Today is the fourth day of IDWeek 2022. If you happen to be at the conference and missed our posts last week, here is a quick guide to UNMC members presenting today, October 22nd.
Saturday, October 22nd, 2022
10:30-11:45am – Erica Stohs, MD, MPH – Panelist on ” Challenging Cases in Transplant Infectious Diseases”
12:15-12:45pm – Riley Ostdiek, Medical Student – Rapid Fire presenter on “A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers”
12:15pm-1:30pm – Poster Presentations
Shawnalyn Sunagawa, PharmD – Sexually Transmitted Infection (STI) Therapy Compliance Pre and Post Centers for Disease Control and Prevention (CDC) STI Treatment Guideline Update
Jon Freese, Medical Student – Perceptions of the COVID-19 Vaccine within the Sudanese American Community
Salman Ashraf, MBBS – A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers
Laura Fischer, MPH – Impact of Asymptomatic Upper Respiratory Viral Shedding in Pediatric Cardiothoracic Surgical Patients
Mackenzie Keintz, MD – Outcomes in Intravenous to Oral Antimicrobial Therapy in Beta-Streptococcus Species
Oliva Paetz, Medical Student – Missed Opportunities for Confirmatory HIV Testing at a Midwestern Medical Center
3:15-3:30pm – Jonathan Ryder, MD, and Clayton Mowrer, DO, MBA – Speaking on “Adoption and Utilization of Social Media among Adult and Pediatric Infectious Diseases Divisions and Fellowship Programs in the United States and Canada
4:05-4:30pm – M. Salman Ashraf, MBBS – Speaking on “Antibiotic Stewardship in Long-Term Care Facilities – We’re Doing It!
Today is the third day of IDWeek 2022. If you happen to be at the conference and missed our posts last week, here is a quick guide to UNMC members presenting today, October 21st.
Friday, October 21st, 2022
7:30-9:00am – Jasmine Marcelin, MD – Panelist on ” Women in ID”
10:30-11:45am – Sara Bares, MD – Panelist on “Challenging HIV Clinical Cases”
12:15pm-1:30pm – Poster Presentations
Bryan Alexander, PharmD – Clinical Outcomes and Cost Savings of Dalbavancin Use in OPAT: Focus on Complicated Staphylococcus aureus Infections
Anum Abbas, MD– Cerebrospinal Fluid Findings of Solid Organ Transplant Recipients with West Nile Virus Infections
Nikki Regan, APRN– Telehealth Utilization and 2-year Outcomes among People with HIV at a Midwestern Clinic
Ryan Boyland, Medical Student– Curbsiding Twitter: Potential Value and Patient Confidentiality Implications of Infectious Diseases Clinician Peer Consultations via Social Media
Riley Ostdiek, Medical Student– A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers
Titilola Labisi, MHA, MPH– Telehealth Utilization and 2-year Outcomes among People with HIV at a Midwestern Clinic
Josh Havens, PharmD– Patient perspectives on pharmacy experiences for antiretroviral refills
Timothy McElroy, MD – Local Antibiogram for Mycobacterium abscessus Shows Variability from Previously Published Susceptibility Data
Josh Havens, PharmD– B/F/TAF in HIV-Infected Adults with Substance Use Disorders: BASE Week 48 Results
Jeremy Tigh, PharmD– Acute Kidney Injury Rates Before and After Implementation of Integrated Bayesian Software for Vancomycin Dosing
3:15-3:40pm – Scott Bergman, PharmD – Speaking on “Influential Publications in Antimicrobial Stewardship From the Past Year”
Today is the second day of IDWeek 2022. If you happen to be at the conference and missed our posts last week, here is a quick guide to UNMC members presenting today, October 20th.
