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Wyszynski DF, Demetriou L, Renz C, Aliabadi S, Rafailovic D, Shulman LP, Drysdale M, Wurst KE. Use of Sotrovimab in Pregnancy: Experiences from the COVID-19 International Drug Pregnancy Registry. Drug Saf 2024; 47:843-851. [PMID: 38727875 PMCID: PMC11324716 DOI: 10.1007/s40264-024-01439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Available data regarding the safety and efficacy of sotrovimab in pregnant patients remain limited due to their exclusion from clinical trials. METHODS The COVID-19 International Drug Pregnancy Registry (COVID-PR) was established to gather comprehensive safety data from pregnant women who have received monoclonal antibody (mAb) or antiviral treatments for mild, moderate, or severe coronavirus disease 2019 (COVID-19) during pregnancy. Participants actively contributed self-reported data concerning their COVID-19 symptoms, in addition to sociodemographic and health-related characteristics. Obstetric, neonatal, and infant outcomes were also documented, with follow-up extending up to 12 months after childbirth. RESULTS As of 30 November 2023, sotrovimab was administered to 39 participants enrolled in the COVID-PR. At the time of this report, 26 participants had given birth, with nine deliveries performed via cesarean section. The infants' birthweight ranged from 2381 g to 4762 g, with a mean of 3439.91 g. Twenty-five infants were born at ≥37 weeks. A total of 31 adverse events (AEs) were reported by 12 participants. The most frequently reported AE was gestational hypertension, observed in three participants. COVID-19 re-infection, fatigue, gestational diabetes, headache, and morning sickness were each reported by two participants. Of the reported AEs, eight (in five participants) were classified as serious, including four AEs (prolonged labor, pre-eclampsia, polyhydramnios, premature labor) that affected pregnancy. Seven of these eight serious AEs (SAEs) were found to be unrelated to sotrovimab, with one event (urinary retention) not assessable. A total of 44 AEs were reported in 19 delivered infants or in utero fetuses. The most common were COVID-19 (n = 6 events), ear infection (n = 5 events), neonatal dyspnea (n = 3 events), and respiratory syncytial virus infection (n = 3 events). Sixteen AEs (in 11 infants/fetuses) were classified as serious, including one report each of fetal cardiac disorder, congenital ankyloglossia, persistent right umbilical vein, and congenital hydronephrosis; the latter was considered a major congenital malformation. For all assessable SAEs, causality of sotrovimab treatment was ruled out based on lack of a temporal relationship alone or in combination with absence of a plausible mechanism. CONCLUSION A sizable proportion of sotrovimab-treated participants in the COVID-PR had underlying medical conditions associated with an increased risk of severe COVID-19. None of the assessable SAEs were considered to be related to sotrovimab treatment.
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Affiliation(s)
| | | | | | | | | | - Lee P Shulman
- Division of Clinical Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Feuerstadt P, Crawford CV, Tan X, Pokhilko V, Bancke L, Ng S, Guthmueller B, Bidell MR, Tillotson G, Johnson S, Skinner AM. Fecal Microbiota, Live-jslm for the Prevention of Recurrent Clostridioides difficile Infection : Subgroup Analysis of PUNCH CD2 and PUNCH CD3. J Clin Gastroenterol 2024; 58:818-824. [PMID: 38019088 PMCID: PMC11305620 DOI: 10.1097/mcg.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/19/2023] [Indexed: 11/30/2023]
Abstract
GOALS To assess fecal microbiota, live-jslm (REBYOTA, abbreviated as RBL, formerly RBX2660) efficacy and safety in participants grouped by recurrent Clostridioides difficile infection (rCDI) risk factors and treatment-related variables. BACKGROUND RBL is the first microbiota-based live biotherapeutic approved by the US Food and Drug Administration for the prevention of rCDI in adults after antibiotic treatment for rCDI. STUDY Treatment success rates across subgroups for PUNCH CD3 (NCT03244644) were estimated using a Bayesian hierarchical model, borrowing data from PUNCH CD2 (NCT02299570). Treatment-emergent adverse events were summarized for the double-blind treatment period within 8 weeks. RESULTS Treatment differences between RBL and placebo at 8 weeks were similar to the total population for most subgroups. Treatment effect sizes were similar between CDI tests, higher for oral vancomycin courses >14 days versus ≤14 days and higher for antibiotic washout periods of 3 days versus ≤2 days. The largest reductions in the rate of rCDI with RBL versus placebo were observed for participants with a 3-day CDI antibiotic washout period and participants with ≥4 previous CDI episodes. Most RBL-treated participants experienced TEAEs that were mild or moderate in severity and related to preexisting conditions. CONCLUSION This analysis provides further evidence of RBL efficacy and safety across subgroups, including those at high risk for rCDI.
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Affiliation(s)
- Paul Feuerstadt
- Yale School of Medicine, Division of Digestive Diseases, New Haven, CT
- PACT Gastroenterology Center, Hamden, CT
| | | | - Xing Tan
- Ferring Pharmaceuticals, Parsippany, NJ
| | | | | | - Samson Ng
- Ferring Pharmaceuticals, Parsippany, NJ
| | | | | | | | - Stuart Johnson
- Edward Hines Jr. Veterans Affairs Hospital, Department of Research and Medicine, Hines, IL
- Loyola University Medical Center, Department of Medicine, Fahey Center, Maywood, IL
| | - Andrew M. Skinner
- Edward Hines Jr. Veterans Affairs Hospital, Department of Research and Medicine, Hines, IL
- Loyola University Medical Center, Department of Medicine, Fahey Center, Maywood, IL
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Wang SH, Teng CK, Chan MC, Yang KY, Sheu CC, Liang SJ, Huang WH, Feng JY, Chen CM, Weng ZX, Peng CK. The impact and risk factors for developing pneumogenic bacteremia in carbapenem-resistant Acinetobacter baumannii nosocomial pneumonia in the intensive care unit: A multicenter retrospective study. Int J Infect Dis 2024; 146:107128. [PMID: 38852767 DOI: 10.1016/j.ijid.2024.107128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVES This study analyzed the risk and impact of developing pneumogenic bacteremia in patients with CRAB nosocomial pneumonia in ICU. METHODS This is multicenter retrospective study. Clinical outcomes were compared between bacteremia and non-bacteremia group, and the risk factors for mortality and developing pneumogenic CRAB bacteremia were analyzed. RESULTS After patient recruitment, 164 cases were in the bacteremia group, and 519 cases were in the non-bacteremia group. The bacteremia group had 22.4 percentage of increase in-hospital mortality than the non-bacteremia group (68.3% vs 45.9%, P < 0.001). Multivariate analysis showed bacteremia was an independent risk factor for in-hospital mortality (aHR = 2.399, P < 0.001). A long time-interval between ICU admission and pneumonia onset was an independent risk factor for developing bacteremia (aOR = 1.040, P = < 0.001). Spearman's rank correlation analysis indicated a high correlation between the days from ICU admission to pneumonia onset and the days of ventilator use before pneumonia onset (correlation coefficient (ρ) = 0.777). CONCLUSIONS In patients with CRAB nosocomial pneumonia, bacteremia increased the in-hospital mortality, and a longer interval from ICU admission to pneumonia onset was an independent risk factor for developing bacteremia, which was highly associated with the use of mechanical ventilation.
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Affiliation(s)
- Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Kang Teng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Cheng Chan
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; National Chung Hsing University, Taichung, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cancer and Immunology Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Jye Liang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Hsuan Huang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Min Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zi-Xeng Weng
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Begum S, Cabrera ES, Restrepo OH, Burman C, Sohn WY, Kuylen E, Shah H, Kocaata Z. Quantifying Stated Preferences for Meningococcal Vaccines Among Adolescents/Young Adults and Parents of Adolescents in the United States: A Discrete Choice Experiment. Infect Dis Ther 2024; 13:2001-2015. [PMID: 39044053 PMCID: PMC11343927 DOI: 10.1007/s40121-024-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16-23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. METHODS An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. RESULTS Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2-3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. CONCLUSIONS Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.
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Farmer G, Sikdar KC, Lo T, Conly J, Slobodan J, Ross J, James S, Usman H, Kemp K, Baker K, Doucette K, Nijssen-Jordan C, Saxinger LM, Joffe AM. Real-world evidence of sotrovimab effectiveness for preventing severe outcomes in patients with COVID-19: A quality improvement propensity-matched retrospective cohort study of a pan-provincial program in Alberta, Canada. Int J Infect Dis 2024; 146:107136. [PMID: 38880123 DOI: 10.1016/j.ijid.2024.107136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES Post-marketing surveillance of sotrovimab's effect during implementation in the Canadian population is limited. METHODS The study used a propensity score-matched retrospective cohort design. Follow-up began between the periods of December 15, 2021 and April 30 2022. The study assessed any severe outcome defined as all-cause hospital admission or mortality within 30 days of a confirmed COVID-19-positive test. Covariate-adjusted odds ratios between sotrovimab treatment and the severe outcome was conducted using logistic regression. RESULTS There were 22,289 individuals meeting the treatment criteria for sotrovimab. There were 1603 treated and 6299 untreated individuals included in the analysis. The outcome occurrence in the study was 5.49% (treated) and 4.21% (untreated), with a median time from diagnosis to treatment of 1.00 days (interquartile range 2.00 days). In the propensity-matched cohort, sotrovimab was not associated with lower odds of a severe outcome (odds ratio 1.20, 95% confidence interval 0.91-1.58), adjusting for confounding variables. CONCLUSIONS After adjusting for confounding variables, sotrovimab treatment was not associated with lower odds of a severe outcome within 30-days of COVID-19-positive date.
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Affiliation(s)
- Gregory Farmer
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada.
| | - Khokan C Sikdar
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tkt Lo
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - John Conly
- Department of Medicine, Division of Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada; Alberta Health Services, Alberta, Canada
| | - Jeremy Slobodan
- Department of Drug Utilization, Information and Stewardship, Alberta Health Services, Edmonton, Canada
| | - Jordan Ross
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Samantha James
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Hussain Usman
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Kyle Kemp
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Kristi Baker
- Department of Oncology, Division of Experimental Oncology, University of Alberta, Edmonton, Canada
| | - Karen Doucette
- Alberta Health Services, Alberta, Canada; Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Lynora M Saxinger
- Alberta Health Services, Alberta, Canada; Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - A Mark Joffe
- Alberta Health Services, Alberta, Canada; Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Chen J, Wang Q, Li S, Han R, Wang C, Cheng S, Yang B, Diao L, Yang T, Sun D, Zhang D, Dong Y, Wang T. Does Two-Step Infusion Improve the Pharmacokinetics/Pharmacodynamics Target Attainment of Meropenem in Critically Ill Patients? J Pharm Sci 2024; 113:2904-2914. [PMID: 38996917 DOI: 10.1016/j.xphs.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024]
Abstract
The optimal method for administering meropenem remains controversial. This study was conducted to explore the optimal two-step infusion strategy (TIT), and to investigate whether TIT is superior to intermittent infusion therapy (IIT) and prolonged infusion therapy (PIT). A physiologically based pharmacokinetics model for critically ill patients was established and evaluated. The validated model was utilized to evaluate the pharmacokinetics/pharmacodynamics (PK/PD) target attainment of meropenem. The PK/PD target attainment of different TITs varied greatly, and the total infusion duration and the first-step dose greatly affected these values. The optimal TIT was 0.25 g (30 min) + 0.75 g (150 min) at MICs of ≤2 mg/L, and 0.25 g (45 min) + 0.75 g (255 min) at MICs of 4-8 mg/L. The PK/PD target attainment of optimal TIT, PIT, and IIT were 100 % at MICs of ≤1 mg/L. When MIC increased to 2-8 mg/L, the PK/PD target attainment of optimal TIT was similar to that of PIT and higher than IIT. In conclusion, TIT did not significantly improve the PK/PD target attainment of meropenem compared with PIT. IIT is adequate at MICs of ≤1 mg/L, and PIT may be the optimal meropenem infusion method in critically ill patients with MICs of 2-8 mg/L.
