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Candida auris is a new drug-resistant fungus emerging globally and in the US early detection is key to controlling spread of deadly drug-resistant fungus

July 29, 2019

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. Candida auris is a new drug-resistant fungus emerging globally and in the U.S. Early detection is key to controlling spread of deadly drug-resistant fungus

Physicians should be aware of risk factors and screen patients suspected of infection or colonization

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2205 URLs go live when the embargo lifts

Early identification of Candida auris, a potentially deadly fungus that causes bloodstream and intra-abdominal infections, is the key to controlling its spread. Its emergence has highlighted gaps in fungal identification capacity in the U.S. and around the world, and physicians should be on alert for risk factors. A commentary is published in Annals of Internal Medicine.

Candida auris is different from more familiar Candida species in several ways and its drug resistance is unprecedented among known human-pathogenic yeasts. Most Candida species are not believed to be transmitted in health care settings and do not require infection control measures when a patient develops an infection. However, unlike other Candida species, C auris is commonly transmitted between patients in health care settings, causing outbreaks that not only affect a single facility but also spread through networks of facilities. The ability of C auris to persist in and contaminate the health care environment and medical devices likely contributes to these outbreaks.

According to experts from the Centers for Disease Control and Prevention (CDC), previous hospitalization in a country with C auris transmission is a known risk factor for infection or colonization, as is receiving of health care in long-term acute care hospitals and nursing homes that take care of very sick patients who need long-term ventilators. Frequent hospitalizations and receiving of multiple courses of very-broad-spectrum antibiotics are also important risk factors. The authors suggest that being on high alert for these risk factors and screening appropriate patients is the key to controlling the spread of C auris.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Snigdha Vallabhaneni, MD, MPH, please contact media@cdc.gov.

2. Google Translate proves accurate for translating medical research into English

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0891

URLs go live when the embargo lifts

Google Translate is a viable, accurate tool for translating non-English language trials for the purpose of conducting systematic reviews. Using this tool could help researchers maximize the number of trials available to include in scientific evidence reviews. Findings from a brief research report are published in Annals of Internal Medicine.

A critical marker of high-quality systematic reviews is the identification and inclusion of all relevant studies. Many systematic reviews have language restrictions, which can exclude important trials. A 2012 study assessing Google Translate recommended caution in using this service.

Researchers from around the world, let by a team from the Medical College of Wisconsin, searched PubMed for randomized controlled trials (RCTs) published in 9 languages (Chinese, French, German, Italian, Japanese, Korean, Romanian, Russian, and Spanish) over an 18 year period to determine how accurately Google Translate translated the data into English for the purpose of abstracting data for systematic reviews. Data from the original-language versions of the RCTs were abstracted by native-speaking physicians whose experience in conducting systematic reviews varied. In total, 6,370 variables from 45 articles were abstracted, with 91 percent overall agreement. Agreement for the 9 languages ranted from 85 percent to 97 percent. According to the researchers, these results suggest that Google Translate is a viable tool for translating articles published in languages other than English and that Google Translate is more accurate than previously reported.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Jeffrey L. Jackson, MD, MPH, please contact him directly at jjackson@mcw.edu.

3. SGLT-2 inhibitors not associated with increased risk for severe UTI

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3136

Editorial: http://annals.org/aim/article/doi/10.7326/M18-1950

URLs go live when the embargo lifts

Patients taking sodium-glucose cotransporter-2 (SGLT-2) inhibitors do not seem to be at increased risk for severe urinary tract infections (UTIs) when compared to patients to patients taking other second-line antidiabetic therapies. Findings from a population-based cohort study are published in Annals of Internal Medicine.

Due to their mechanism of action, SGLT-2 inhibitors are thought to increase the risk for UTIs. In 2015, the U.S. Food and Drug Administration issued a warning about increased risk for serious UTIs with SGLT-2 inhibitor use, based on 19 cases of urosepsis and pyelonephritis reported to the Administration's Adverse Event Reporting System. Given the limitations of the data, it is not clear if this risk is present in clinical practice.

Researchers from Brigham and Women's Hospital studied two large, U.S.-based databases of commercial claims to assess whether patients initiating use of SGLT-2 inhibitors were at increased risk for severe UTI events compared with those initiating use of dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide-1 receptor (GLP-1) agonists. Two cohorts were created and matched 1:1 on propensity score. UTI events among patients using SGLT-2 inhibitors were similar to those using other antidiabetic medications in both cohorts. According to the researchers, these findings suggest that other factors beyond risk for UTI should be considered in decisions about whether to prescribe SGLT-2 therapy for patients with diabetes in routine care settings.

The authors of an accompanying editorial from McGill University and Lady Davis Institute at the Jewish General Hospital say that these findings are reassuring, but should be considered with some caution. First, the study excluded high-risk patients and those with a history of UTI, key subgroups for which further evidence is needed. Second, some analyses of secondary outcomes (such as urosepsis) in some comparisons had more modest statistical power, suggesting further safety assessments may be needed to address these issues.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Chintan V. Dave, PharmD, PhD, please contact chintandave19@gmail.com. To reach the author of the accompanying editorial, Kristian Filion, PhD, please contact Tod Hoffman at tod.hoffman@ladydavis.ca.

4. Cardiac device implantation complications vary widely among hospitals

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2810

Editorial: http://annals.org/aim/article/doi/10.7326/M19-1895

URLs go live when the embargo lifts

Quality of care may account for the wide variation in complication rates seen among hospitals following cardiovascular implantable electronic device (CIED) procedures. Findings from a cohort study are published in Annals of Internal Medicine.

CIEDs, including permanent pacemakers and implantable cardioverter-defibrillators, are among the most common and costly devices implanted in hospitals. While effective, these devices are associated with early device-related complications, such as infection, pneumothorax, and lead dislodgement. Whether or not these complications vary among institutions has not been confirmed.

Researchers from the University of Adelaide, South Australia, studied patient records at 174 hospitals in Australia and New Zealand to assess institutional variation in risk-standardized rates of CIED complications. The study included 81,304 patients who received a new CIED with 65,711 permanent pacemakers and 15,593 implantable cardioverter-defibrillators. The data showed that CIED complications are common (8.2 percent of patients with new CIEDs had a major device-related complication within 90 days) and complication rates varied 2-3 fold among hospitals, suggesting institutional variation in CIED care quality. Most of the complications were attributed to pacemakers which were implanted far more frequently. The authors suggest that concerted clinical and policy interventions may be needed to address CIED-related complications, especially for pacemakers.

The authors of an accompanying editorial from McMaster University say that this study adds to the understanding of the early complications associated with CIEDs and the institutional variability in the quality of CIED implantation.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Isuru Ranasinghe, MBChB, MMed, PhD please contact Crispin Savage at crispin.savage@adelaide.edu.au. To reach the lead editorialist, Jorge A. Wong, MD, MPH, please contact Jorge A. Wong, MD, MPH at Jorge.Wong@phri.ca.
-end-
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