Thursday, October 20th, 2022
Poster Presentations: 12:15pm-1:30pm
12:15pm-1:30pm – Poster Presentations
Erica Stohs, MD, MPH – Biofire pneumonia panel use in severe pneumonia and antibiotic treatment in COVID-19 patients
Casey Zelus, MD – BioFire FilmArray Pneumonia Panel Implementation: Examining Appropriate Usage and Opportunities for Diagnostic Stewardship
12:15-1:00pm – Trevor Van Schooneveld, MD – Speaking on “Pneumonia Panel Implementation Lessons”
1:45-3:00pm – David Brett-Major, MD, MPH – Panelist on “Unforgettable Cases in Tropical Medicine”
2:10-2:35pm – Kimberly Scarsi, PharmD – Speaking on “New Drugs and Delivery Systems”
3:15-3:50pm – Sara Bares, MD – Speaking on “LA ART: Ready for Use in High-Risk Populations? Pro/Con
Today is the first day of IDWeek 2022. If you happen to be at the conference and missed our posts last week, here is a quick guide to UNMC members presenting today, October 19th.
Wednesday, October 19th, 2022
9:45-10:45am – Nada Fadul, MD – Panelist on “Putting Quality into Practice
10:45-12:00pm – Trevor Van Schooneveld, MD – Speaking on “Careers in Antimicrobial Stewardship” as part of Fellows’ Day Workshop
7:30-9:30pm – Kimberly Scarsi, PharmD – Speaking as part of “State of the Science in HIV: Clinical Applications Across the Care Continuum”
In early September, the Nebraska Infectious Disease Society (NIDS) held its first meeting. Read on below for a fantastic recap of this meeting provided by UNMC ID’s Dr. Clayton Mowrer.
The NIDS annual inaugural meeting in the books, with a really great turnout of ID and public health providers from across the state. Here’s a brief recap of the morning:
The meeting started off with Dr. Maureen Tierney recapping our achievements in our first year, highlighting quite a bit of work that has already been done and emphasizing all that is still to be done.
Drs. Schnaubelt, Fadul, Lawler, and McClain sitting on a panel discussion.
Next, Dr. Angela Hewlett discussed the current multinational monkeypox outbreak. She relayed the situation update, noting some improvement seen in incidence here in NE. She also emphasized the differences in clinical presentations in this current outbreak compared with our previous understanding of the disease, reviewed the diagnosis, and noted the currently available treatment options as well as challenges to follow up. Dr. Hewlett’s discussion was followed by a panel discussion with Lt. Col. Elizabeth Schnaubelt, MD, Nada Fadul, MD, James Lawler, MD, MPH, and Kimmai McClain, PharmD. The panel took questions from the audience, generating some fascinating and important discussions regarding the processes for obtaining therapies and vaccines (improving, but still much to do on this front), the efficacy of TPOXX (which seems to speed clinical recovery and resolution of the lesions), and that there are many more opportunities to engage with our patients and make efforts to reduce stigmatization.
Daniel Cramer, APRN, FNP-c spoke on the experience UNMC’s Specialty Care Clinic has had with the implementation of and the implications following the administration long-acting ART (cabotegravir/rilpivirine). He began by reviewing the dosing, reviewed the eligibility criteria, and had a wonderful discussion of how they approach patient education about this new medication, which includes the use of patient liaisons. He wrapped up his talk with looking forward to the future and the hope of making this more available to our patients.
Arthur Chang, MD – pediatric ID faculty at CHMC – had a fantastic presentation of congenital syphilis, where he focused on a brief review with some highlighted discussion points. Important takeaways: 1) there are increasing rates nationwide, and the reasons are multifactorial; 2) the diagnosis and recognition of disease is complicated by varying testing requirements and methods within practices and among different specialties; 3) it is absolutely critical that there needs to be specific documentation about the diagnosis and treatment of the pregnant person during the pregnancy to avoid uncertainty when the baby is born.
Several individuals provided COVID-19 updates.
-David Quimby, MD, talked about the data behind some of the therapies used currently with acute COVID infections – particularly noting Paxlovid. He reviewed some of the studies behind the data: namely, EPIC-HR and the unpublished EPIC-SR, and how these data might be interpreted in real world management, suggesting that the highest benefit appears to be in our patients >60 years of age and high-risk.