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Affiliation(s)
- Jiaojiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Quanfang Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Sihan Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ruiying Han
- Department of Pharmacy, Xi'an Hospital of Traditional Chinese Medicine, Xi'an 710021, China
| | - Chuhui Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Shiqi Cheng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Baogui Yang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Lizhuo Diao
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tingting Yang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Dan Sun
- Department of Pharmacy, Xi'an Hospital of Traditional Chinese Medicine, Xi'an 710021, China
| | - Di Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Taotao Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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Bonneux B, Jacoby E, Ceconi M, Stobbelaar K, Delputte P, Herschke F. Direct-acting antivirals for RSV treatment, a review. Antiviral Res 2024; 229:105948. [PMID: 38972604 DOI: 10.1016/j.antiviral.2024.105948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
Respiratory syncytial virus (RSV) causes respiratory disease and complications in infants, the elderly and the immunocompromised. While three vaccines and two prophylactic monoclonal antibodies are now available, only one antiviral, ribavirin, is currently approved for treatment. This review aims to summarize the current state of treatments directly targeting RSV. Two major viral processes are attractive for RSV-specific antiviral drug discovery and development as they play essential roles in the viral cycle: the entry/fusion process carried out by the fusion protein and the replication/transcription process carried out by the polymerase complex constituted of the L, P, N and M2-1 proteins. For each viral target resistance mutations to small molecules of different chemotypes seem to delineate definite binding pockets in the fusion proteins and in the large proteins. Elucidating the mechanism of action of these inhibitors thus helps to understand how the fusion and polymerase complexes execute their functions. While many inhibitors have been studied, few are currently in clinical development for RSV treatment: one is in phase III, three in phase II and two in phase I. Progression was halted for many others because of strategic decisions, low enrollment, safety, but also lack of efficacy. Lessons can be learnt from the halted programs to increase the success rate of the treatments currently in development.
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Affiliation(s)
- Brecht Bonneux
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp, Universiteitsbaan 1, 2610, Wilrijk, Belgium; Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Edgar Jacoby
- Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Martina Ceconi
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp, Universiteitsbaan 1, 2610, Wilrijk, Belgium
| | - Kim Stobbelaar
- Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene, University of Antwerp, Universiteitsbaan 1, 2610, Wilrijk, Belgium.
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Perdrizet JE, Rozenbaum MH, Heffler MJ. Pediatric Pneumococcal Conjugate Vaccine and Dosing Schedule Perceptions Among Health Care Providers and Caregivers in Germany, France, Spain, and Greece. Infect Dis Ther 2024; 13:2017-2034. [PMID: 39060825 PMCID: PMC11343953 DOI: 10.1007/s40121-024-01022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Most European infant national immunization programs (NIPs) recommend pneumococcal conjugate vaccines (PCVs), which currently cover 10-15 serotypes administered in a three-dose schedule (two primary plus one booster). Recently, a PCV covering 20 serotypes that is administered in a four-dose schedule (three primary plus one booster) was licensed. METHODS An online survey was administered to collect data from health care providers (HCPs) and caregivers of children aged 0-5 (including expectant mothers) in four European countries (Germany, France, Spain, and Greece). All caregiver respondents had a shared or full responsibility to make health decisions for their child. Data on opinions, perceptions, and openness to a change in childhood vaccination dosing schedules were collected, along with demographic information for HCPs as well as caregivers. RESULTS A total of 601 HCPs and 1954 caregivers were recruited across the four countries. Nearly all HCPs (93%) agreed that broader serotype coverage against pneumococcal disease for children is a significant unmet need, and 92% had a "sense of urgency" to vaccinate children. Both HCPs and caregivers were supportive of an additional PCV dose and doctor visit, assuming it provided at least 20% more serotype coverage than what is currently available. Caregivers strongly agreed on the importance of full vaccination for pneumococcal disease, even if an extra dose and visit to the doctor was required. CONCLUSIONS HCPs and caregivers were virtually unanimous in their support for a PCV with broader serotype coverage and showed a subsequent willingness to include an extra infant dose/visit. These results can help guide broader discussions regarding public health policy and vaccine administration in the context of important efforts to reduce the global disease burden associated with pneumococcal disease.
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Haddara A, Houry Z, Zahreddine N, Atallah M, Boutros CF, Tannous J, Sadaka C, Wehbe S, Kadi T, Ibrahim A, Ahmadieh R, Kardas T, Soudani N, Kalamouni HA, Zgheib Y, Yaman NE, Khafaja S, Lteif M, Shaker R, Casals AA, Youssef Y, Youssef N, Zein ZE, Chamseddine S, Chmaisse A, Haj M, Fayad D, Kiblawi S, Isaac I, Anan H, Radwan N, Wakim RH, Zaraket H, Kanj SS, Dbaibo GS. Characteristics of medically attended influenza infection across age groups before the COVID-19 pandemic in Lebanon. J Infect Public Health 2024; 17:102521. [PMID: 39173555 DOI: 10.1016/j.jiph.2024.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Influenza represents a significant global health burden for individuals and society. This study assessed the burden of medically attended influenza at a tertiary medical center in Lebanon to describe the demographics, risk factors, and outcomes prior to the COVID-19 pandemic. METHODS This was a retrospective review of patients who tested positive for the influenza virus during three seasons between July 1, 2016 to June 30, 2019, at the American University of Beirut Medical Center. RESULTS A total of 2049 patients who tested positive for influenza were analyzed. Influenza A accounted for 79.6 % of cases, and influenza B for 19.7 %, with influenza activity starting in October/November and peaking in December/January. Older age above 65 years (AOR=3.584), obesity (AOR=2.183), and chronic conditions such as chronic lung diseases (AOR=1.832), and bacterial co-infection (AOR= 2.834) were found to be independent risk factors for developing complications. Viral co-infection increased the likelihood of death tenfold. Vaccinated patients had a shorter mean hospital stay duration and a lower intensive care unit admission rate. CONCLUSION The burden of medically attended influenza at our tertiary medical center in Lebanon prior to the COVID-19 pandemic was high. Vaccination decreased the likelihood of complications leading to intensive care unit admission in patients at risk.
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Affiliation(s)
- Amani Haddara
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Zeina Houry
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Nada Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Mark Atallah
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Celina F Boutros
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Joseph Tannous
- Infection Control and Prevention Program, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Infection Control Department, Emirates health services, Dubai Silicon Oasis, Dubai, United Arab Emirates
| | - Christian Sadaka
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Sarah Wehbe
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Tamara Kadi
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Ahmad Ibrahim
- Infection Control and Prevention Program, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Rihab Ahmadieh
- Infection Control and Prevention Program, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Tala Kardas
- Infection Control and Prevention Program, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Infection Control Department, Danat Al Emarat Hospital for Women & Children, Rabdan, Abu Dhabi, United Arab Emirates
| | - Nadia Soudani
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Beirut, Lebanon
| | - Habib Al Kalamouni
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Beirut, Lebanon
| | - Youssef Zgheib
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Noha El Yaman
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Sarah Khafaja
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Mireille Lteif
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Rouba Shaker
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Aia Assaf Casals
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Yolla Youssef
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Nour Youssef
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Zeinab El Zein
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Sarah Chamseddine
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Ahmad Chmaisse
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Magda Haj
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Danielle Fayad
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Shereen Kiblawi
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Imad Isaac
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon
| | - Hind Anan
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Najwa Radwan
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Rima Hanna Wakim
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon
| | - Hassan Zaraket
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Beirut, Lebanon.
| | - Souha S Kanj
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Infection Control and Prevention Program, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Infectious Diseases Division, Department of Internal Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon.
| | - Ghassan S Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Hamra, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon; Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Hamra, Beirut, Lebanon.
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Mitratza M, Elsobky M, Liang C, Bruyndonckx R, Polkowska-Kramek A, Ewnetu WB, Peerawaranun P, Tran TMP, Nuttens C, Grajales AG, Nzula S, Gessner BD, Begier E. Estimated Incidence of Hospitalizations Attributable to RSV Infection Among Adults in Ontario, Canada, Between 2013 and 2019. Infect Dis Ther 2024; 13:1949-1962. [PMID: 39004648 PMCID: PMC11343949 DOI: 10.1007/s40121-024-01018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Adult respiratory syncytial virus (RSV) burden is underestimated due to non-specific symptoms, limited standard-of-care and delayed testing, reduced diagnostic test sensitivity-particularly when using single diagnostic specimen-when compared to children, and variable test sensitivity based on the upper airway specimen source. We estimated RSV-attributable hospitalization incidence among adults aged ≥ 18 years in Ontario, Canada, using a retrospective time-series model-based approach. METHODS The Institute for Clinical Evaluative Sciences data repository provided weekly numbers of hospitalizations (from 2013 to 2019) for respiratory, cardiovascular, and cardiorespiratory disorders. The number of hospitalizations attributable to RSV was estimated using a quasi-Poisson regression model that considered probable overdispersion and was based on periodic and aperiodic time trends and viral activity. As proxies for viral activity, weekly counts of RSV and influenza hospitalizations in children under 2 years and adults aged 60 years and over, respectively, were employed. Models were stratified by age and risk group. RESULTS In patients ≥ 60 years, RSV-attributable incidence rates were high for cardiorespiratory hospitalizations (range [mean] in 2013-2019: 186-246 [215] per 100,000 person-years, 3‒4% of all cardiorespiratory hospitalizations), and subgroups including respiratory hospitalizations (144-192 [167] per 100,000 person-years, 5‒7% of all respiratory hospitalizations) and cardiovascular hospitalizations (95-126 [110] per 100,000 person-years, 2‒3% of all cardiovascular hospitalizations). RSV-attributable cardiorespiratory hospitalization incidence increased with age, from 14-18 [17] hospitalizations per 100,000 person-years (18-49 years) to 317-411 [362] per 100,000 person-years (≥ 75 years). CONCLUSIONS Estimated RSV-attributable respiratory hospitalization incidence among people ≥ 60 years in Ontario, Canada, is comparable to other incidence estimates from high-income countries, including model-based and pooled prospective estimates. Recently introduced RSV vaccines could have a substantial public health impact.
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Affiliation(s)
| | | | - Caihua Liang
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
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Ispas SA, Iliescu D, Ren L, So S, Toy M. Psychometric Tests for Hepatitis B - A Systematic Review. Eval Health Prof 2024; 47:235-253. [PMID: 37461882 DOI: 10.1177/01632787231188458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Hepatitis B is a condition that directly affects hundreds of millions of people, who may require testing for certain psychological constructs. This systematic review presents the current state with regard to the instruments that are used for the measurement of psychological variables in relation to hepatitis B. We conducted a comprehensive search in bibliographic databases (PubMed, Embase, Scopus, Web of Science, PsycINFO, CINAHL, and the Cochrane Library), and grey literature search. We identified commonly used measures, their psychometric properties and gaps in the research. Our findings from the 38 papers included in the review indicate that while several tests have been developed to cater to hepatitis B patients, most are focused on quality of life, with few targeting other needed directions, such as stigma or attitudes to vaccination. We also show the limits in current measures and discuss potential improvements.
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Affiliation(s)
- Simona-Alexandra Ispas
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Dragos Iliescu
- Faculty of Psychology and Educational Sciences, University of Bucharest, Bucuresti, Romania
- Stellenbosch University, Stellenbosch, South Africa
| | - Lily Ren
- Lane Medical Library, Stanford University, School of Medicine, Stanford, CA, USA
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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62
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Dagan A, Epstein D, Neuberger A, Isenberg J. Amikacin treatment in urinary tract infection patients: evaluating the risk of acute kidney injury - a retrospective cohort study. J Chemother 2024; 36:398-402. [PMID: 38372170 DOI: 10.1080/1120009x.2024.2319454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
The rise in ESBL-producing and carbapenem-resistant Gram-negative bacterial infections is alarming. Aminoglycosides remain attractive for treating urinary tract infections (UTIs). However, aminoglycosides-associated acute kidney injury (AKI) raises concerns, especially in patients with underlying renal impairment. We conducted a retrospective cohort study to evaluate the risk of AKI in patients with UTI empirically treated with amikacin. Among 395 patients (median age 41.9 years [IQR 28.3-67.1], 342 [86.6%] female), 162 (41.0%) received amikacin and 233 (59.0%) were empirically treated with other antibiotics. AKI incidence was low (5.6%) and not associated with amikacin exposure (OR 0.56, 95% CI 0.22-1.43, p = 0.23), even in those with pre-existing renal impairment or AKI on admission. The clinical outcomes (including cure by the third day, AKI, maximal creatinine, length of stay, mortality, and readmission) did not differ between the groups. Once-daily amikacin may offer a safe UTI treatment option amid increasing multi-drug resistance.
