A total of 50 flu-related pediatric deaths have been reported during the 2015-2016 season, the CDC said. The overall proportion of deaths attributed to pneumonia and influenza was below the system-specific threshold in the National Center for Health Statistics Mortality Surveillance System, but above the system-specific threshold in the 122 Cities Mortality Reporting System.

rfranki@frontlinemedcom.com

Overall activity of influenza-like illness (ILI) in the United States continued to fall, but New Jersey took a turn for the worse during the week ending April 9, 2016, according to the Centers for Disease Control and Prevention.

New Jersey’s ILI activity level went from 8 the previous week to 10 on the CDC’s 1-10 scale. For the week ending April 9, it was the only U.S. state in the “high” range, with Hawaii the next highest at level 6 – the only state in the “moderate” range, the CDC reported.

Nationwide, the proportion of outpatient visits for ILI was 2.1%, which is at the national baseline of 2.1% and down from 2.5% the week before. That number has now dropped for 4 consecutive weeks since hitting a season high of 3.7% for the week ending March 12. The CDC also reported a cumulative rate of 26.6 influenza-associated hospitalizations per 100,000 population.

Ten flu-related pediatric deaths were reported during the week, of which only one occurred during the week. A total of 50 flu-related pediatric deaths have been reported during the 2015-2016 season, the CDC said. The overall proportion of deaths attributed to pneumonia and influenza was below the system-specific threshold in the National Center for Health Statistics Mortality Surveillance System, but above the system-specific threshold in the 122 Cities Mortality Reporting System.

rfranki@frontlinemedcom.com

VANCOUVER—Women with epilepsy seeking pregnancy had comparable likelihood of achieving pregnancy, time to achieve pregnancy, and pregnancy outcomes, compared with a group of healthy peers, according to study findings presented at the 68th Annual Meeting of the American Academy of Neurology. "These findings should reassure women with epilepsy and clinicians when counseling women with epilepsy who are planning pregnancy," said Page B. Pennell, MD, Associate Professor of Neurology at Brigham and Women's Hospital and Harvard Medical School in Boston, and her research colleagues.

Page B. Pennell, MD, Associate Professor of Neurology at Brigham and Women's Hospital and Harvard Medical School in Boston, and her research colleagues.

Page B. Pennell, MD

Previous studies suggested that women with epilepsy have lower fertility compared with healthy controls. Dr. Pennell and colleagues sought to compare time to pregnancy and outcomes (eg, live birth, miscarriage) among women with epilepsy and healthy controls. The Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) study was a multicenter, prospective, observational study of women with epilepsy and healthy controls.

Dr. Pennell and colleagues enrolled and prospectively followed women with epilepsy and healthy controls, ages 18 to 41, seeking pregnancy within six months of discontinuing contraception. The customized WEPOD electronicdiary captured medication use, seizures, sexual activity, and menstrual bleeding. Pregnancy tests were performed if there was no menses by cycle day 35. Outcomes included proportions of women who achieved pregnancy and time to pregnancy from cessation of birth control. The researchers used a proportional hazard model to evaluate the association between time to pregnancy and certain baseline characteristics.

Enrolled in the study were 88 women with epilepsy and 109 healthy controls with similar demographic characteristics. Among women with epilepsy, 61.4% achieved pregnancy versus 60.6% for healthy controls. Median time to pregnancy was six months in women with epilepsy, compared with nine months for healthy controls. Time to pregnancy was no different across the two groups after controlling for age, BMI, parity, and race. Race and parity were significantly associated with time to pregnancy.

Of the pregnancies that occurred, a similar proportion resulted in miscarriage (12.9% among women with epilepsy and 19.7% among controls), live birth (80.0% among women with epilepsy and 80.3% controls) or other outcome (5.0% versus 0.0%).

The WEPOD study was supported by the Epilepsy Foundation.

VANCOUVER—Women with epilepsy seeking pregnancy had comparable likelihood of achieving pregnancy, time to achieve pregnancy, and pregnancy outcomes, compared with a group of healthy peers, according to study findings presented at the 68th Annual Meeting of the American Academy of Neurology. "These findings should reassure women with epilepsy and clinicians when counseling women with epilepsy who are planning pregnancy," said Page B. Pennell, MD, Associate Professor of Neurology at Brigham and Women's Hospital and Harvard Medical School in Boston, and her research colleagues.

Page B. Pennell, MD, Associate Professor of Neurology at Brigham and Women's Hospital and Harvard Medical School in Boston, and her research colleagues.

Page B. Pennell, MD

Previous studies suggested that women with epilepsy have lower fertility compared with healthy controls. Dr. Pennell and colleagues sought to compare time to pregnancy and outcomes (eg, live birth, miscarriage) among women with epilepsy and healthy controls. The Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) study was a multicenter, prospective, observational study of women with epilepsy and healthy controls.

Dr. Pennell and colleagues enrolled and prospectively followed women with epilepsy and healthy controls, ages 18 to 41, seeking pregnancy within six months of discontinuing contraception. The customized WEPOD electronicdiary captured medication use, seizures, sexual activity, and menstrual bleeding. Pregnancy tests were performed if there was no menses by cycle day 35. Outcomes included proportions of women who achieved pregnancy and time to pregnancy from cessation of birth control. The researchers used a proportional hazard model to evaluate the association between time to pregnancy and certain baseline characteristics.

Enrolled in the study were 88 women with epilepsy and 109 healthy controls with similar demographic characteristics. Among women with epilepsy, 61.4% achieved pregnancy versus 60.6% for healthy controls. Median time to pregnancy was six months in women with epilepsy, compared with nine months for healthy controls. Time to pregnancy was no different across the two groups after controlling for age, BMI, parity, and race. Race and parity were significantly associated with time to pregnancy.