-Maureen Tierney, MD, MS, presented an excellent review of what we know thus far regarding Long COVID (PASC). She notes that it is strikingly commonly reported in the US: 1 in 13 adults (7.5%) have with symptoms for more than 3 months. This syndrome seems most commonly reported in young persons, females > males, with Hispanic persons (9%) among the highest reported population. There does, however, seem to be some regional differences in prevalence.
– Alice Sato, MD, PhD, had a fantastic and thorough review on vaccinations, with a focus on the pediatric population, reminding us that kids do get sick and are hospitalized with COVID, and that long COVID can have a significant impact on the well-being of children (e.g., missing school or other activities due to their symptoms). She further highlighted some of the benefits of vaccination in children, noting the significantly reduced rate of MIS-C after vaccination, the excellent efficacy, while also highlighting the great safety profile, even in young (6 month-5 year old) persons noting that zero cases of myocarditis have been reported in this population. She wrapped up her discussion by noting the excellent efficacy of COVID vaccinations in early trials but that it is important to realize that the newer variants (BA.4/5) are the most antigenically distinct variants, thus the need for the newer bivalent boosters.
Dr. Jonathan Ryder reviewing vector-borne diseases in Nebraska at the NIDS meeting
Jonathan Ryder, MD, spoke in place of Jeff Hamik (the NE state vector-borne epidemiologist, who was unable to make the talk), and he provided a fascinating review of the epidemiologic data of vector-borne illnesses in NE. He reviewed: the rise in neuroinvasive cases of West Nile Virus; the appearance of invasive Aedes mosquitos (A. aegypti, A. albopictus) in SE NE, though providing reassurance that A. aegypti eggs cannot survive the winter here and are likely single events; the establishment of Ixodes ticks in NE as of 2019, with now a couple cases of Lyme disease and the isolation of B. burgdorferi from ticks here in NE; a rise in tick vectors for SFGR, Ehrlichia, and Tularemia. Because of these data, NE DHHS has received funding for further tick surveillance and testing. Lastly, he emphasized the important role that climate change is likely playing on the spread of such vectors and the rise in incidence of these diseases.
Finally, several trainees presented some fun cases:
Anne Lentino – a medical student with Creighton School of Medicine – presented a case of a child with Bartonella henselae infection, initially presenting as FUO.
Annie Nguyen – another medical student at Creighton – presented an impressive study reviewing the incidence of fungal infections in patients hospitalized with acute SARS-CoV-2 infection.
Stephen Cooper, MD, MPH – an internal medicine resident at Creighton School of Medicine – presented a really great QI study on improved awareness and usage of local antibiograms among resident trainees, providing excellent implementation protocol and follow up. The results were promising.
Mackenzie Keintz, MD – an infectious diseases fellow at UNMC – presented her research asking the question if or when it is appropriate for transition to PO antibiotics in uncomplicated beta-hemolytic streptococcal bloodstream infection. Early data suggests PO transition can reduce length of stay in stable patients.
And with that, our successful first meeting was brought to a close!
(Note: Photos of this meeting were taken from ID Nebraska’s Twitter page. Check them out here: @IdNebraska)
Next week begins IDWeek 2022, and UNMC will have a strong showing at the conference! Want to support UNMC ID at this event? Follow us on Twitter @UNMC_ID throughout the conference.
Below, we have gathered info on all oral presentations, panel participation, and other involvement, so read on!