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Affiliation(s)
- Avner Dagan
- Department of Internal Medicine "H", Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ami Neuberger
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Internal Medicine "D", Rambam Health Care Campus, Haifa, Israel
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan Isenberg
- Hemato-oncology Department, Rambam Health Care Campus, Haifa, Israel
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63
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Rose PC, Davies C, Cotton MF, Otwombe K, Browne SH, Vaida F, Innes S, Nel EDLR. Longitudinal controlled attenuation parameter and liver stiffness in children with and without perinatal HIV infection in South Africa. AIDS 2024; 38:1638-1647. [PMID: 38905492 PMCID: PMC11317452 DOI: 10.1097/qad.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging cause of liver disease in HIV. Transient elastography (TE) with controlled attenuation parameter (CAP) measures liver stiffness as a marker of liver fibrosis and CAP as a measure of hepatic steatosis. Our aim was to evaluate longitudinal CAP and liver stiffness in children with perinatally acquired HIV (PHIV) on antiretroviral therapy (ART) from early life compared to children without HIV (HU). DESIGN Prospective cohort study. METHODS PHIV and HU were followed annually for two years. During the study, 60% of PHIV switched from older ART regimens to tenofovir disoproxil, lamivudine and dolutegravir (TLD). Longitudinal evolution of CAP and liver stiffness were investigated in two PHIV groups - on older ART and on TLD - compared to HU children using linear mixed effects models. RESULTS 263 children and adolescents (112 PHIV, 151 HU) aged 7-20 years were followed. PHIV on older ART had CAP 8.61% (95% CI 4.42-12.97, P < 0.001) greater than HU and no significant difference in CAP between PHIV on TLD and HU. No significant difference in liver stiffness was found between PHIV on older ART regimens and PHIV on TLD compared to HU. CONCLUSION PHIV on older ART had higher CAP than HU, whereas in PHIV switched to TLD there was no difference in CAP compared to HU. There was no difference in liver stiffness between either PHIV group and HU. This suggests starting ART early in life might protect PHIV from developing hepatic fibrosis.
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Affiliation(s)
- Penelope C Rose
- Department of Paediatrics of Child Health, Tygerberg Hospital, Stellenbosch University
| | - Claire Davies
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences
| | - Mark F Cotton
- Department of Paediatrics of Child Health, Tygerberg Hospital, Stellenbosch University
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Florin Vaida
- Division of Biostatistics and Bioinformatics, School of Public Health, University of California, San Diego, CA, USA
| | - Steve Innes
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Etienne De la Rey Nel
- Department of Paediatrics of Child Health, Tygerberg Hospital, Stellenbosch University
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Bernabè G, Castagliuolo I, Porzionato A, Casarotto G, Monte RD, Carpi A, Brun P. Insoluble polysaccharides produced in plant cell cultures protect from Clostridioides difficile colitis. Microbiol Res 2024; 286:127812. [PMID: 38954992 DOI: 10.1016/j.micres.2024.127812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/18/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
Clostridioides difficile infection (CDI) poses a significant health threat due to high recurrence rates. Antimicrobial agents are commonly used to manage CDI-related diarrhoea; however, by aggravating intestinal dysbiosis, antibiotics enable C. difficile spores germination and production of toxins, the main virulence factors. Therefore, the binding of exotoxins using adsorbents represents an attractive alternative medication for the prevention and treatment of relapses. In this study, we provided evidence that the natural insoluble polysaccharides, named ABR119, extracted by plant cell cultures, effectively trap C. difficile toxins. In our experiments, ABR119 exhibited no cytotoxicity in vitro and was safely administered in vivo. In the animal model of C. difficile-associated colitis, ABR119 (50 mg/kg body weight) significantly reduced the colonic myeloperoxidase activity and severity of inflammation, preventing body weight loss. These effects were not evident when we treated animals with wheat bran polysaccharides. We did not detect bacterial killing effects of ABR119 against C. difficile nor against bacterial species of the normal gut microbiota. Moreover, ABR119 did not interfere in vitro with the antimicrobial activities of most clinically used antibiotics. In summary, ABR119 holds promise for treating and preventing C. difficile colitis by trapping the bacterial toxins, warranting further studies to assess the ABR119 potential in human infections caused by C. difficile.
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Affiliation(s)
- Giulia Bernabè
- University of Padova, Department of Molecular Medicine via A. Gabelli, 63, Padova 35121, Italy
| | - Ignazio Castagliuolo
- University of Padova, Department of Molecular Medicine via A. Gabelli, 63, Padova 35121, Italy; Microbiology Unit of Padua University Hospital, via N. Giustiniani, 2, Padova 35128, Italy
| | - Andrea Porzionato
- University of Padova, Department of Neurosciences, via A. Gabelli, 65, Padova 35121, Italy
| | - Gino Casarotto
- Active Botanicals Research, Via dell'Impresa, 1, Brendola, Vicenza 36040, Italy
| | - Renzo Dal Monte
- Active Botanicals Research, Via dell'Impresa, 1, Brendola, Vicenza 36040, Italy
| | - Andrea Carpi
- Active Botanicals Research, Via dell'Impresa, 1, Brendola, Vicenza 36040, Italy
| | - Paola Brun
- University of Padova, Department of Molecular Medicine via A. Gabelli, 63, Padova 35121, Italy.
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Kim MB, Lee YJ. Emergence of Salmonella Infantis carrying the pESI-like plasmid from eggs in egg grading and packing plants in Korea. Food Microbiol 2024; 122:104568. [PMID: 38839227 DOI: 10.1016/j.fm.2024.104568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
The plasmid of emerging S. Infantis (pESI) or pESI-like plasmid in Salmonella enterica Infantis are consistently reported in poultry and humans worldwide. However, there has been limited research on these plasmids of S. Infantis isolated from eggs. Therefore, this study aimed to analyze the prevalence and characteristics of S. Infantis carrying the pESI-like plasmid from eggs in egg grading and packing plants. In this study, the pESI-like plasmid was only detected in 18 (78.3%) of 23 S. Infantis isolates, and it was absent in the other 9 Salmonella serovars. In particular, S. Infantis isolates carrying the pESI-like plasmid showed the significantly higher resistance to β-lactams, phenicols, cephams, aminoglycosides, quinolones, sulfonamides, and tetracyclines than Salmonella isolates without the pESI-like plasmid (p < 0.05). Moreover, all S. Infantis isolates carrying the pESI-like plasmid were identified as extended-spectrum β-lactamase (ESBL) producer, harboring the blaCTX-M-65 and blaTEM-1 genes, and carried non-β-lactamase resistance genes (ant(3'')-Ia, aph(4)-Ia, aac(3)-IVa, aph(3')-Ic, sul1, tetA, dfrA14, and floR) against five antimicrobial classes. However, all isolates without the pESI-like plasmid only carried the blaTEM-1 gene among the β-lactamase genes, and either had no non-β-lactamase resistance genes or harbored non-β-lactamase resistance genes against one or two antimicrobial classes. Furthermore, all S. Infantis isolates carrying the pESI-like plasmid carried class 1 and 2 integrons and the aadA1 gene cassette, but none of the other isolates without the pESI-like plasmid harbored integrons. In particular, D87Y substitution in the gyrA gene and IncP replicon type were observed in all the S. Infantis isolates carrying the pESI-like plasmid but not in the S. Infantis isolates without the pESI-like plasmid. The distribution of pulsotypes between pESI-positive and pESI-negative S. Infantis isolates was clearly distinguished, but all S. Infantis isolates were classified as sequence type 32, regardless of whether they carried the pESI-like plasmid. This study is the first to report the characteristics of S. Infantis carrying the pESI-like plasmid isolated from eggs and can provide valuable information for formulating strategies to control the spread of Salmonella in the egg industry worldwide.
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Affiliation(s)
- Min Beom Kim
- College of Veterinary Medicine & Institute for Veterinary Biomedical Science, Kyungpook National University, Daegu, 41556, Republic of Korea.
| | - Young Ju Lee
- College of Veterinary Medicine & Institute for Veterinary Biomedical Science, Kyungpook National University, Daegu, 41556, Republic of Korea.
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Dramowski A, Prusakov P, Goff DA, Brink A, Govender NP, Annor AS, Balfour L, Bekker A, Cassim A, Gijzelaar M, Holgate SL, Kolman S, Messina A, Tootla H, Schellack N, van Jaarsveld A, Reddy K, Pillay S, Conradie L, van Niekerk AM, Bester T, Alexander P, Andrews A, Dippenaar M, Bamford C, Brits S, Chirwa P, Erasmus H, Ekermans P, Gounden P, Kriel T, Mawela D, Moncho M, Mphuthi T, Nhari R, Charani E, Sánchez PJ, Bergh DVD. Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa: The Neonatal Antimicrobial Stewardship (NeoAMS) study. Int J Infect Dis 2024; 146:107158. [PMID: 38945432 DOI: 10.1016/j.ijid.2024.107158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization. METHODS Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis. FINDINGS During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians' acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032). INTERPRETATION This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis. FUNDING A grant from Merck provided partial support.
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | | | - Debra A Goff
- The Ohio State University College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Adrian Brink
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nelesh P Govender
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ama Sakoa Annor
- Department of Pharmacy, Dr George Mukhari Academic Hospital, Pretoria, South Africa; Department of Clinical pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Liezl Balfour
- Department of Nursing, Lenmed Group, Johannesburg, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Azraa Cassim
- Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - Sandi L Holgate
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sonya Kolman
- Department of Pharmacy, Nelson Mandela Children's Hospital, Johannesburg, South Africa
| | - Angeliki Messina
- Antimicrobial Stewardship Unit, Netcare Hospitals Ltd, Johannesburg, South Africa
| | - Hafsah Tootla
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service Tygerberg and Stellenbosch University, Cape Town, South Africa
| | - Shakti Pillay
- Division of Neonatology, Department of Paediatrics and Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Lucinda Conradie
- Pharmacy Department, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Anika M van Niekerk
- Division of Neonatology, Department of Paediatrics and Child Health, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa
| | - Tarina Bester
- Netcare GNE Regional Clinical Pharmacy, Pretoria, South Africa
| | - Pearl Alexander
- Department of Nursing, Lenmed Royal Hospital & Heart Centre, Kimberley, South Africa
| | - Antoinette Andrews
- Department of Nursing, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - Magdel Dippenaar
- Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa
| | - Colleen Bamford
- Pathcare, East London, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sharnel Brits
- Pharmacy Department, George Provincial Hospital, George, South Africa
| | - Pinky Chirwa
- Neonatal Unit, Nelson Mandela Childrens Hospital, Johannesburg, South Africa
| | - Hannelie Erasmus
- Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa
| | - Pieter Ekermans
- Ampath Laboratory, National Reference Laboratory, Department of Medical Microbiology, Pretoria, South Africa
| | - Pebenita Gounden
- Department of Pharmacy, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - Teresa Kriel
- Pharmacy Department, Life Beacon Bay, East London, South Africa
| | - Dini Mawela
- Department of Paediatrics and Child Health, School of Medicine, Sefako Makgatho Health Sciences University, Gauteng, South Africa
| | - Masego Moncho
- Department of Medical Microbiology-National Health Laboratory Services, Sefako Makgatho Health Sciences University, Gauteng, South Africa
| | - Tonia Mphuthi
- Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Ronald Nhari
- Department of Pharmacy, Life Springs Parkland Hospital, Johannesburg, South Africa
| | - Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Pablo J Sánchez
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dena van den Bergh
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Karampatakis T, Kandilioti E, Katsifa H, Nikopoulou A, Harmanus C, Tsergouli K, Kuijper E, Kachrimanidou M. Clostridioides difficile infection epidemiology during the COVID-19 pandemic in Greece. Future Microbiol 2024; 19:1119-1127. [PMID: 38913938 DOI: 10.1080/17460913.2024.2358653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/20/2024] [Indexed: 06/26/2024] Open
Abstract
Aim: The aim was to highlight the incidence and epidemiology of C. difficile infections (CDI) in a tertiary Greek hospital during the COVID-19 pandemic.Methods: A single-center prospective observational cohort study was conducted (October 2021 until April 2022). 125 C. difficile isolates were cultured from hospitalized patients stool samples and screened by PCR for toxin A (tcdA), toxin B (tcdB), binary toxin (cdtA and cdtB) genes and the regulating gene of tcdC.Results: The incidence of CDI increased to 13.1 infections per 10,000 bed days. The most common PCR ribotypes identified included hypervirulent RT027-related RT181 (73.6%), presumably hypervirulent RT126 (8.0%) and toxin A negative RT017 (7.2%).Conclusion: Although the incidence of CDI increased significantly, the CDI epidemiology remained stable.
