Stability of Direct Oral Anticoagulants Concentrations in Blood Samples for Accessibility Expansion of Chromogenic Assays Anna Gavrilova, Jānis Meisters, Gustavs Latkovskis, Inga Urtāne Medicina Lithuania, 2023 Background and Objectives: Direct oral anticoagulants (DOACs) are used for minimising the risk of thromboembolic events. In clinical practice, there is no need to measure DOAC concentration in the routine. Nevertheless, there are cases where such measurements are necessary, as the European Society of Cardiology’s guideline recommends. However, determining DOAC levels is not available for everyone due to chromogenic assay availability limitations from sample storage problems, as tests are performed only in a few healthcare settings. This study aimed to assess whether more applicable storage conditions could be used for transportation to provide chromogenic assays for outpatient healthcare and other hospitals’ practices. Materials and Methods: Chromogenic assays measuring anti-FXa (for rivaroxaban and edoxaban) and anti-FIIa (for dabigatran) were used. Concentrations were determined immediately after blood collection as baseline value: (1) after the storage of citrated whole blood in refrigerator (+2–8 °C); (2) of citrated plasma in refrigerator (+2–8 °C); and (3) of citrated frozen plasma (−20 °C) on the third and seventh days of storage. Acceptable change limits were considered stable if the deviation did not exceed ±20% of the baseline value. Results: The median (Cl 95%) baseline value of rivaroxaban was 168 (147–236) ng/mL; of dabigatran 139 (99–178) ng/mL; and of edoxaban—174 (135–259) ng/mL. The median deviation from a baseline value stored as citrate whole blood samples (+2–8 °C) was 5.4% and 3.4%; as citrated plasma (+2–8 °C) was 0.4% and −0.6%; and as citrated frozen plasma (−20 °C) was −0.2% and 0.2% on the third and seventh days of storage, respectively. Conclusions: Our data suggest that whole blood samples stored in a refrigerator, as well as citrated plasma samples stored in both the refrigerator and freezer, preserve DOAC concentration stable at +2–8 °C or −20 °C for up to 7 days, and are suitable for transportation, except for low-concentration samples.
Epidemiological characterization of clinical fungal isolates from pauls stradinš clinical university hospital, latvia: A 4-year surveillance report Nityanand Jain, Inese Jansone, Tatjana Obidenova, Raimonds Sīmanis, Jānis Meisters, Dagnija Straupmane, Aigars Reinis Life, 2021 Nosocomial fungal infections are an emerging global public health threat that requires urgent attention and proper management. With the limited availability of treatment options, it has become necessary to understand the emerging epidemiological trends, mechanisms, and risk factors. However, very limited surveillance reports are available in the Latvian and broader European context. We therefore conducted a retrospective analysis of laboratory data (2017–2020) from Pauls Stradinš Clinical University Hospital (PSCUH), Riga, Latvia, which is one of the largest public multispecialty hospitals in Latvia. A total of 2278 fungal isolates were analyzed during the study period, with Candida spp. comprising 95% of the isolates, followed by Aspergillus spp. and Geotrichum spp. Amongst the Candida spp., C. albicans and C. glabrata made up about 75% of the isolates. The Department of Lung Diseases and Thoracic Surgery had the highest caseload followed by Intensive Care Department. Majority of the fungal isolates were collected from the bronchoalveolar lavage (37%), followed by urine (19%) and sputum (18%) samples. A total of 34 cases of candidemia were noted during the study period with C. albicans being the most common candidemia pathogen. Proper surveillance of emerging epidemiological trends serve as the most reliable and powerful cornerstone towards tackling this emerging threat.
Antimicrobial resistance in nosocomial isolates of gram-negative bacteria: Public health implications in the latvian context Nityanand Jain, Inese Jansone, Tatjana Obidenova, Raimonds Simanis, Jānis Meisters, Dagnija Straupmane, Aigars Reinis Antibiotics, 2021 Antimicrobial resistance (AMR) is one of the most serious threats in modern medicine which requires the constant monitoring of emerging trends amongst clinical isolates. However, very limited surveillance data is available in the Latvian context. In the present study, we conducted a retrospective analysis of microbiological data from one of the largest public multispecialty hospitals in Latvia from 2017 to 2020. AMR trends for 19 gram-negative bacterial (GNB) genera were investigated. During the study period, 11,437 isolates were analyzed with Escherichia spp. (34.71%), Klebsiella spp. (19.22%) and Acinetobacter spp. (10.05%) being the most isolated. Carbapenems like Meropenem and Ertapenem were the most effective against GNBs (3% and 5.4% resistance rates, respectively) while high resistance rates (>50%) were noted against both Ampicillin and Amoxicillin/Clavulanic acid. Enterobacter spp. and Klebsiella spp. showed a significant increase in resistance rate against Ertapenem (p = 0.000) and Trimethoprim-Sulfamethoxazole (p = 0.000), respectively. A decrease in the prevalence of Extended-Spectrum Beta-Lactamase positive (ESBL+) Enterobacterales was noted. Despite the lower prescription levels of the penicillin group antimicrobials than the European average (as reported in ESAC-Net Surveillance reports), GNBs showed high average resistant rates, indicating the role of ESBL+ isolates in driving the resistance rates. Constant and careful vigilance along with proper infection control measures are required to track the emerging trends in AMR in GNBs.