Tuesday, October 18th, 2022
All Day – Andrea Zimmer, MD – Moderator of “Vincent T. Andriole ID Board Review Course (Virtual)”
Wednesday, October 19th, 2022
9:45-10:45am – Nada Fadul, MD – Panelist on “Putting Quality into Practice
10:45-12:00pm – Trevor Van Schooneveld, MD – Speaking on “Careers in Antimicrobial Stewardship” as part of Fellows’ Day Workshop
7:30-9:30pm – Kimberly Scarsi, PharmD – Speaking as part of “State of the Science in HIV: Clinical Applications Across the Care Continuum”
Thursday, October 20th, 2022
12:15-1:00pm – Trevor Van Schooneveld, MD – Speaking on “Pneumonia Panel Implementation Lessons”
1:45-3:00pm – David Brett-Major, MD, MPH – Panelist on “Unforgettable Cases in Tropical Medicine”
2:10-2:35pm – Kimberly Scarsi, PharmD – Speaking on “New Drugs and Delivery Systems”
3:15-3:50pm – Sara Bares, MD – Speaking on “LA ART: Ready for Use in High-Risk Populations? Pro/Con
Friday, October 21st, 2022
7:30-9:00am – Jasmine Marcelin, MD – Panelist on ” Women in ID”
10:30-11:45am – Sara Bares, MD – Panelist on “Challenging HIV Clinical Cases”
3:15-3:40pm – Scott Bergman, PharmD – Speaking on “Influential Publications in Antimicrobial Stewardship From the Past Year”
10:30-11:45am – Erica Stohs, MD, MPH – Panelist on ” Challenging Cases in Transplant Infectious Diseases”
12:15-12:45pm – Riley Ostdiek, Medical Student – Rapid Fire presenter on “A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers”
3:15-3:30pm – Jonathan Ryder, MD, and Clayton Mowrer, DO, MBA – Speaking on “Adoption and Utilization of Social Media among Adult and Pediatric Infectious Diseases Divisions and Fellowship Programs in the United States and Canada
4:05-4:30pm – M. Salman Ashraf, MBBS – Speaking on “Antibiotic Stewardship in Long-Term Care Facilities – We’re Doing It!
Sunday, October 23rd, 2022
8:30-9:00am – Nada Fadul, MD – Speaking on “Disparities of Post/Long COVID-19 Syndrome in Women and Young Adults”
Next week begins IDWeek 2022, and UNMC will have a strong showing at the conference! Want to support UNMC ID at this event? Follow us on Twitter @UNMC_ID throughout the conference.
Below, we have gathered info on all poster presentations given by UNMC members. Be sure to stop by these posters and show your support. Tomorrow, we will also post all oral presentations, panel participation, and other involvement, so stay tuned!
Posters Presented at IDWeek 2022:
Thursday, October 20th, 2022; 12:15pm-1:30pm
Erica Stohs, MD, MPH – Biofire pneumonia panel use in severe pneumonia and antibiotic treatment in COVID-19 patients
Casey Zelus, MD – BioFire FilmArray Pneumonia Panel Implementation: Examining Appropriate Usage and Opportunities for Diagnostic Stewardship
Friday, October 21st, 2022; 12:15pm – 1:30pm
Bryan Alexander, PharmD – Clinical Outcomes and Cost Savings of Dalbavancin Use in OPAT: Focus on Complicated Staphylococcus aureus Infections
Anum Abbas, MD – Cerebrospinal Fluid Findings of Solid Organ Transplant Recipients with West Nile Virus Infections
Nikki Regan, APRN – Telehealth Utilization and 2-year Outcomes among People with HIV at a Midwestern Clinic
Ryan Boyland, Medical Student – Curbsiding Twitter: Potential Value and Patient Confidentiality Implications of Infectious Diseases Clinician Peer Consultations via Social Media
Riley Ostdiek, Medical Student – A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers
Titilola Labisi, MHA, MPH – Telehealth Utilization and 2-year Outcomes among People with HIV at a Midwestern Clinic
Josh Havens, PharmD – Patient perspectives on pharmacy experiences for antiretroviral refills
Timothy McElroy, MD – Local Antibiogram for Mycobacterium abscessus Shows Variability from Previously Published Susceptibility Data
Josh Havens, PharmD – B/F/TAF in HIV-Infected Adults with Substance Use Disorders: BASE Week 48 Results
Jeremy Tigh, PharmD – Acute Kidney Injury Rates Before and After Implementation of Integrated Bayesian Software for Vancomycin Dosing
Saturday, October 22nd, 2022; 12:15pm-1:30pm
Shawnalyn Sunagawa, PharmD – Sexually Transmitted Infection (STI) Therapy Compliance Pre and Post Centers for Disease Control and Prevention (CDC) STI Treatment Guideline Update
Jon Freese, Medical Student – Perceptions of the COVID-19 Vaccine within the Sudanese American Community
Salman Ashraf, MBBS – A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers
Laura Fischer, MPH – Impact of Asymptomatic Upper Respiratory Viral Shedding in Pediatric Cardiothoracic Surgical Patients
Mackenzie Keintz, MD – Outcomes in Intravenous to Oral Antimicrobial Therapy in Beta-Streptococcus Species
Oliva Paetz, Medical Student – Missed Opportunities for Confirmatory HIV Testing at a Midwestern Medical Center
The following content was largely provided by Dr. Abbas to spread awareness about the new clinical trial starting soon at UNMC. To aid in participant recruitment, please share this with those who may be interested in the work.