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Affiliation(s)
| | - Eleni Kandilioti
- Microbiology Department, Papanikolaou General Hospital, 570 10, Thessaloniki, Greece
| | - Helen Katsifa
- Microbiology Department, Papanikolaou General Hospital, 570 10, Thessaloniki, Greece
| | - Anna Nikopoulou
- Infectious Disease Unit, Papanikolaou General Hospital, 570 10, Thessaloniki, Greece
| | - Celine Harmanus
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, European Study Group of C. difficile (ESGCD), 2333ZA, Leiden, The Netherlands
| | - Katerina Tsergouli
- Microbiology Department, Agios Pavlos General Hospital, 551 34, Thessaloniki, Greece
| | - Ed Kuijper
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, European Study Group of C. difficile (ESGCD), 2333ZA, Leiden, The Netherlands
| | - Melina Kachrimanidou
- Department of Microbiology, Aristotle University of Thessaloniki, Medical School, 541 24, Thessaloniki, Greece
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Ohbayashi H, Sakurai T, Himeji D, Fukushima Y, Takahashi H, Kiyosue A, Sabater Cabrera E, Matsuki T, Molnar D, Preckler Moreno V, Damaso S, Pirçon JY, Moitinho de Almeida M. Burden of respiratory syncytial virus infections in older adults with acute respiratory infection in Japan: An epidemiological study among outpatients. Respir Investig 2024; 62:914-921. [PMID: 39126825 DOI: 10.1016/j.resinv.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/31/2024] [Accepted: 06/16/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illness, with severe outcomes in older adults. Information on the prevalence, hospitalization rate, and impact on the health-related quality of life (HRQoL) of RSV in older adults with acute respiratory infections (ARI) in outpatient settings in Japan is limited. METHODS This multi-center epidemiological study included outpatients aged ≥60 years presenting with ARI between August 2021 and February 2023. Nasal and throat swabs were collected and tested by reverse transcription polymerase chain reaction (RT-PCR). The prevalence of RT-PCR-confirmed RSV (cRSV)-ARI, cRSV-lower respiratory tract disease (LRTD), and other respiratory viruses was calculated by season, region, age group, and RSV subtype. HRQoL was assessed via patient-reported outcomes. RESULTS The study included 923 ARI episodes (cRSV-ARI: N = 24; non-cRSV-ARI: N = 899). In years 1 and 2 (August 2021-July 2022 and August 2022-February 2023), the prevalence of cRSV-ARI was 2.5% and 2.8%, respectively. There was a predominance of RSV-B and RSV-A subtypes in years 1 and 2, respectively. In years 1 and 2 combined, 37.5% of cRSV-ARI cases had lower respiratory tract infection; all cRSV-LRTD cases occurred in those aged 60-74 years. RSV-ARI cases reported throat, chest, and respiratory symptoms, leading to impaired functioning and HRQoL. CONCLUSIONS During the observed study period, RSV was circulating among older adults in Japan. RSV was a leading cause of ARI and LRTD. More data are needed to fully clarify the burden of RSV among older adults in Japan.
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Affiliation(s)
- Hiroyuki Ohbayashi
- Medical Corporation, Syureikai, Tohno Chuo Clinic, 1 Chome-14-1 Matsugasecho, Mizunami City, Gifu 50-6134, Japan
| | - Takayuki Sakurai
- NTT Medical Center, 5 Chome-9-22 Higashigotanda, Shinagawa City, Tokyo 141-8625, Japan
| | - Daisuke Himeji
- Miyazaki Prefectural Hospital, 5-30 Kitatakamatsucho, Miyazaki, 880-0017, Japan
| | - Yasushi Fukushima
- Fukuwa Clinic, 1 Chome-1-6, Kyobachi, Cyuo-ku, Tokyo 103-0027, Japan
| | - Hiroshi Takahashi
- Saka General Hospital, 16-5 Nishikicho, Shiogama, Miyagi 985-0024, Japan
| | - Arihiro Kiyosue
- Tokyo-Eki Center-building Clinic, 3 Chome-2-2 Nihonbashi, Chuo City, Tokyo 103-0027, Japan
| | | | - Taizo Matsuki
- GSK, Akasaka Intercity Air, 1 Chome-8-1 Akasaka, Minato City, Tokyo 107-0052, Japan
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Haeberer M, Mengel M, Fan R, Toquero-Asensio M, Martin-Toribio A, Liu Q, He Y, Uppal S, Rojo-Rello S, Domínguez-Gil M, Hernán-García C, Fernández-Espinilla V, Liang C, Begier E, Castrodeza Sanz J, Eiros JM, Sanz-Muñoz I. RSV Risk Profile in Hospitalized Adults and Comparison with Influenza and COVID-19 Controls in Valladolid, Spain, 2010-2022. Infect Dis Ther 2024; 13:1983-1999. [PMID: 39033476 PMCID: PMC11343947 DOI: 10.1007/s40121-024-01021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION We aimed to describe the risk profile of respiratory syncytial virus (RSV) infections among adults ≥ 60 years in Valladolid from January 2010 to August 2022, and to compare them with influenza and COVID-19 controls. METHODS This was a retrospective cohort study of all laboratory-confirmed RSV infections identified in centralized microbiology database during a 12-year period. We analyzed risk factors for RSV hospitalization and severity (length of stay, intensive care unit admission, in-hospital death or readmission < 30 days) and compared severity between RSV patients vs. influenza and COVID-19 controls using multivariable logistic regression models. RESULTS We included 706 RSV patients (635 inpatients and 71 outpatients), and 598 influenza and 60 COVID-19 hospitalized controls with comparable sociodemographic profile. Among RSV patients, 96 (15%) had a subtype identified: 56% A, 42% B, and 2% A + B. Eighty-one percent of RSV patients had cardiovascular conditions, 65% endocrine/metabolic, 46% chronic lung, and 43% immunocompromising conditions. Thirty-six percent were coinfected (vs. 21% influenza and 20% COVID-19; p = < .0001 and 0.01). Ninety-two percent had signs of lower respiratory infection (vs. 85% influenza and 72% COVID-19, p = < .0001) and 27% cardiovascular signs (vs. 20% influenza and 8% COVID-19, p = 0.0031 and 0.0009). Laboratory parameters of anemia, inflammation, and hypoxemia were highest in RSV. Among RSV, being a previous smoker (adjusted OR 2.81 [95% CI 1.01, 7.82]), coinfection (4.34 [2.02, 9.34]), and having cardiovascular (3.79 [2.17, 6.62]), neurologic (2.20 [1.09, 4.46]), or chronic lung (1.93 [1.11, 3.38]) diseases were risks for hospitalization. Being resident in care institutions (1.68 [1.09, 2.61]) or having a coinfection (1.91[1.36, 2.69]) were risks for higher severity, while RSV subtype was not associated with severity. Whereas RSV and influenza patients did not show differences in severity, RSV patients had 68% (38-84%) lower odds of experiencing any severe outcome compared to COVID-19. CONCLUSIONS RSV especially affects those with comorbidities, coinfections, and living in care institutions. RSV vaccination could have an important public health impact in this population.
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Affiliation(s)
- Mariana Haeberer
- Pfizer SLU, Av Europa 20B, 28108, Madrid, Spain.
- Pfizer Inc, Collegeville, USA.
| | | | | | - Marina Toquero-Asensio
- National Influenza Centre, Valladolid, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León, ICSCYL, Soria, Spain
| | | | | | | | | | - Silvia Rojo-Rello
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Domínguez-Gil
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina Hernán-García
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Javier Castrodeza Sanz
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José M Eiros
- National Influenza Centre, Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ivan Sanz-Muñoz
- Instituto de Estudios de Ciencias de la Salud de Castilla y León, ICSCYL, Soria, Spain
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Gesser AF, Campos ML, Artismo RS, Karloh M, Matte DL. Impact of COVID-19 critical illness on functional status, fatigue symptoms, and health-related quality of life one-year after hospital discharge: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:4086-4097. [PMID: 37818936 DOI: 10.1080/09638288.2023.2266365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To estimate the prevalence and severity of impairments in functional status, fatigue, and health-related quality of life (HRQoL) among critical COVID-19 survivors one-year after hospital discharge. METHODS A systematic review was conducted following PRISMA statement and registered in PROSPERO (CRD42021258356), with searches in eight databases. Observational studies were selected. The prevalence meta-analysis of abnormalities was performed using random-effects models. Risk of bias was evaluated using the National Heart, Lung, and Blood Institute tool. RESULTS Twenty studies were included, with data collected between 12 and 13.5 months after hospital discharge and a total of 1828 participants. Of these, 71% were men, and 77.7% were intubated in the intensive care unit (ICU). Impairments and sequelae were identified in varying prevalence and degrees, with greater impact on functional capacity and physical components of fatigue and HRQoL. The prevalence of abnormalities of 32.3% [95% CI 23.9; 41.9] found in the meta-analysis is substantially high. Most studies were classified as having fair and poor quality. CONCLUSION Critical COVID-19 survivors experience impairments in functional status, fatigue, and HRQoL to varying degrees one-year after hospital discharge, particularly among patients who stayed in the ICU and on MV for a prolonged period.
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Affiliation(s)
- Ana Flávia Gesser
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Mariana Lanzoni Campos
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Regiana Santos Artismo
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Manuela Karloh
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Darlan Laurício Matte
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
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Taynton T, Allsup D, Barlow G. How can we optimize antifungal use and stewardship in the treatment of acute leukemia? Expert Rev Hematol 2024; 17:581-593. [PMID: 39037307 DOI: 10.1080/17474086.2024.2383401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/18/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The global need for antifungal stewardship is driven by spreading antimicrobial and antifungal resistance. Triazoles are the only oral and relatively well-tolerated class of antifungal medications, and usage is associated with acquired resistance and species replacement with intrinsically resistant organisms. On a per-patient basis, hematology patients are the largest inpatient consumers of antifungal drugs, but are also the most vulnerable to invasive fungal disease. AREAS COVERED In this review we discuss available and forthcoming antifungal drugs, antifungal prophylaxis and empiric antifungal therapy, and how a screening based and diagnostic-driven approach may be used to reduce antifungal consumption. Finally, we discuss components of an antifungal stewardship program, interventions that can be employed, and how impact can be measured. The search methodology consisted of searching PubMed for journal articles using the term antifungal stewardship plus program, intervention, performance measure or outcome before 1 January 2024. EXPERT OPINION Initial focus should be on implementing effective antifungal stewardship programs by developing and implementing local guidelines and using interventions, such as post-prescription review and feedback, which are known to be effective. Technologies such as microbiome analysis and machine learning may allow the development of truly individualized risk-factor-based approaches to antifungal stewardship in the future.
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Affiliation(s)
- Thomas Taynton
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Centre for Biomedical Research, Hull York Medical School, Hull, UK
| | - David Allsup
- Biomedical Institute for Multimorbidity, Hull York Medical School, Hull, UK
- Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Gavin Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
- York Biomedical Research Institute and Hull York Medical School, University of York, York, UK
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Deng S, Cong B, Edgoose M, De Wit F, Nair H, Li Y. Risk factors for respiratory syncytial virus-associated acute lower respiratory infection in children under 5 years: An updated systematic review and meta-analysis. Int J Infect Dis 2024; 146:107125. [PMID: 38945430 DOI: 10.1016/j.ijid.2024.107125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children. With substantial advances in RSV research, we aimed to conduct an updated systematic review of risk factors for RSV-ALRI in children under 5 years. METHODS We updated our previously published literature search to November 2022 among three English databases and additionally searched three Chinese databases (from January 1995) to identify all relevant publications. We performed random-effects meta-analyses to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) for each risk factor and each outcome (RSV-ALRI in the community and RSV-ALRI hospitalization). RESULTS A total of 47 studies were included (26 from the updated search). Indoor air pollution was identified as a possible risk factor for RSV-ALRI in the community (OR 1.45, 95% CI: 1.10-1.90). The identified risk factors for RSV-ALRI hospitalization fall into four categories: demographic (male sex, Māori and Pacific ethnicities vs European or other ethnicities), pre- and post-neonatal (prematurity, low birth weight, small for gestational age, maternal smoking during pregnancy or lactation, maternal age <30 years vs 30-34 years, multiparity, caesarean section vs vaginal), household and environmental (having siblings, passive smoking, maternal asthma, daycare centre attendance) and health and medical conditions (any chronic diseases, bronchopulmonary dysplasia, HIV infections, congenital heart disease, Down syndrome, cystic fibrosis, previous asthma). The pooled ORs ranged from 1.14 to 4.55. CONCLUSION Our findings on the risk factors for RSV-ALRI help identify RSV high-risk groups, which has important implications for RSV prevention at both individual and population levels.
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Affiliation(s)
- Shuyu Deng
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Bingbing Cong
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Madeleine Edgoose
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Femke De Wit
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Harish Nair
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, South Africa
| | - You Li
- National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; Changzhou Third People's Hospital, Changzhou Medical Centre, Nanjing Medical University, Changzhou, China.