Of the pregnancies that occurred, a similar proportion resulted in miscarriage (12.9% among women with epilepsy and 19.7% among controls), live birth (80.0% among women with epilepsy and 80.3% controls) or other outcome (5.0% versus 0.0%).

The WEPOD study was supported by the Epilepsy Foundation.

VANCOUVER—Women with epilepsy seeking pregnancy had comparable likelihood of achieving pregnancy, time to achieve pregnancy, and pregnancy outcomes, compared with a group of healthy peers, according to study findings presented at the 68th Annual Meeting of the American Academy of Neurology. "These findings should reassure women with epilepsy and clinicians when counseling women with epilepsy who are planning pregnancy," said Page B. Pennell, MD, Associate Professor of Neurology at Brigham and Women's Hospital and Harvard Medical School in Boston, and her research colleagues.

Page B. Pennell, MD, Associate Professor of Neurology at Brigham and Women's Hospital and Harvard Medical School in Boston, and her research colleagues.

Page B. Pennell, MD

Previous studies suggested that women with epilepsy have lower fertility compared with healthy controls. Dr. Pennell and colleagues sought to compare time to pregnancy and outcomes (eg, live birth, miscarriage) among women with epilepsy and healthy controls. The Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) study was a multicenter, prospective, observational study of women with epilepsy and healthy controls.

Dr. Pennell and colleagues enrolled and prospectively followed women with epilepsy and healthy controls, ages 18 to 41, seeking pregnancy within six months of discontinuing contraception. The customized WEPOD electronicdiary captured medication use, seizures, sexual activity, and menstrual bleeding. Pregnancy tests were performed if there was no menses by cycle day 35. Outcomes included proportions of women who achieved pregnancy and time to pregnancy from cessation of birth control. The researchers used a proportional hazard model to evaluate the association between time to pregnancy and certain baseline characteristics.

Enrolled in the study were 88 women with epilepsy and 109 healthy controls with similar demographic characteristics. Among women with epilepsy, 61.4% achieved pregnancy versus 60.6% for healthy controls. Median time to pregnancy was six months in women with epilepsy, compared with nine months for healthy controls. Time to pregnancy was no different across the two groups after controlling for age, BMI, parity, and race. Race and parity were significantly associated with time to pregnancy.

Of the pregnancies that occurred, a similar proportion resulted in miscarriage (12.9% among women with epilepsy and 19.7% among controls), live birth (80.0% among women with epilepsy and 80.3% controls) or other outcome (5.0% versus 0.0%).

The WEPOD study was supported by the Epilepsy Foundation.

The Vascular Research Initiatives Conference - VRIC - is less than three weeks away. The one-day conference, on May 4 in Nashville, focuses on translational research. This year’s theme is “Outside In: Paradigm Shifts in Vascular Disease.”

VRIC takes place the day before the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) Scientific Sessions, and at the same venue in Nashville. VRIC is considered a key event for meeting and reconnecting with vascular research collaborators.

The Vascular Research Initiatives Conference - VRIC - is less than three weeks away. The one-day conference, on May 4 in Nashville, focuses on translational research. This year’s theme is “Outside In: Paradigm Shifts in Vascular Disease.”

VRIC takes place the day before the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) Scientific Sessions, and at the same venue in Nashville. VRIC is considered a key event for meeting and reconnecting with vascular research collaborators.

The Vascular Research Initiatives Conference - VRIC - is less than three weeks away. The one-day conference, on May 4 in Nashville, focuses on translational research. This year’s theme is “Outside In: Paradigm Shifts in Vascular Disease.”

VRIC takes place the day before the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) Scientific Sessions, and at the same venue in Nashville. VRIC is considered a key event for meeting and reconnecting with vascular research collaborators.

The Patient-Centered Outcomes Research Institute (PCORI) has announced new funding for pragmatic clinical trials, large simple trials or large-scale observational studies that compare the relative effectiveness of two or more alternatives for improving patient-centered outcomes.

Up to $1 million in direct costs for each study will be available through the initiative, “Pragmatic Clinical Studies to Evaluate Patient-Centered Outcomes.”

PCORI has a list of priority topics, though any study that addresses critical choices faced by patients, caregivers, clinicians and/or delivery systems will be considered.

Deadline for letters of intent is May 4. Application deadline is Aug. 8, and awards will be announced in January 2017.

The Patient-Centered Outcomes Research Institute (PCORI) has announced new funding for pragmatic clinical trials, large simple trials or large-scale observational studies that compare the relative effectiveness of two or more alternatives for improving patient-centered outcomes.

Up to $1 million in direct costs for each study will be available through the initiative, “Pragmatic Clinical Studies to Evaluate Patient-Centered Outcomes.”

PCORI has a list of priority topics, though any study that addresses critical choices faced by patients, caregivers, clinicians and/or delivery systems will be considered.

Deadline for letters of intent is May 4. Application deadline is Aug. 8, and awards will be announced in January 2017.

The Patient-Centered Outcomes Research Institute (PCORI) has announced new funding for pragmatic clinical trials, large simple trials or large-scale observational studies that compare the relative effectiveness of two or more alternatives for improving patient-centered outcomes.

Up to $1 million in direct costs for each study will be available through the initiative, “Pragmatic Clinical Studies to Evaluate Patient-Centered Outcomes.”

PCORI has a list of priority topics, though any study that addresses critical choices faced by patients, caregivers, clinicians and/or delivery systems will be considered.

Deadline for letters of intent is May 4. Application deadline is Aug. 8, and awards will be announced in January 2017.