What is a clinical trial?
While much of medicine is practiced within guidelines and evidence-based practices, getting the evidence for these practices is no small endeavor. This is achieved through the use of clinical trials, or research studies on treatments with good evidence for their potential use which need to be confirmed to work in the patient population. These foundational components of academic medical research pave the way for new treatments and future guidelines, ensuring that medical practice keeps pace with biomedical research.
What is HSV?
HSV (or herpes simplex virus) is a human viral pathogen which infects a large proportion of the population. Colloquially considered a sexually-transmitted infection, HSV comes in two types. HSV-1 is more common throughout the world and generally spread orally, causing cold sores or remaining asymptomatic. HSV-2 is less prevalent and is the type transmitted sexually.
Purpose of the UNMC PRIOH-1 Study:
The purpose of the PRIOH-1 study is to compare the effectiveness of the study drug pritelivir to the drug foscarnet in subjects with compromised immune systems who also have herpes simplex virus (HSV) lesions that have not responded to acyclovir treatment.
What is pritelivir?
The study drug is an investigational medication called pritelivir that you swallow as a tablet. Pritelivir is designed to protect uninfected cells from HSV infection. It is considered “investigational” because it has not been approved by any regulatory agency for treating acyclovir-resistant HSV skin lesions in subjects with compromised immune systems. The other drug in this study, foscarnet, is already approved and is administered through the vein (IV). This study is seeking an alternative to foscarnet that is more effective, safe, and convenient.
Do you have herpes lesions that keep coming back?
You may be eligible for the PRIOH-1 clinical research study. The PRIOH-1 study is for people with weakened immune systems (because of conditions such as HIV infection, organ transplantation, certain cancers, or long-term steroid use) and lesions caused by herpes simplex virus (HSV).
Study participants receive at no cost:
Possible access to a new study medication called pritelivir
Some participants may receive foscarnet, an approved treatment for HSV lesions
Study support and monitoring by a healthcare team
The opportunity to help advance HSV research
Who can participate?
You may be able to participate in the PRIOH-1 study if you are 16 years of age or older with a weakened immune system and an acyclovir-resistant HSV infection (skin lesions), requiring a switch to foscarnet treatment. Other criteria will apply.
About the study:
If you agree to participate and meet all eligibility criteria for Part C, you will be randomly assigned to receive either the study drug pritelivir or foscarnet. You have an even chance of receiving the study drug or approved drug. Those taking pritelivir will take an initial dose of 4 tablets, and then you will take one tablet each day. Those taking foscarnet will receive an hour-long IV infusion from study staff two or three times each day. You will visit the clinic weekly during the treatment period, so the study team can assess your lesions.
Study length:
Your participation in this study may last up to 152 days, depending on how long your treatment period lasts and when your lesion heals. The treatment period will continue until complete healing of all lesions or up to 28 days, whichever occurs first. If your lesions have not healed after 28 days, there will be up to 14 additional treatment days.
The battle between human and pathogen is one as old as time, shaping our evolution as well as culture. However, with the relatively recent invention of modern medicine and the germ theory of disease, it is often difficult to peer back into time and assess which pathogens ancient civilization may have dealt with. The historical records are spotty, ambiguous, and written through the lens of a different understanding of disease. But every once in a while, we get lucky. That is exactly what has recently happened with a 1400 year old Chinese treatise recently translated into English which, among other things, describes an illness suspiciously similar to what we call pertussis (or whooping cough). Read on for a quick digest of a fascinating article published in Open Forum Infectious Diseases describing a historical aspect of ID.
