Browsing by Author "Ruffin, F"
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Item Open Access Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.(Clin Infect Dis, 2015-11-01) Lantos, PM; Branda, JA; Boggan, JC; Chudgar, SM; Wilson, EA; Ruffin, F; Fowler, VG; Auwaerter, PG; Nigrovic, LEBACKGROUND: Lyme disease is diagnosed by 2-tiered serologic testing in patients with a compatible clinical illness, but the significance of positive test results in low-prevalence regions has not been investigated. METHODS: We reviewed the medical records of patients who tested positive for Lyme disease with standardized 2-tiered serologic testing between 2005 and 2010 at a single hospital system in a region with little endemic Lyme disease. Based on clinical findings, we calculated the positive predictive value of Lyme disease serology. Next, we reviewed the outcome of serologic testing in patients with select clinical syndromes compatible with disseminated Lyme disease (arthritis, cranial neuropathy, or meningitis). RESULTS: During the 6-year study period 4723 patients were tested for Lyme disease, but only 76 (1.6%) had positive results by established laboratory criteria. Among 70 seropositive patients whose medical records were available for review, 12 (17%; 95% confidence interval, 9%-28%) were found to have Lyme disease (6 with documented travel to endemic regions). During the same time period, 297 patients with a clinical illness compatible with disseminated Lyme disease underwent 2-tiered serologic testing. Six of them (2%; 95% confidence interval, 0.7%-4.3%) were seropositive, 3 with documented travel and 1 who had an alternative diagnosis that explained the clinical findings. CONCLUSIONS: In this low-prevalence cohort, fewer than 20% of positive Lyme disease tests are obtained from patients with clinically likely Lyme disease. Positive Lyme disease test results may have little diagnostic value in this setting.Item Open Access Positive follow-up blood cultures identify high mortality risk Among patients with gram negative bacteremia.(Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2020-02-27) Maskarinec, SA; Park, LP; Ruffin, F; Turner, NA; Patel, N; Eichenberger, EM; van Duin, D; Lodise, T; Fowler, VG; Thaden, JTOBJECTIVES:The role of follow-up blood cultures (FUBCs) in management of gram-negative bacteremia (GNB) is poorly understood. This study aims to determine utility of FUBCs in identifying patients with increased mortality risk. METHODS:An observational study with a prospectively enrolled cohort of adult inpatients with GNB was conducted at Duke University Health System from 2002-2015. FUBCs were defined as blood cultures drawn from 24 hours to 7 days from initial positive blood culture. RESULTS:Among 1702 patients with GNB, 1164 (68%) had FUBCs drawn. When drawn, FUBCs were positive in 20% (228/1113) of cases. FUBC acquisition was associated with lower all-cause in-hospital mortality (20% [108/538] versus 15% [176/1164], p=0.01) and attributable in-hospital mortality (15% [78/538] versus 8% [98/1164]; p<0.0001). Propensity score-weighted Cox proportional hazards models revealed that obtaining FUBCs was associated with reductions in all-cause (Hazard ratio [HR]=0.629; 95% confidence interval (CI), 0.511-0.772; p<0.0001) and attributable mortality (HR=0.628; 95% CI, 0.480-0.820; p=0.0007. Positive FUBCs were associated with increased all-cause mortality (21% [49/228] versus 11% [110/885]; p=0.0005) and attributable mortality (12% [27/228] versus 7% [61/885]; p=0.01) relative to negative FUBCs. Propensity score-weighted Cox proportional hazards models revealed that positive FUBCs were associated with increased all-cause (HR=2.099; 95% CI, 1.567-2.811; p<0.0001) and attributable mortality (HR=1.800; 95% CI, 1.245-2.603; p=0.002). In a calibration analysis, a scoring system accurately identified patients at high risk of positive FUBCs. CONCLUSIONS:Rates of positive FUBCs were high and identified patients at increased risk for mortality. Clinical variables can identify patients at high risk for positive FUBCs. FUBCs should be considered in the management of GNB.