Methods for detection of direct oral anticoagulants and their role in clinical practice Katrina Pukite, Ketija Apsite, Irina Pupkevica, Ilze Cernevska, Oksana Boichuk, Janis Meisters, Dagnija Straupmane, Inga Urtane, Aivars Lejnieks, Oskars Kalejs Cor Et Vasa, 2019 Ăvod: Fibrilace sĂnĂ (FS) je nejÄastÄjĹĄĂ arytmiĂ, jejĂĹž incidence se zvyĹĄuje s vÄkem; u osob ve vÄku 50 let se kaĹž- dĂ˝ch deset let zdvojnĂĄsobuje a u pacientĹŻ ve vÄku ≥ 80 let dosahuje pĹibliĹžnÄ 10 %.1 PĹes pĹedvĂdatelnou farmakokinetiku a farmakodynamiku pĹĂmĂ˝ch perorĂĄlnĂch antikoagulanciĂ (direct oral anticoagulant, DOAC) je nutno v zĂĄjmu ĂşÄinnĂŠ a bezpeÄnĂŠ lĂŠÄby, stejnÄ jako pro predikci a detekci trombotickĂ˝ch a krvĂĄcivĂ˝ch pĹĂhod, provĂĄdÄt laboratornĂ vyĹĄetĹenĂ, a to i v situacĂch, kdy by doÄasnĂŠ vysazenĂ lĂŠkĹŻ mohlo bĂ˝t ŞådoucĂ.2 CĂl: CĂlem tĂŠto studie bylo stanovit a analyzovat nutnost provĂĄdÄnĂ koagulaÄnĂch testĹŻ u pacientĹŻ s FS a vysokĂ˝m kardiovaskulĂĄrnĂm rizikem v klinickĂŠ praxi. Metody: V obdobĂ od ĹĂjna 2016 do Äervna 2017 byla v kardiocentru fakultnĂ nemocnice Pauls Stradins Clinical University Hospital v lotyĹĄskĂŠ Rize provedena kvantitativnĂ, analytickĂĄ, prĹŻĹezovĂĄ klinickĂĄ studie. V tĂŠto studii se shromaĹžÄovaly Ăşdaje pacientĹŻ s nevalvulĂĄrnĂ FS lĂŠÄenĂ˝ch antikoagulancii po dobu ≥ 3 mÄsĂcĹŻ, definovanĂ˝ch na zĂĄkladÄ skĂłre CHA2DS2-VASc (≥ 2 nebo 3) jako vysoce rizikovĂĄ skupina muŞů i Ĺžen. Pro analĂ˝zu ĂşdajĹŻ byl pouĹžit software SPSS. VĂ˝sledky: Celkem byly zĂskĂĄny Ăşdaje 143 pacientĹŻ, z nichĹž 46,2 % (n = 66) byli muĹži; prĹŻmÄrnĂ˝ vÄk dosahoval 69,7 (SD ± 9,9) roku. PĹibliĹžnÄ u dvou tĹetin (73,1 %) pacientĹŻ se FS vyskytovala po dobu vĂce neĹž jednoho roku. PrĹŻmÄrnĂĄ hodnota skĂłre CHA2DS2-VASc byla 4,2 (SD ± 1,5). NejÄastÄjĹĄĂmi pĹidruĹženĂ˝mi onemocnÄnĂmi byly arteriĂĄlnĂ hypertenze (65,0 %; 93), chronickĂŠ srdeÄnĂ selhĂĄnĂ (48,3 %; 69), ischemickĂĄ choroba srdeÄnĂ (32,9 %; 47), diabetes mellitus (24,5 %; 35) a dyslipidemie (25,9 %; 37). PĹibliĹžnÄ polovina (46,2 %; 66) uĹžĂvala DOAC, z toho 31,5 % rivaroxaban a 14,7 % dabigatran; navĂc 1,4 % pacientĹŻ uĹžĂvalo DOAC s antiagregancii. U 71 (49,7 %) pacientĹŻ existovalo zvýťenĂŠ riziko moĹžnĂ˝ch lĂŠkovĂ˝ch interakcĂ, nejÄastÄji s inhibitory protonovĂŠ pumpy (16,8 %; 24), amiodaronem (24,5 %; 35) a protizĂĄnÄtlivĂ˝mi lĂŠky (49,0 %; 70). UĹžĂvĂĄnĂ DOAC a moĹžnĂŠ lĂŠkovĂŠ interakce zvyĹĄujĂ skĂłre rizika s maximĂĄlnĂ hodnotou 3 (16,1 %; 23) a prĹŻmÄrnĂ˝m ÄastĂ˝m skĂłre 4,4 u 86 (60,1 %) pacientĹŻ s FS. Koncentrace lĂŠkĹŻ v krvi byly niŞťĂ, neĹž se oÄekĂĄvalo, a dosahovaly hodnoty pĹibliĹžnÄ 75,2 % Cmax. ZĂĄvÄr: UĹžĂvĂĄnĂ DOAC koreluje se skĂłre CHA2DS2-VASc s prĹŻmÄrnou Äastou hodnotou 4,4 u 86 (60,1 %) pa- cientĹŻ s FS. KoagulaÄnĂ testy pro stanovenĂ koncentracĂ DOAC v plazmÄ byly provedeny u vĂce neĹž poloviny pacientĹŻ (60,1 %).