A page from Zhubing Yuanhou Lun (Treatise on the Origin and Symptoms of Diseases)
Chao Yuanfang, imperial physician of the Sui Dynasty was by all accounts a revered medical scholar and physician to the emperor in the early 600s CE. He is one possible author of the preeminent medical text of the time and region, Zhubing yuanhou lun (Treatise on the Origin and Symptoms of Diseases). This Treatise is composed of 50 scrolls detailing over 1700 medical illnesses, each categorized into 71 categories spanning all ages and organ systems.
The details of this work are incredibly interesting and discussed further in the article, but one illness description stood out- the loosely translated “cough of 100 days”. This disease was noted in the text to be a serious ailment most often found in children. It was said that “[If] it is not cured within 1 month and there is a cough within 100 days, only 1 or 2 of 10 will recover”. Some think this may be the earliest description of pertussis ever recorded.
To modern medicine, pertussis is a highly contagious bacterial disease caused by Bordetella pertussis. Before the dissemination of a vaccine in the 1940s, 200,000 children contracted this illness annually in the United States, causing mortality in 9,000 of those cases. Luckily, successful vaccination efforts dramatically reduced the harm of this infection, with current annual pertussis incidence between 10,000 and 40,000 with few deaths.
The article, titled Chao Yuanfang: Imperial Physician of the Sui Dynasty and an Early Pertussis Observer?, expands upon this idea, and shares additional details about these newly translated medical texts (link here). If truly describing pertussis, or some other ancient predecessor to this modern illness, these revelations further illustrate not only the rich history of medicine, but also the shared struggles that modern civilization may share with antiquity.
A #PharmToExamTable question about adverse vancomycin reactions, answered by Quynh Tran, PharmD, a Graduate of UNMC College of Pharmacy.
(Reviewed by Andrew Watkins, PharmD)
Vancomycin is a glycopeptide antibiotic frequently utilized to treat infections caused by resistant gram-positive organisms such as methicillin resistant Staphylococcusaureus (MRSA).1 Due to widespread vancomycin use, resistant organisms such as vancomycin-resistant Enterococcus (VRE) and vancomycin-resistant Staphylococcusaureus (VRSA) have been a growing problem within healthcare facilities. Thus, the glycopeptide family of antibiotics has since expanded to help overcome these resistances and offer alternate treatment options. New lipoglycopeptides antibiotics such as telavancin, oritavancin, and dalbavancin have been utilized for the treatment of resistant gram-positive organisms, particularly MRSA and Enterococcusfaecium. Clinical cross-reactivity between glycopeptides remains controversial, with varied reports suggesting possible immunological cross-reactivity. This review will focus on potential cross-reactivities between vancomycin and lipoglycopeptides.
What are Glycopeptide Antibiotics?
Glycopeptides are bactericidal cyclic non-ribosomal peptides produced by various filamentous actinomycetes. They facilitate inhibition of cell wall synthesis by impeding transglycosylation & transpeptidation.2 Vancomycin was one of the first glycopeptides discovered, and it can be used intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by most gram-positive organisms. Due to an increase in resistance to vancomycin, lipoglycopeptides (a class of antibiotics that have lipophilic side chains linked to glycopeptides) were developed. The three antibiotics in this class approved by the FDA are telavancin, dalbavancin, and oritavancin. All three antibiotics are approved for skin/soft tissue infections, and they can be used for gram-positive bacteria that are resistant to vancomycin. Another benefit of these antibiotics is their prolonged duration of action, allowing less frequent administration. While telavancin typically requires administration every 24 hours, dalbavancin can be administered as a once weekly injection for 1-2 doses depending on the infection.3 In theory, telavancin is most at risk of possible cross-reactivity as its glycopeptide core is vancomycin.4 Due to their benefit, the lipoglycopeptides have been used more frequently in clinical settings, but because of their structural similarities to vancomycin, it is important to understand their cross-reactivity with vancomycin to assist in safe use of these medications in patients with vancomycin allergy.