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73
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Sutton AJ, Lupu DS, Bergin SP, Holland TL, McAdams SA, Dadwal SS, Nguyen K, Nolte FS, Tremblay G, Perkins BA. Cost-Effectiveness of Plasma Microbial Cell-Free DNA Sequencing When Added to Usual Care Diagnostic Testing for Immunocompromised Host Pneumonia. PHARMACOECONOMICS 2024; 42:1029-1045. [PMID: 38955978 PMCID: PMC11343789 DOI: 10.1007/s40273-024-01409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Immunocompromised host pneumonia (ICHP) is an important cause of morbidity and mortality, yet usual care (UC) diagnostic tests often fail to identify an infectious etiology. A US-based, multicenter study (PICKUP) among ICHP patients with hematological malignancies, including hematological cell transplant recipients, showed that plasma microbial cell-free DNA (mcfDNA) sequencing provided significant additive diagnostic value. AIM The objective of this study was to perform a cost-effectiveness analysis (CEA) of adding mcfDNA sequencing to UC diagnostic testing for hospitalized ICHP patients. METHODS A semi-Markov model was utilized from the US third-party payer's perspective such that only direct costs were included, using a lifetime time horizon with discount rates of 3% for costs and benefits. Three comparators were considered: (1) All UC, which included non-invasive (NI) and invasive testing and early bronchoscopy; (2) All UC & mcfDNA; and (3) NI UC & mcfDNA & conditional UC Bronch (later bronchoscopy if the initial tests are negative). The model considered whether a probable causative infectious etiology was identified and if the patient received appropriate antimicrobial treatment through expert adjudication, and if the patient died in-hospital. The primary endpoints were total costs, life-years (LYs), equal value life-years (evLYs), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio per QALY. Extensive scenario and probabilistic sensitivity analyses (PSA) were conducted. RESULTS At a price of $2000 (2023 USD) for the plasma mcfDNA, All UC & mcfDNA was more costly ($165,247 vs $153,642) but more effective (13.39 vs 12.47 LYs gained; 10.20 vs 9.42 evLYs gained; 10.11 vs 9.42 QALYs gained) compared to All UC alone, giving a cost/QALY of $16,761. NI UC & mcfDNA & conditional UC Bronch was also more costly ($162,655 vs $153,642) and more effective (13.19 vs 12.47 LYs gained; 9.96 vs 9.42 evLYs gained; 9.96 vs 9.42 QALYs gained) compared to All UC alone, with a cost/QALY of $16,729. The PSA showed that above a willingness-to-pay threshold of $50,000/QALY, All UC & mcfDNA was the preferred scenario on cost-effectiveness grounds (as it provides the most QALYs gained). Further scenario analyses found that All UC & mcfDNA always improved patient outcomes but was not cost saving, even when the price of mcfDNA was set to $0. CONCLUSIONS Based on the evidence available at the time of this analysis, this CEA suggests that mcfDNA may be cost-effective when added to All UC, as well as in a scenario using conditional bronchoscopy when NI testing fails to identify a probable infectious etiology for ICHP. Adding mcfDNA testing to UC diagnostic testing should allow more patients to receive appropriate therapy earlier and improve patient outcomes.
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Affiliation(s)
| | | | - Stephen P Bergin
- Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Thomas L Holland
- Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Jiang L, Yin D, Song P, Tang C, Liu X, Hu F. Evaluation of the in vitro activity of ampicillin-sulbactam and cefoperazone-sulbactam against A. Baumannii by the broth disk elution test. Eur J Clin Microbiol Infect Dis 2024; 43:1711-1719. [PMID: 38970691 DOI: 10.1007/s10096-024-04889-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
To evaluate the in vitro activity of ampicillin-sulbactam and cefoperazone-sulbactam against A. baumannii using the broth disk elution testing, a total of 150 A. baumannii isolates were collected from across China between January 2019 and January 2021, including 51 carbapenem-susceptible and 99 carbapenem-resistant isolates. Broth disk elution (BDE) and the broth microdilution (BMD) method were performed for all strains. The concentration range of the BDE was 10/10 µg/mL, 20/20 µg/mL, and 30/30 µg/mL for ampicillin-sulbactam, and 37.5/15 µg/mL, 75/30 µg/mL, 112.5/45 µg/mL, and 150/60 µg/mL for cefoperazone-sulbactam, respectively. Compared with BMD, the BDE results of ampicillin-sulbactam and cefoperazone-sulbactam showed a categorical agreement of 83.3% (125/150) and 95.3% (143/150), with minor errors of 16.7% (25/150) and 4.7% (7/150), respectively. No major error or very major errors were detected. The sensitivity differences by BDE of carbapenem-resistant A. baumannii (CRAb) to different concentrations of ampicillin-sulbactam showed statistically significant (p < 0.017), while those to cefoperazone-sulbactam at 37.5/15 µg/mL, 75/30 µg/mL, and 112.5/45 µg/mL were significant (p < 0.008). However, no significant difference in sensitivity was observed between 112.5/45 µg/mL and 150/60 µg/mL (p > 0.008). In conclusion, the BDE is a reliable and convenient method to detect the in vitro activity of cefoperazone-sulbactam against A. baumannii, and the results could serve as a clinical reference value when deciding whether or not to use high-dose sulbactam for the treatment of A. baumannii infections.
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Affiliation(s)
- Lan Jiang
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
- Department of Laboratory, Urumqi Maternal and Child Health Hospital, Urumqi, China
| | - Dandan Yin
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Peipei Song
- Department of Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chengkang Tang
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China.
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Attaianese F, Dalpiaz I, Failla M, Pasquali E, Galli L, Chiappini E. Fixed-dose antiretroviral combinations in children living with human immunodeficiency virus type 1 (HIV-1): a systematic review. J Chemother 2024; 36:355-369. [PMID: 38153234 DOI: 10.1080/1120009x.2023.2297095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
Fixed-Dose antiretroviral Combinations (FDCs) are the most used drug regimes in adult patients with human-immunodeficiency virus 1 infection, since they increase adherence to antiretroviral therapy and enable good quality of life. The European AIDS Clinical Society guidelines recommend the use of FDCs in paediatrics. However, the use of FDCs in paediatric population is restricted since studies in children and adolescents are mostly conducted in small sample sizes and are heterogeneous in settings and design. This systematic review aims to summarize the current knowledge about the use of FDCs in paediatric population, highlighting the relevant outcomes regarding efficacy and effectiveness, adherence, safety, and adverse events of these regimens.
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Affiliation(s)
- Federica Attaianese
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Irene Dalpiaz
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Martina Failla
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Elisa Pasquali
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
- Paediatric Infectious Disease Unit, IRCCS Anna Meyer Children's Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
- Paediatric Infectious Disease Unit, IRCCS Anna Meyer Children's Hospital, Florence, Italy
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Wensel D, Gartland M, Beloor J, Shetty KN, Wolf J, Stewart E, Clark A, Tenorio A, Krystal M. The sensitivity of HIV-1 gp120 polymorphs to inhibition by temsavir correlates to temsavir binding on-rate. Antiviral Res 2024; 229:105953. [PMID: 38960100 DOI: 10.1016/j.antiviral.2024.105953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/13/2024] [Accepted: 06/29/2024] [Indexed: 07/05/2024]
Abstract
Temsavir binds directly to the HIV-1 envelope glycoprotein gp120 and selectively inhibits interactions between HIV-1 and CD4 receptors. Previous studies identified gp120 amino acid positions where substitutions are associated with reduced susceptibility to temsavir. The mechanism by which temsavir susceptibility is altered in these envelope glycoproteins was evaluated. Pseudoviruses encoding gp120 substitutions alone (S375H/I/M/N, M426L, M434I, M475I) or in combination (S375H + M475I) were engineered on a wild-type JRFL background. Temsavir-gp120 and CD4-gp120 binding kinetics and ability of temsavir to block CD4-gp120 binding were evaluated using the purified polymorphic gp120 proteins and a Creoptix® WAVE Delta grating-coupled interferometry system. Fold-change in half-maximal inhibitory concentration (IC50) in JRFL-based pseudoviruses containing the aforementioned polymorphisms relative to that of wild-type ranged from 4-fold to 29,726-fold, while temsavir binding affinity for the polymorphic gp120 proteins varied from 0.7-fold to 73.7-fold relative to wild-type gp120. Strong correlations between temsavir IC50 and temsavir binding affinity (r = 0.7332; P = 0.0246) as well as temsavir binding on-rate (r = -0.8940; P = 0.0011) were observed. Binding affinity of gp120 proteins for CD4 varied between 0.4-fold and 3.1-fold compared with wild-type gp120; no correlations between temsavir IC50 and CD4 binding kinetic parameters were observed. For all polymorphic gp120 proteins, temsavir was able to fully block CD4 binding; 3 polymorphs required higher temsavir concentrations. Loss of susceptibility to temsavir observed for gp120 polymorphisms strongly correlated with reductions in temsavir binding on-rate. Nonetheless, temsavir retained the ability to fully block CD4-gp120 engagement given sufficiently high concentrations.
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Affiliation(s)
- David Wensel
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA.
| | - Margaret Gartland
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Jagadish Beloor
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA
| | - Kartika N Shetty
- Domainex Ltd, Chesterford Research Park, Saffron Walden, CB10 1XL, UK
| | - Jana Wolf
- Domainex Ltd, Chesterford Research Park, Saffron Walden, CB10 1XL, UK
| | - Eugene Stewart
- GSK, 1250 S Collegeville Road, Collegeville, PA, 19426, USA
| | - Andrew Clark
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Allan Tenorio
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA
| | - Mark Krystal
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA
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Hwang YJ, Lesko CR, Brown TT, Alexander GC, Zalla LC, Keruly JC, Snow LN, Pytell JD, Falade-Nwulia O, Jones JL, Moore RD, Fojo AT. Association between switching to integrase strand transfer inhibitors and incident diabetes in people with HIV. AIDS 2024; 38:1696-1702. [PMID: 38864578 PMCID: PMC11293974 DOI: 10.1097/qad.0000000000003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Integrase strand transfer inhibitors (INSTI) are associated with weight gain in people with HIV (PWH), but their impact on diabetes is unclear. We evaluated the association between switching from nonnucleoside reverse-transcriptase inhibitors (NNRTI) or protease inhibitors (PI) to INSTI and incident diabetes. DESIGN Longitudinal cohort study. METHODS We included PWH aged ≥18 years from the Johns Hopkins HIV Clinical Cohort (2007-2023) without history of diabetes who had used NNRTI or PI for ≥180 days. We followed participants up to 10 years from HIV primary care visits where they switched to INSTI or continued NNRTI or PI. We estimated the hazard of incident diabetes associated with switching to INSTI using weighted Cox regression with robust variance estimator. RESULTS We included 2075 PWH who attended 22 116 visits where they continued NNRTI or PI and 631 visits where they switched to INSTI. Switching to INSTI was associated with a weighted hazard ratio (wHR) of 1.11 [95% confidence interval (CI), 0.77-1.59] for incident diabetes. The association if no weight gain occurred during the first two years was not qualitatively different (wHR 1.22; 95% CI, 0.82-1.80). In a posthoc analysis, switching to INSTI conferred a significant wHR of 1.79 (95% CI, 1.13-2.84) for diabetes within the first two years but not after. CONCLUSIONS Switching from NNRTI or PI to INSTI did not significantly increase overall diabetes incidence in PWH, although there may be elevated risk in the first two years. These findings can inform considerations when switching to INSTI-based regimens.
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Affiliation(s)
- Y Joseph Hwang
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - G Caleb Alexander
- Department of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren C Zalla
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeanne C Keruly
- Department of Medicine, Johns Hopkins University School of Medicine
| | - LaQuita N Snow
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Joyce L Jones
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins University School of Medicine
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Sharif F, Shahzad L, Batool M. The association between climatic factors and waterborne infectious outbreaks with a focus on vulnerability in Pakistan: integrative review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:3299-3316. [PMID: 38195067 DOI: 10.1080/09603123.2024.2302040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
Climate change affects the spread of waterborne infectious diseases, yet research on vulnerability to outbreaks remains limited. This integrative review examines how climate variables (temperature and precipitation) relate to human vulnerability factors in Pakistan. By 2060, mean temperatures are projected to rise from 21.68°C (2021) to 30°C, with relatively stable precipitation. The epidemiological investigation in Pakistan identified Diarrhea (119,000 cases/year), Malaria (2.6 million cases/year), and Hepatitis (A and E) as the most prevalent infections. This research highlighted vulnerability factors, including poverty (52% of the population), illiteracy (59% of the population), limited healthcare accessibility (55% of the population), malnutrition (38% of the population), dietary challenges (48% of the population), as well as exposure to water pollution (80% of the population) and air pollution (55% of the population). The findings suggest that the coordinated strategies are vital across health, environmental, meteorological, and social sectors, considering climatic variability patterns and population vulnerability determinants.
