NCT01995695 and NCT02274545.

No abstract

The emergence of the novel coronavirus, SARS-CoV-2, and its associated clinical syndrome, COVID-19, resulted in the largest global pandemic since the 1918 influenza. While widespread in the general population, to date, there are few reports of COVID-19 in solid organ transplant (SOT) recipients. 1-5 Herein, we report a case of COVID-19 infection in the early postoperative period following lung transplantation (LT). A 68 year-old white female with idiopathic pulmonary fibrosis, gastroesophageal reflux disease, hyperlipidemia, and psoriasis was listed for bilateral LT with a lung allocation score of 31.8784. At admission for transplant, the patient reported feeling well without symptoms of acute respiratory infection. Vital signs included temperature, 37.1°C; heart rate, 78 beats per minute; blood pressure, 124/83 mm Hg; and oxygen saturation, 94% on 3 L/min oxygen. The donor, a 30 year-old female with a history of hypertension and inflammatory bowel disease treated with a tumor necrosis factor inhibitor presented to the hospital with severe headache, confusion, and vomiting. There was no history of fever or respiratory symptoms. She was intubated, and head CT revealed a large intracerebral hemorrhage. Due to poor neurologic prognosis, her family elected to pursue organ donation following cardiac death. Chest CT demonstrated "focal areas of consolidation in the bilateral dependent lower lobes with adjacent tree-in-bud opacities most consistent with pneumonia, possibly secondary to aspiration" (Figure 1A). Bronchoscopic examination identified erythematous mucosa of the trachea and main carina with purulent secretions in all lobes. Bronchoalveolar lavage (BAL) culture resulted in normal upper respiratory flora. No viral testing was performed, and no confirmed COVID-19 cases had been reported in the county of the donor hospital. p a O 2 on the last challenge arterial blood gas prior to procurement was 482 mm Hg.

What is known Daptomycin is associated with a number of adverse effects including eosinophilic pneumonia, hypersensitivity reaction, myopathy, rhabdomyolysis, headache and transaminitis. The adverse effects of high‐dose daptomycin have not been fully evaluated in patients with end‐stage renal disease (ESRD). Objective To determine the incidence and characteristics of significant adverse effects in patients receiving high‐dose daptomycin with severe renal dysfunction. Methods A single‐centre, retrospective study was conducted to assess safety outcomes of high‐dose daptomycin in patients with an estimated creatinine clearance less than 30 mL/min. Adult patients aged 18 to 89 years admitted between 1 July 2015 and 1 July 2019 were eligible for inclusion. Patients must have received definitive daptomycin therapy with doses greater than or equal to 7.5 mg/kg based on actual body weight. The primary outcome was overall incidence of creatine phosphokinase (CK) elevation, myopathy and rhabdomyolysis. Results and discussion A total of 74 patients who received daptomycin therapy were screened with 50 included in the study. The population was well distributed in terms of gender (48% male, n = 24) with a median age of 61 (IQR, 48‐67) years. The primary indication for daptomycin use was Gram‐positive bacteremia. The median daptomycin dose was 750 (IQR, 600‐875) mg, or 8.46 (IQR, 7.92‐9.96) mg/kg based on actual body weight, with a median patient weight of 81 (IQR, 65‐113) kg. The median duration of therapy was 27 (IQR, 14‐42) days. One patient experienced significant CK elevation while on daptomycin therapy with rhabdomyolysis; however, daptomycin was continued as there was an alternative explanation for an elevated CK. One patient experienced daptomycin discontinuation due to CK elevation without meeting the definition for significant CK elevation. What is new and conclusion In a cohort of patients with severe renal dysfunction treated with daptomycin 7.5 mg/kg or greater, significant CK elevation on daptomycin therapy was infrequently observed. Future research should confirm these findings, with special consideration for higher mg/kg dosages and/or obese populations.

This study reports that focused collaboration between infectious diseases and emergency medicine providers results in increased identification of patients with syphilis and HIV in the emergency department.