Adverse Vancomycin Reactions
Adverse drug reactions with vancomycin include both non-immune mediated reactions such as nephrotoxicity and non-immunoglobulin E (IgE) mediated mast cell reactions (i.e., red man syndrome) as well as immune-mediated reactions such as T-cell mediated severe cutaneous adverse reactions (i.e., drug reaction with eosinophilia and systemic symptoms (DRESS)).
Non-IgE mediated vancomycin hypersensitivity – red man syndrome – is typically characterized by a pruritic, erythematous rash that predominantly affects the face, neck, and trunk and is caused by mast cell degranulation.5 It is usually related to intravenous doses greater than 1000 mg with rapid administration under 60 minutes. Recurrence of red man syndrome can usually be managed by reducing the rate of infusion of vancomycin and/or premedication with antihistamines. A potential mechanism for this reaction is direct mast cell degranulation via the MAS-related G-protein coupled receptor X2 (MPGPRX2).6
On the other hand, patients might experience immune mediated hypersensitivity with vancomycin such as IgE mediated reactivity (true anaphylaxis) and DRESS. There is no clear way to distinguish red man syndrome from IgE mediated reactions in patients receiving vancomycin; thus, IgE mediated hypersensitivity should be suspected in patients who have severe multiorgan involvement suggesting anaphylaxis or who fail red man protocols for intravenous administration.7 DRESS most frequently occurs during vancomycin therapy with a median of 18 days after start of therapy. Its clinical presentation includes widespread rash, fever, facial edema, increase in white blood cells, and involvement of internal organs. Konvinse et al. reviewed a cohort study of 23 patients with vancomycin DRESS and showed that over 80% of these patients carried the HLA-A*32:-01 allele compared to the 0 in 46 vancomycin tolerant controls.8
What About Lipoglycopeptide Cross-reactivity?
A recent study by Nakkam et al. looking at DRESS cross-reactivity among vancomycin, teicoplanin, dalbavancin, telavancin showed that patients with a history of previous vancomycin-induced DRESS had potential risk of cross-reactivity between vancomycin, teicoplanin, and telavancin, but lower risk of cross-reactivity with dalbavancin. This result aids in decision making in the future and reassures the use of dalbavancin in vancomycin-allergic patients.9
In conclusion…
Telavancin has higher potential cross-reactivity with vancomycin compared to dalbavancin and oritavancin due to its similarity in the core structure with vancomycin. However, further studies are needed to understand more about the cross-reactivity mechanism. Future studies on an association of vancomycin-induced DRESS with HLA-A*32:-01 could be important in understanding cross-reactivity for immune mediated reactions.
Zhanel GG, Calic D, Schweizer F, et al. New lipoglycopeptides: a comparative review of dalbavancin, oritavancin, and telavancin. Drugs 2010; 70: 859-886.
Kahne D, Leimkuhler C, Lu W, Walsh C. Glycopeptide and Lipoglycopeptide antibiotics. Chemical Reviews 2005; 105: 425-448.
Gelfand MS, Cleveland KO, Memon KA. Detection of vancomycin levels in patients receiving telavancin but not vancomycin. J Antimicrobial Chemotherapy 2012; 67: 508-509.
Sivagnanam S, Deleu D. Red man syndrome. Critical Care 2003; 7:119.
Azimi E, Reddy VB, Lerner EA. Brief communication: MRGPRX2, atopic dermatitis and red man syndrome. Itch (Phila) 2017; 2:e5.
Minhas JS, Wickner PG, Long AA, et al. Immune-mediated reactions to vancomycin. Ann Allergy, Asthma Immunol 2016; 116:544-553.
Konvinse KC, Trubiano JA, Pavlos R, et al. HLA-A*32:01 is strongly associated with vancomycin-induced drug reaction with eosinophilia and systemic symptoms. J Allergy Clin Immunol 2019; 144:183-192.
Nakkam N, Gibson A, Mouhtouris E, Konvinse KC, et al. Cross-reactivity between vancomycin, teicoplanin, and telavancin in patients with HLA-A*32:01 positive vancomycin induced DRESS sharing an HLA class Ii haplotype. Journal of Allergy and Clinical Immunology 2020.
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