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Affiliation(s)
- Faiza Sharif
- Sustainable development study center (SDSC), Government College University, Lahore, Pakistan
| | - Laila Shahzad
- Sustainable development study center (SDSC), Government College University, Lahore, Pakistan
| | - Masooma Batool
- Sustainable development study center (SDSC), Government College University, Lahore, Pakistan
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79
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Wang Z, Wu H, Guo Y, Zhu L, Dai Z, Zhang H, Ma X. Development and validation of a novel prediction model for Carbapenem-resistant organism infection in a large-scale hospitalized patients. Diagn Microbiol Infect Dis 2024; 110:116415. [PMID: 38970947 DOI: 10.1016/j.diagmicrobio.2024.116415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
Carbapenem-resistant organism (CRO) are defined as gram-negative bacteria. The lack of safe and effective antibiotics has led to an increase in incidence rate. The purpose of this study is to establish and determine a risk nomogram to predict CRO infection in hospitalized patients. Hospitalized patients' information were collected from the electronic medical record system of hospital between January 2019 and December 2022. Based on the inclusion and exclusion criteria, we identified 131390 inpatients who met the criteria for this study. For the training cohort, the area under the curves (AUC) for predicting the CRO infection was 0.935. For the validation cohort, the AUC for predicting the CRO infection was 0.937. We have developed the first novel nomogram to predict CRO infection in hospitalized patients, which is reliable and high-performance. The nomogram performs well among hospitalized patients and has good predictive ability.
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Affiliation(s)
- Zhiqiang Wang
- Department of Biostatistics, Akeso Biopharma Inc, Shanghai, China
| | - Hao Wu
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Yunping Guo
- Department of Traditional Chinese Medicine, Pudong New Area People's Hospital, Shanghai, China
| | - Linyin Zhu
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Zhuangqing Dai
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Huihui Zhang
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Xiaoting Ma
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China.
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80
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Akkhasith D, Sayasone S, Homsana A, Hübschen JM, Virachith S, Black AP, Paboriboune P. Challenges to Hepatitis C Virus Testing and Treatment in a Rural Setting of Lao People's Democratic Republic. J Clin Exp Hepatol 2024; 14:101426. [PMID: 38778901 PMCID: PMC11106526 DOI: 10.1016/j.jceh.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Laos
| | - Anousin Homsana
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Laos
| | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand Duchy of Luxembourg
| | | | - Antony P Black
- Institut Pasteur du Laos, Vientiane, Laos
- School of Life Sciences, Westminster University, London, UK
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81
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Friedland PL, Tucker S. Phase II Trial of the Impact 0.5% Povidone-Iodine Nasal Spray (Nasodine®) on Shedding of SARS-CoV-2. Laryngoscope 2024; 134:3947-3952. [PMID: 38554057 DOI: 10.1002/lary.31430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE A Phase II trial was conducted to determine if nasal disinfection with a commercial Good Manufacturing Practice-manufactured 0.5% povidone-iodine nasal spray (Nasodine®) may be a useful adjunct in the management of COVID-19 by reducing viral shedding and prevention of transmission of SARS-CoV-2. The aim was to confirm the results from a human single-dose pilot study by assessing repeated and frequent doses on nasal shedding of SARS-CoV-2 from adult subjects with confirmed COVID-19. METHODS A multicenter, randomized, double-blinded, placebo-controlled Phase II clinical trial involving adults with early COVID-19 symptoms. Baseline nasal swabs were collected to quantify pretreatment SARS-CoV-2 nasal viral load, followed by Nasodine treatment eight times daily over 3 calendar days. Daily nasal swabs were collected post-dose to assess the impact of treatment on nasal viral load, measured by log10 TCID50 in quantitative culture. RESULTS Nasodine subjects exhibited significantly improved reduction in viral load (log10 TCID50) on Days 2-4 compared to placebo recipients (p = 0.028), rate of nasal clearance of viable virus (p = 0.032), and complete (100%) nasal and throat clearance of the virus by Day 5. No difference was seen in antigen shedding as measured by time transition from Rapid Antigen Test (RAT) positivity to RAT negativity. CONCLUSION A total of 20 doses of Nasodine® nasal spray administered over 2.5 days significantly reduced the titers of viable SARS-CoV-2 virus in the nasal passages of COVID-19 subjects. This is the first study demonstrating the efficacy of a tolerable intranasal formulation of povidone-iodine on viral shedding in COVID-19 subjects. Nasal disinfection may diminish viral transmission to others. LEVEL OF EVIDENCE 2 Laryngoscope, 134:3947-3952, 2024.
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Affiliation(s)
- Peter L Friedland
- Faculty of Medical and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department Otorhinolaryngology Head Neck Skull Base Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Firebrick Pharma Limited, Melbourne, Victoria, Australia
| | - Simon Tucker
- Firebrick Pharma Limited, Melbourne, Victoria, Australia
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82
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Jeon P, Yoo B, Kim Y, Lee SY, Woo HM, Lim HY, Lee JY, Park S, Lee H. Characterization of high-affinity antibodies against the surface Gc protein of Dabie bandavirus / severe fever with thrombocytopenia syndrome virus. Biochem Biophys Rep 2024; 39:101779. [PMID: 39099605 PMCID: PMC11296068 DOI: 10.1016/j.bbrep.2024.101779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV) or Dabie bandavirus is an emerging pathogen responsible for SFTS. It is considered a novel threat to human health, given the high associated fatality. SFTSV is a segmented negative-strand RNA virus containing three single-stranded RNAs, with the M segment encoding the glycoproteins Gn and Gc. Gc is vital for viral entry into the host cell surface, along with the Gn protein. As the Gc is the surface-exposable antigen from virions, it is a critical diagnostic marker of infection. Although various SFTSV Gn or N protein-based sero-diagnostic methods have been developed, there are no commercially available sero-diagnostic kits. Therefore, we generated monoclonal antibodies (mAbs) against SFTSV Gc and explored their application in serum diagnostic tests to develop sensitive serodiagnostic tools covering broad-range genotypes (A to F). First, 10 SFTSV Gc antibody-binding fragments (Fabs) were isolated using a phage display system and converted into human IgGs. Enzyme-linked immunosorbent assays (ELISA) of the SFTSV and Rift Valley fever virus (RVFV: same genus as SFTSV) Gc antigens showed that all antibodies attached to the SFTSV Gc protein had high affinity. An immunofluorescence assay (IFA), to verify the cross-reactivity of seven antibodies with high affinities for various SFTSV genotypes (A, B2, B3, D, and F) and detect mAb binding with intact Gc proteins, revealed that five IgG type mAbs were bound to intact Gc proteins of various genotypes. Six high-affinity antibodies were selected using ELISA and IFA. The binding capacity of the six antibodies against the SFTSV Gc antigen was measured using surface plasmon resonance. All antibodies had high binding capacity. Consequently, these antibodies serve as valuable markers in the serological diagnosis of SFTSV.
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Affiliation(s)
- Pyeonghwa Jeon
- Division of Emerging Virus & Vector Research, Center for Emerging Virus Research, Republic of Korea
| | - Bin Yoo
- New Drug Development Center, Osong Medical Innovation Foundation, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Yoonji Kim
- New Drug Development Center, Osong Medical Innovation Foundation, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - So-Young Lee
- Division of Emerging Virus & Vector Research, Center for Emerging Virus Research, Republic of Korea
| | - Hye-Min Woo
- Division of Emerging Virus & Vector Research, Center for Emerging Virus Research, Republic of Korea
| | - Hee-Young Lim
- Division of Emerging Virus & Vector Research, Center for Emerging Virus Research, Republic of Korea
| | - Joo-Yeon Lee
- Center for Emerging Virus Research, Korea National Institute of Infectious Diseases, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheonju-si, Chungcheongbuk-do, 28159, Republic of Korea
| | - Sora Park
- New Drug Development Center, Osong Medical Innovation Foundation, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Hansaem Lee
- Division of Emerging Virus & Vector Research, Center for Emerging Virus Research, Republic of Korea
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Sher EK, Džidić-Krivić A, Sesar A, Farhat EK, Čeliković A, Beća-Zećo M, Pinjic E, Sher F. Current state and novel outlook on prevention and treatment of rising antibiotic resistance in urinary tract infections. Pharmacol Ther 2024; 261:108688. [PMID: 38972453 DOI: 10.1016/j.pharmthera.2024.108688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/16/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
Antibiotic-resistant bacteria are currently an important public health concern posing a serious threat due to their resistance to the current arsenal of antibiotics. Uropathogens Escherichia coli (UPEC), Proteus mirabilis, Klebsiella pneumoniae and Enterococcus faecalis, antibiotic-resistant gram-negative bacteria, cause serious cases of prolonged UTIs, increasing healthcare costs and potentially even leading to the death of an affected patient. This review discusses current knowledge about the increasing resistance to currently recommended antibiotics for UTI therapy, as well as novel therapeutic options. Traditional antibiotics are still a part of the therapy guidelines for UTIs, although they are often not effective and have serious side effects. Hence, novel drugs are being developed, such as combinations of β-lactam antibiotics with cephalosporins and carbapenems. Siderophoric cephalosporins, such as cefiderocol, have shown potential in the treatment of individuals with significant gram-negative bacterial infections, as well as aminoglycosides, fluoroquinolones and tetracyclines that are also undergoing clinical trials. The use of cranberry and probiotics is another potential curative and preventive method that has shown antimicrobial and anti-inflammatory effects. However, further studies are needed to assess the efficacy and safety of probiotics containing cranberry extract for UTI prevention and treatment. An emerging novel approach for UTI treatment is the use of immuno-prophylactic vaccines, as well as different nanotechnology solutions such as nanoparticles (NP). NP have the potential to be used as delivery systems for drugs to specific targets. Furthermore, nanotechnology could enable the development of nano antibiotics with improved features by the application of different NPs in their structure, such as gold and copper NPs. However, further high-quality research is required for the synthesis and testing of these novel molecules, such as safety evaluation and pharmacovigilance.
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Affiliation(s)
- Emina K Sher
- School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, United Kingdom.
| | - Amina Džidić-Krivić
- Department of Neurology, Cantonal Hospital Zenica, Zenica 72000, Bosnia and Herzegovina; International Society of Engineering Science and Technology, Nottingham, United Kingdom
| | - Ana Sesar
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Faculty of Health Studies, Victoria International University, Mostar 88000, Bosnia and Herzegovina
| | - Esma K Farhat
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Faculty of Food Technology, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Amila Čeliković
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Faculty of Medicine, University of Zenica, Zenica 71000, Bosnia and Herzegovina
| | - Merima Beća-Zećo
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Faculty of Health Studies, Victoria International University, Mostar 88000, Bosnia and Herzegovina
| | - Emma Pinjic
- Department of Radiology, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, United States
| | - Farooq Sher
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, United Kingdom.
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Xu Y, Sun F, Chuai Z, Wang J, Bai Z, Bian C, Wang X, Zhao Z, Liu Y, Yang P. Cold-adapted influenza vaccine carrying three repeats of a respiratory syncytial virus (RSV) fusion glycoprotein epitope site protects BALB/c mice and cotton rats against RSV infection. Antiviral Res 2024; 229:105960. [PMID: 38986872 DOI: 10.1016/j.antiviral.2024.105960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Abstract
Respiratory syncytial virus is the major cause of respiratory viral infections, particularly in infants, immunocompromised populations, and the elderly (over 65 years old), the prevention of RSV infection has become a priority. In this study, we generated a chimeric influenza virus, termed LAIV/RSV/HA-3F, using reverse genetics technology which contained three repeats of the RSV fusion protein neutralizing epitope site II to the N terminal in the background of the hemagglutinin (HA) gene of cold adapted influenza vaccine A/California/7/2009 ca. LAIV/RSV/HA-3F exhibited cold-adapted (ca) and attenuated (att) phenotype. BALB/c mice immunized intranasally with LAIV/RSV/HA-3F showed robust immunogenicity, inducing viral-specific antibody responses against both influenza and RSV, eliciting RSV-specific humoral, cellular and mucosal immune responses. LAIV/RSV/HA-3F also conferred protection as indicated by reduced viral titers and improved lung histopathological alterations against live RSV virus challenge. Mechanismly, single-cell RNA sequencing (scRNA-seq) and single-cell T cell antigen receptor (TCR) sequencing were employed to characterize the immune responses triggered by chimeric RSV vaccine, displaying that LAIV/RSV/HA-3F provided protection mainly via interferon-γ (IFN-γ). Moreover, we found that LAIV/RSV/HA-3F significantly inhibited viral replication in the challenged lung and protected against subsequent RSV challenge in cotton rats without causing lung disease. Taken together, our findings demonstrated that LAIV/RSV/HA-3F has potential as a promising bivalent vaccine with dual purpose candidate for the prevention of influenza and RSV, and preclinical and clinical studies warrant further investigations.
