Browsing by Author "Gomez, Mariana"

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    Dalbavancin as sequential therapy for infective endocarditis due to Gram-positive organisms: A review
    Fazili, Tasaduq; Bansal, Ekta N.; Garner, Dorothy; Gomez, Mariana; Stornelli, Nicholas (Elsevier, 2023-02)
    Dalbavancin is a parenteral lipoglycopeptide antibiotic derived from teicoplanin, an analog of vancomycin. It is mainly used for skin and soft tissue infections. The sustained half-life of around 14 days makes dalbavancin a novel option for potential use as sequential treatment in infections like infective endocarditis, which require prolonged antibiotic courses. However, only a few studies have been reported in the literature and its use remains limited. We reviewed the currently available literature using dalbavancin in the treatment of infective endocarditis due to Gram-positive organisms. Almost all patients received dalbavancin as sequential therapy following standard of care antibiotics. The overall clinical efficacy was around 90% and it appeared to be well tolerated.
  • Hepatitis C infection: A public health menace
    Gomez, Mariana (2023-05-05)
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    Profiling renal dysfunction using Raman chemometric urinalysis, with special reference to COVID19, lupus nephritis, and diabetic nephropathy
    Robertson, John L.; Issa, Amr Sayed; Gomez, Mariana; Sullivan, Kathleen; Senger, Ryan S. (Knowledge Enterprise Journals, 2023-09-30)
    Background: Many systemic and urinary tract diseases alter renal structure and function, including changing the composition of urine. While routine urinalysis (physical properties, sediment evaluation, urine chemistry analytes) is useful in screening, it has limitations on separating disease processes, structural changes, and functional abnormalities. Likewise, while many individual ‘biomarkers’ have been used to screen for disease, they have not met with widespread clinical adoption. The recent COVID19 Pandemic and the recognition of post-acute sequelae SARS-CoV-2 infection (PASC) have highlighted the need for rapid, scalable, economical, and accurate screening tools for managing disease. Aims: Validate a Raman spectroscopy-based screening technology for urine analysis that could be used for recognition and quantification of systemic and renal effects of acute and PASC COVID19 disease. Methods: One hundred ten (110) urine specimens were obtained from consented adults diagnosed with COVID19 disease by RT-PCR and/or proximate (household) contact With RT-PCR-confirmed COVID19 disease. Samples were analyzed using Raman chemometric urinalysis, a technology that detects hundreds of discrete chemicals in urine and applies computational comparison-machine learning to detect COVID19-associated molecular patterns (‘fingerprints’). Results: When compared with the urine multimolecular ‘fingerprints’ of healthy individuals and patients with known systemic diseases (diabetes mellitus, lupus) that alter renal structure and function, patients with acute and PASC COVID19 had unique ‘fingerprints’ indicative of alterations in renal function (i.e. – infection altered urine composition). Differences in disease severity (mild to severe) were reflected by different ‘fingerprints’ in urine. Roughly 20% of hospitalized patients developed a degree of renal dysfunction (decrements in eGFR) that were correlated with distinct changes in urine fingerprints. Conclusion: Raman chemometric urinalysis may be a useful tool in management of patients with COVID19 disease, particularly in detecting patients with evolving renal dysfunction for whom there should be attention to medication use and renal health restoration/preservation.
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    A Rare Case of Mycobacterium chelonae Septic Joint
    Torres, Jordan L.; Zhao, Yang; Griffin, Daniel; Baffoe-Bonnie, Anthony W.; Grider, Douglas J.; Gomez, Mariana (2022-10-21)
    Background: Nontuberculous mycobacteria (NTM) are abundant in soil and water. They can cause infection by direct inoculation via even minimal trauma. Chronic soft tissue infection may extend to involve joints and underlying bone by direct extension. Septic joint infections due to NTM are rare and much of what is known about their management is either taken from case reports or extrapolated from the tuberculosis literature. Methods: Here we describe a case of septic ankle due to M. chelonae, a rapidly growing NTM. We also review the literature of mycobacterial infection, prognosis, and the treatment pharmacology of these difficult to treat infections. Results: An 86-year-old man presented to our hospital with complaints of a painful, swollen, left ankle. Three months earlier he had seen a pimple on his left foot after tripping over a lawn mower. The lesion evolved into erythema and swelling of the left ankle which was so painful that he could not bear weight on his left lower extremity (LLE). MRI of the LLE revealed a comminuted nondisplaced fracture of the distal tibial metaphysis. Turbid joint fluid was aspirated, and cell studies showed 211,450 k/uL white blood cells with 97% neutrophils. Patient underwent partial removal of the left tibia with insertion of a drug implant device. Tissue culture grew acid fast bacilli. Histopathology also showed acid-fast bacilli, confirming an atypical mycobacterial infection. Meropenem, linezolid, and azithromycin were initiated until the organism was identified as Mycobacterium chelonae. Based on susceptibility report, meropenem was discontinued, and ciprofloxacin was initiated. After discharge, a repeat MRI showed possible osteomyelitis and small abscesses about the left ankle. This prompted a repeat debridement. Tobramycin was started and ciprofloxacin was discontinued. The patient was re-admitted shortly after discharge with acute renal failure and lactic acidosis; he ultimately passed away on comfort care per patient and family wishes. Conclusion: NTM are more resistant to antimycobacterial therapy compared with mycobacteria tuberculosis (MTb) and repeat surgical debridement is often necessary for cure. Because these cases are rare, it is important to approach treatment as a team including ID physicians, ID pharmacists, and surgeons to improve outcomes.