Browsing by Author "Crothers, Kristina A."

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    Effect of Advanced HIV Infection on the Respiratory Microbiome
    (ATS Journals, 2016-07-15) Twigg, Homer L., III; Knox, Kenneth S.; Zhou, Jin; Crothers, Kristina A.; Nelson, David E.; Toh, Evelyn; Day, Richard B.; Lin, Huaiying; Gao, Xiang; Dong, Qunfeng; Mi, Deming; Katz, Barry P.; Sodergren, Erica; Weinstock, George M.; Medicine, School of Medicine
    RATIONALE: Previous work found the lung microbiome in healthy subjects infected with HIV was similar to that in uninfected subjects. We hypothesized the lung microbiome from subjects infected with HIV with more advanced disease would differ from that of an uninfected control population. OBJECTIVES: To measure the lung microbiome in an HIV-infected population with advanced disease. METHODS: 16s RNA gene sequencing was performed on acellular bronchoalveolar lavage (BAL) fluid from 30 subjects infected with HIV with advanced disease (baseline mean CD4 count, 262 cells/mm(3)) before and up to 3 years after starting highly active antiretroviral therapy (HAART) and compared with 22 uninfected control subjects. MEASUREMENTS AND MAIN RESULTS: The lung microbiome in subjects infected with HIV with advanced disease demonstrated decreased alpha diversity (richness and diversity) and greater beta diversity compared with uninfected BAL. Differences improved with HAART, but still persisted up to 3 years after starting therapy. Population dispersion in the group infected with HIV was significantly greater than in the uninfected cohort and declined after treatment. There were differences in the relative abundance of some bacteria between the two groups at baseline and after 1 year of therapy. After 1 year on HAART, HIV BAL contained an increased abundance of Prevotella and Veillonella, bacteria previously associated with lung inflammation. CONCLUSIONS: The lung microbiome in subjects infected with HIV with advanced disease is altered compared with an uninfected population both in diversity and bacterial composition. Differences remain up to 3 years after starting HAART. We speculate an altered lung microbiome in HIV infection may contribute to chronic inflammation and lung complications seen in the HAART era.
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    Treatment of Community-Acquired Pneumonia in Immunocompromised Adults
    (Elsevier, 2020-06) Ramirez, Julio A.; Musher, Daniel M.; Evans, Scott E.; Dela Cruz, Charles; Crothers, Kristina A.; Hage, Chadi A.; Aliberti, Stefano; Anzueto, Antonio; Arancibia, Francisco; Arnold, Forest; Azoulay, Elie; Blasi, Francesco; Bordon, Jose; Burdette, Steven; Cao, Bin; Cavallazzi, Rodrigo; Chalmers, James; Charles, Patrick; Chastre, Jean; Claessens, Yann-Erick; Dean, Nathan; Duval, Xavier; Fartoukh, Muriel; Feldman, Charles; File, Thomas; Froes, Filipe; Furmanek, Stephen; Gnoni, Martin; Lopardo, Gustavo; Luna, Carlos; Maruyama, Takaya; Menendez, Rosario; Metersky, Mark; Mildvan, Donna; Mortensen, Eric; Niederman, Michael S.; Pletz, Mathias; Rello, Jordi; Restrepo, Marcos I.; Shindo, Yuichiro; Torres, Antoni; Waterer, Grant; Webb, Brandon; Welte, Tobias; Witzenrath, Martin; Wunderink, Richard; Medicine, School of Medicine
    Background Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. Research Question There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. Study Design and Methods This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. Results The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. Interpretation This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.