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Affiliation(s)
- Yongru Xu
- The First Medical Center of Chinese PLA General Hospital, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing, 100853, China
| | - Fang Sun
- The First Medical Center of Chinese PLA General Hospital, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing, 100853, China; Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Zhengran Chuai
- Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Junyun Wang
- Harbin GenVista Medical Laboratory Co., Ltd, Harbin, 150001, China; Heilongjiang Hulu Institute of Precision Medicine Co., Ltd, Harbin 150001, China
| | - Zhifang Bai
- Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Chengrong Bian
- Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, China
| | - Xiliang Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, 100071, China
| | - Zhongpeng Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, 100071, China
| | - Yongzhuang Liu
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Penghui Yang
- The First Medical Center of Chinese PLA General Hospital, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing, 100853, China.
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Fonseca MJ, Hagenaars S, Bangert M, Flach C, Hudson RD. Respiratory Syncytial Virus Hospital Admission Rates and Patients' Characteristics Before the Age of 2 Years in England, 2015-2019. Pediatr Infect Dis J 2024; 43:909-915. [PMID: 39163535 PMCID: PMC11319075 DOI: 10.1097/inf.0000000000004467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND A granular understanding of respiratory syncytial virus (RSV) burden in England is needed to prepare for new RSV prevention strategies. We estimated the rates of RSV hospital admissions before the age of 2 years in England and described baseline characteristics. METHODS A birth cohort of all infants born between March 1, 2015, and February 28, 2017 (n = 449,591) was established using Clinical Practice Research Datalink-Hospital Episode Statistics. Case cohorts included infants with admission for (1) RSV, (2) bronchiolitis, (3) any respiratory tract infection (RTI) <24 months and (4) RSV predicted by an algorithm <12 months. Baseline characteristics were described in the case and comparative cohorts (infants without corresponding admission). Cumulative incidence and admission rates were calculated. Multiple linear regression was used to estimate the proportion of RTI healthcare visits attributable to RSV. RESULTS The RSV-coded/RSV-predicted case cohorts were composed of 4813/12,694 infants (cumulative incidence: 1.1%/2.8%). Case cohort infants were more likely to have low birth weight, comorbidities and to be born during RSV season than comparative cohort infants, yet >77% were term-healthy infants and >54% were born before the RSV season. During the first year of life, 11.6 RSV-coded and 34.4 RSV-predicted hospitalizations occurred per 1000 person-years. Overall, >25% of unspecified lower RTI admissions were estimated to be due to RSV. CONCLUSIONS In England, 1 in 91 infants had an RSV-coded admission, likely underestimated by ~3-fold. Most infants were term-healthy infants born before the RSV season. To decrease the total burden of RSV at the population level, immunization programs need to protect all infants.
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Elyass J, Desalegn A, Trinh NTH, Orangzeb S, Zidan M, Nordeng H, Lupattelli A. Individual and familial factors associated with mRNA COVID-19 vaccine uptake in pregnancy: A large-scale registry-based linkage study. Vaccine 2024; 42:126171. [PMID: 39079814 DOI: 10.1016/j.vaccine.2024.126171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024]
Abstract
The association between maternal COVID-19 vaccination in pregnancy and factors such as high risk for severe COVID-19, pre-existing asthma, prior adverse reproductive history, or paternal COVID-19 vaccination during pregnancy, remains unclear. The aim of this study is two-fold: (i) to describe uptake of COVID-19 vaccine during pregnancy by maternal risk for severe COVID-19 and asthma, and (ii) to comprehensively examine individual and familial factors associated with vaccine uptake during pregnancy in Norway. Based on nation-wide registry-linkage data in Norway, we included 101,659 deliveries with gestational length ≥12 weeks, in 2021-2022. Our outcome measure was uptake of at least one dose of mRNA COVID-19 vaccine during pregnancy, using a narrow (first ever dose) and broad (any dose) definition. We fit univariate and multivariate modified Poisson regression models, clustered by county of residency and adjusted for calendar time, to estimate risk ratios (RR) with 95 % Confidence Intervals (CIs). Gestational uptake of any COVID-19 vaccine dose increased from <1 % before mid Aug-2021, to 38.8 % in the rest of 2021, and 48.9 % in 2022. Only 28.8 % and 33.9 % pregnant individuals with high risk for severe COVID-19 or asthma, respectively, received at least one COVID-19 vaccine dose. Paternal COVID-19 vaccination was strongly associated with greater vaccine uptake by pregnant individuals (adjusted RR: 7.2, 95 % CI: 6.8-7.5). Maternal SARS-CoV-2 infection pre-pregnancy (adjusted RR: 0.31, 95 % CI: 0.26, 0.37), familial and individual migrant status were associated with a considerable decreased likelihood of vaccine uptake in pregnancy. History of miscarriage or pregnancy with congenital anomaly were not associated with vaccine uptake. Despite rising COVID-19 vaccine rates in pregnancy, uptake remained low for high-risk individuals. Paternal vaccination, pre-pregnancy infection, migration status, and maternal citizenship were strongly associated with prenatal vaccine uptake. This knowledge can inform tailoring of future vaccination campaigns.
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Affiliation(s)
- Jovan Elyass
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Université Bordeaux, INSERM, Bordeaux Population Health, Bordeaux, France
| | - Anteneh Desalegn
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Nhung T H Trinh
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Saima Orangzeb
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Mahmoud Zidan
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
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87
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Hu JC, Sethi S. New methods to detect bacterial or viral infections in patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2024:1-15. [PMID: 39175157 DOI: 10.1080/17476348.2024.2396413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/22/2024] [Accepted: 08/21/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) are frequently colonized and infected by respiratory pathogens. Identifying these infectious etiologies is critical for understanding the microbial dynamics of COPD and for the appropriate use of antimicrobials during exacerbations. AREAS COVERED Traditional methods, such as bacterial and viral cultures, have been standard in diagnosing respiratory infections. However, these methods have significant limitations, including lack of sensitivity and prolonged turnaround time. Modern molecular approaches offer rapid, sensitive, and specific detection, though they also come with their own challenges. This review explores and evaluates the clinical utility of the latest advancements in detecting bacterial and viral respiratory infections in COPD, encompassing molecular techniques, biomarkers, and emerging technologies. EXPERT OPINION In the evolving landscape of COPD management, integrating molecular diagnostics and emerging technologies holds great promise. The enhanced sensitivity of molecular techniques has significantly advanced our understanding of the role of microbes in COPD. However, many of these technologies have primarily been developed for pneumonia diagnosis or research applications, and their clinical utility in managing COPD requires further evaluation.
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Affiliation(s)
- John C Hu
- Division of Infectious Diseases, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Sanjay Sethi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Lopera C, Monzó P, Aiello TF, Chumbita M, Peyrony O, Gallardo-Pizarro A, Pitart C, Cuervo G, Morata L, Bodro M, Herrera S, Del Río A, Martínez JA, Soriano A, Puerta-Alcalde P, Garcia-Vidal C. Prevalence and impact of multidrug-resistant bacteria in solid cancer patients with bloodstream infection: a 25-year trend analysis. Microbiol Spectr 2024:e0296123. [PMID: 39194256 DOI: 10.1128/spectrum.02961-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/14/2024] [Indexed: 08/29/2024] Open
Abstract
The study aimed to describe the epidemiology of multidrug-resistant (MDR) bacteria among solid cancer (SC) patients with bloodstream infections (BSIs), evaluating inappropriate empiric antibiotic treatment (IEAT) use and mortality trends over a 25-year period. All BSI occurrences in adult SC patients at a university hospital were analyzed across five distinct five-year intervals. MDR bacteria were classified as extended-spectrum beta-lactamases (ESBL)-producing and/or Carbapenem-resistant Enterobacterales, non-fermenting Gram-negative bacilli (GNB) resistant to at least three antibiotic classes, methicillin-resistant Staphylococcus aureus (MRSA), and Vancomycin-resistant Enterococci. A multivariate regression model identified the risk factors for MDR BSI. Of 6,117 BSI episodes, Gram-negative bacilli (GNB) constituted 60.4% (3,695/6,117), being the most common are Escherichia coli with 26.8% (1,637/6,117), Klebsiella spp. with 12.4% (760/6,117), and Pseudomonas aeruginosa with 8.6% (525/6,117). MDR-GNB accounted for 644 episodes (84.8% of MDR or 644/759), predominantly ESBL-producing strains (71.1% or 540/759), which escalated significantly over time. IEAT was administered in 24.8% of episodes, mainly in MDR BSI, and was associated with higher mortality (22.9% vs. 14%, P < 0.001). Independent factors for MDR BSI were prior antibiotic use [odds ratio (OR) 2.93, confidence interval (CI) 2.34-3.67], BSI during antibiotic treatment (OR 1.46, CI 1.18-1.81), biliary (OR 1.84, CI 1.34-2.52) or urinary source (OR 1.86, CI 1.43-2.43), admission period (OR) 1.28, CI 1.18-1.38, and community-acquired infection (OR 0.57, CI 0.39-0.82). The study showed an increase in MDR-GNB among SC patients with BSI. A quarter received IEAT, which was linked to increased mortality. Improving risk assessment for MDR infections and the judicious prescription of empiric antibiotics are crucial for better outcomes. IMPORTANCE Multidrug-resistant (MDR) bacteria pose a global public health threat as they are more challenging to treat, and they are on the rise. Solid cancer patients are often immunocompromised due to their disease and cancer treatments, making them more susceptible to infections. Understanding the changes and trends in bloodstream infections in solid cancer patients is crucial, to help physicians make informed decisions about appropriate antibiotic therapies, manage infections in this vulnerable population, and prevent infection. Solid cancer patients often require intensive and prolonged treatments, including surgery, chemotherapy, and radiation therapy. Infections can complicate these treatments, leading to treatment delays, increased healthcare costs, and poorer patient outcomes. Investigating new strategies to combat MDR infections and researching novel antibiotics in these patients is of paramount importance to avoid these negative impacts.
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Affiliation(s)
- Carlos Lopera
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Patricia Monzó
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Cristina Pitart
- Microbiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ana Del Río
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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89
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Krasselt M, Trawinski H, Lübbert C. [Zoster vaccination]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024:10.1007/s00108-024-01764-6. [PMID: 39196355 DOI: 10.1007/s00108-024-01764-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/29/2024]
Abstract
Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60 years and for persons ≥ 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome.
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Affiliation(s)
- Marco Krasselt
- Bereich Rheumatologie, Medizinische Klinik III, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Rheumatologisches Zentrum Leipzig, Leipzig, Deutschland
| | - Henning Trawinski
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christoph Lübbert
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland.
- Klinik für Infektiologie und Tropenmedizin, Klinikum St. Georg gGmbH, Leipzig, Deutschland.
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90
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Schmid KL, Backhouse S, Harduwar K, Jalbert I. Antimicrobial stewardship and education in optometry. Clin Exp Optom 2024:1-8. [PMID: 39197169 DOI: 10.1080/08164622.2024.2394101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/30/2024] Open
Abstract
CLINICAL RELEVANCE Antimicrobial stewardship aims to improve how antibiotics are prescribed by clinicians and used by patients, to ensure safe appropriate use, and to prevent and contain antimicrobial resistance. BACKGROUND Australian optometrists can prescribe a range of antimicrobial agents, but to what extent they consider antimicrobial stewardship is not known. This study evaluated what final-year optometry students and optometrists understood about antimicrobial stewardship in eye care and considered relevance to oral prescribing and education. METHODS A knowledge, attitude, and practice (KAP) questionnaire was developed comprising four sections: i) demographic questions, ii) 10 multiple choice questions regarding Knowledge about antimicrobial agents and likely pathogens, diagnosis, treatment, and preventing resistance, iii) 10 Likert rating scale questions about thoughts and Attitudes, iv) mix of question types (5× MCQ: course of action, 16 Likert scale: confidence) related to Practice (diagnosis, management, and prescribing). Descriptive analyses were conducted (medians, mean±SD, and distributions). RESULTS Thirteen students and 36 optometrists completed the survey. Both groups had a good understanding of microbial resistance and antibiotic prescribing for ocular conditions; average knowledge scores were 9.2 ± 0.7 and 8.7 ± 1.1 for students and practitioners, respectively. Scores were neutral to agree for questions related to the need for more educational programs. The answers of practice-related MCQs had a dichotomy of answers indicating a diversity of opinion, as can be the case in practice. Average total practice confidence scores were approximately 57/80 for students and 68/80 for optometrists. Optometrists and students were very confident in their ability to conduct an appropriate case history and use their knowledge and clinical skills, including slit lamp anterior eye assessment. The lowest confidence scores were for conducting microbial testing, i.e. taking swabs for pathology. CONCLUSION Student and optometrist knowledge, attitudes, and practice around antimicrobial stewardship were high and in line with other health professions globally. There is scope for increased stewardship training.
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Affiliation(s)
- Katrina L Schmid
- Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Kieran Harduwar
- Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
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91
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Tejeda MI, Fernández J, Valledor P, Almirall C, Barberán J, Romero-Brufau S. Retrospective validation study of a machine learning-based software for empirical and organism-targeted antibiotic therapy selection. Antimicrob Agents Chemother 2024:e0077724. [PMID: 39194206 DOI: 10.1128/aac.00777-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/16/2024] [Indexed: 08/29/2024] Open
Abstract
Errors in antibiotic prescriptions are frequent, often resulting from the inadequate coverage of the infection-causative microorganism. The efficacy of iAST, a machine-learning-based software offering empirical and organism-targeted antibiotic recommendations, was assessed. The study was conducted in a 12-hospital Spanish institution. After model fine-tuning with 27,531 historical antibiograms, 325 consecutive patients with acute infections were selected for retrospective validation. The primary endpoint was comparing each of the top three of iAST's antibiotic recommendations' success rates (confirmed by antibiogram results) with the antibiotic prescribed by the physicians. Secondary endpoints included examining the same hypothesis within specific study population subgroups and assessing antibiotic stewardship by comparing the percentage of antibiotics recommended that belonged to different World Health Organization AWaRe groups within each arm of the study. All of iAST first three recommendations were non-inferior to doctor prescription in the primary endpoint analysis population as well as the secondary endpoint. The overall success rate of doctors' empirical treatment was 68.93%, while that of the first three iAST options was 91.06% (P < 0.001), 90.63% (P < 0.001), and 91.06% (P < 001), respectively. For organism-targeted therapy, the doctor's overall success rate was 84.16%, and that of the first three ranked iAST options was 97.83% (P < 0.001), 94.09% (P < 0.001), and 91.30% (P < 0.001), respectively. In empirical therapy, compared to physician prescriptions, iAST demonstrated a greater propensity to recommend access antibiotics, fewer watch antibiotics, and higher reserve antibiotics. In organism-targeted therapy, iAST advised a higher utilization of access antibiotics. The present study demonstrates iAST accuracy in predicting antibiotic susceptibility, showcasing its potential to promote effective antibiotic stewardship. CLINICAL TRIALS This study is registered with ClinicalTrials.gov as NCT06174519.
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Affiliation(s)
- Maria Isabel Tejeda
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Javier Fernández
- Research and Innovation Department, Pragmatech AI Solutions, Oviedo, Spain
- Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Microbiology and Infectious Pathology, ISPA, Oviedo, Spain
- Functional Biology Department, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Valledor
- Research and Innovation Department, Pragmatech AI Solutions, Oviedo, Spain
| | | | - José Barberán
- Infectious Diseases Unit, Hospital Universitario HM Montepríncipe, Madrid, Spain
- HM Faculty of Health Sciences, University Camilo Jose Cela, Madrid, Spain
| | - Santiago Romero-Brufau
- Research and Innovation Department, Pragmatech AI Solutions, Oviedo, Spain
- Department of Otorhinolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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92
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Ando K, Miyahara S, Hanada S, Fukuda K, Saito M, Sakai A, Maruo A, Zenke Y. Effective biofilm eradication in MRSA isolates with aminoglycoside-modifying enzyme genes using high-concentration and prolonged gentamicin treatment. Microbiol Spectr 2024:e0064724. [PMID: 39191399 DOI: 10.1128/spectrum.00647-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
Bone and soft tissue infections caused by biofilm-forming bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), remain a significant clinical challenge. While the control of local infection is necessary, systemic treatment is also required, and biofilm eradication is a critical target for successful management. Topical antibiotic treatments, such as antibiotic-loaded bone cement (ALBC), have been used for some time, and continuous local antibiotic perfusion therapy, a less invasive method, has been developed by our group. However, the optimal antibiotics and concentrations for biofilms of clinical isolates are still not well understood. We examined the efficacy of high concentrations of gentamicin against MRSA biofilms and the role of gentamicin resistance genes in biofilm eradication. We collected 101 MRSA samples from a hospital in Japan and analyzed their gene properties, including methicillin and gentamicin resistance, and their minimum biofilm eradication concentration (MBEC) values. Our results showed that high concentrations of gentamicin are effective against MRSA biofilms and that even concentrations lower than the MBEC value could eliminate biofilms after prolonged exposure. We also identified three aminoglycoside/gentamicin resistance genes [aac(6')-aph(2″), aph(3')-III, and ant(4')-IA] and found that the presence or absence of these genes may inform the selection of treatments. It was also found that possession of the aac(6')-aph(2″) gene correlated with the minimum inhibitory concentration/MBEC values of gentamicin. Although this study provides insight into the efficacy of gentamicin against MRSA biofilms and the role of gentamicin resistance genes, careful selection of the optimal treatment strategy is needed for clinical application. IMPORTANCE Our analysis of 101 MRSA clinical isolates has provided valuable insights that could enhance treatment selection for biofilm infections in orthopedics. We found that high concentrations of gentamicin were effective against MRSA biofilms, and even prolonged exposure to concentrations lower than the minimum biofilm eradication concentration (MBEC) value could eliminate biofilms. The presence of the aac(6')-aph(2″) gene, an aminoglycoside resistance gene, was found to correlate with the minimum inhibitory concentration (MIC) and MBEC values of gentamicin, providing a potential predictive tool for treatment susceptibility. These results suggest that extended high concentrations of local gentamicin treatment could effectively eliminate MRSA biofilms in orthopedic infections. Furthermore, testing for gentamicin MIC or the possession of the aac(6')-aph(2″) gene could help select treatment, including topical gentamicin administration and surgical debridement.
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Affiliation(s)
- Kohei Ando
- Department of Emergency and Intensive Care Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Miyahara
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shuhei Hanada
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazumasa Fukuda
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mitsumasa Saito
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihiro Maruo
- Department of Orthopedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Yukichi Zenke
- Department of Emergency and Intensive Care Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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93
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Liu CH, Chang YP, Kao JH. Cutting-edge pharmacotherapy for hepatitis C virus infection: a comprehensive review. Expert Opin Pharmacother 2024:1-16. [PMID: 39169665 DOI: 10.1080/14656566.2024.2396024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Pharmacotherapy against hepatitis C virus (HCV) infection has tremendously improved since the advent of interferon (IFN)-free direct-acting antivirals (DAAs). Additionally, fixed-dose pangenotypic DAAs, which are safe, potent, easy for use, and can cover a wide spectrum of patients, have been recommended by professional guidelines for DAA-naïve and DAA-experienced patients with HCV. AREAS COVERED We review the pharmacokinetics, pharmacodynamics, and potential drug-drug interactions (DDIs) of fixed-dose pangenotypic DAA regimens, including glecaprevir/pibrentasvir (GLE/PIB), sofosbuvir/velpatasvir (SOF/VEL), and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). Additionally, we summarize the efficacy and safety of these regimens in clinical trials as well as real-world studies for treating different populations. Lastly, we discuss unmet medical needs in managing HCV in the era of fixed-dose pangenotypic DAAs. EXPERT OPINION Protease inhibitors (PIs), including GLE and VOX, are prone to have more frequent DDIs, compared to the non-structural (NS) 5A and 5B inhibitors. These regimens are generally well tolerated and can be applied to different populations, except for the contraindicated use of PI-containing DAA regimens in decompensated cirrhosis. Using the first-line GLE/PIB and SOF/VEL can eradicate HCV in more than 95% of DAA-naïve patients across different populations. The viral cure usually exceeds 95% when using the rescue SOF/VEL/VOX regimen for prior DAA failures.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Yu-Ping Chang
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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94
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Hong H, Chen Y, Zhou L, Bao J, Ma J. Risk factors analysis and construction of predictive models for acute kidney injury in overweight patients receiving vancomycin treatment. Expert Opin Drug Saf 2024:1-10. [PMID: 39140731 DOI: 10.1080/14740338.2024.2393285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/15/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Vancomycin-induced acute kidney injury (VI-AKI) is one of its serious adverse reactions. The purpose of this study is to discuss the risk factors for VI-AKI in overweight patients and construct a clinical prediction model based on the results of the analysis. METHODS Multivariable logistic regression analysis was used to identify risk factors for VI-AKI and constructed nomogram models. The performance of the nomogram was evaluated based on the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). RESULT Cancer (OR 4.186, 95% CI 1.473-11.896), vancomycin trough concentration >20.0 μg/mL (OR 6.251, 95% CI 2.275-17.180), concomitant furosemide (OR 2.722, 95% CI 1.071-6.919) and vasoactive agent (OR 2.824, 95% CI 1.086-7.340) were independent risk factors for VI-AKI. The AUC of the nomogram validation cohorts were 0.807 (95% CI 0.785-0.846). The calibration curve revealed that the predicted outcome was in agreement with the actual observations. Finally, the DCA curves showed that the nomogram had a good clinical applicability value. CONCLUSION There are four independent risk factors for the occurrence of VI-AKI in overweight patients, and the nomogram prediction model has good predictive ability, which can provide reference for clinical decision-making.
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Affiliation(s)
- Huadong Hong
- Department of Pharmacy, Medical Center of Soochow University, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Yichen Chen
- Department of Pharmacy, Medical Center of Soochow University, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling Zhou
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian'an Bao
- Department of Pharmacy, Medical Center of Soochow University, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingjing Ma
- Department of Pharmacy, Medical Center of Soochow University, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
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Bassetti M, Monti G, Henriksen AS, Longshaw C. Predicting early appropriate therapy for patients infected by carbapenem-resistant Gram-negative pathogens in intensive care units in Italy. Antimicrob Resist Infect Control 2024; 13:91. [PMID: 39183351 PMCID: PMC11345987 DOI: 10.1186/s13756-024-01452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Antibiotic resistance among Gram-negative bacteria in intensive care units (ICUs) is linked with high morbidity and mortality in patients. In this study, we estimated the therapeutic coverage of various antibiotics, focusing on cefiderocol and comparators, administered empirically against an infection of unknown origin in the ICU. METHODS In the ARTEMIS surveillance study, susceptibilities of 624 Italian Gram-negative isolates to amikacin, aztreonam-avibactam, cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, colistin, imipenem-relebactam, meropenem, and meropenem-vaborbactam were tested by broth microdilution, and results were interpreted by European Committee on Antimicrobial Susceptibility Testing breakpoints. The susceptibility rates from the ARTEMIS study were extrapolated to Gram-negative isolates obtained from 5,774 patients in Italian ICUs in 2021. The sum of the predicted susceptibilities of individual pathogens represented the overall likelihood of in vitro activity of each antibiotic as early targeted therapy for ICU patients. RESULTS A total of 624 Italian Gram-negative isolates included 206 Pseudomonas aeruginosa, 138 Acinetobacter baumannii, 187 Klebsiella pneumoniae, and 93 Escherichia coli. Against A. baumannii, K. pneumoniae, P. aeruginosa, and E. coli, the overall susceptibility rates for cefiderocol were 87.7%, 96.8%, 99%, and 100%, respectively; and for comparator agents, 8.7-96.4%, 25.7-100%, 73.3-100%, and 89.2-100%, respectively. Among the subset of meropenem-resistant isolates, susceptibility rates of A. baumannii, K. pneumoniae, and P. aeruginosa to cefiderocol were 86.4%, 96.2% and 100%, respectively. Corresponding susceptibility rates to comparator agents were 0-96.8%, 0-100%, and 6.4-100%, respectively. There were no meropenem-resistant isolates of E. coli. The extrapolation of data to isolates from Italian ICUs showed that the highest likelihood of therapeutic coverage, both overall and among meropenem-resistant isolates, was reported for colistin (96.8% and 72.2%, respectively) and cefiderocol (95.7% and 71.4%, respectively). All other antibiotics were associated with a likelihood below 73% overall and between 0% and 41.4% for meropenem-resistant isolates. CONCLUSIONS Based on confirmed susceptibility rates and reported ICU prevalence of multiple Gram-negative species, cefiderocol showed a higher predicted therapeutic coverage and utility in ICUs compared with comparator beta-lactam-beta-lactamase inhibitor antibiotics. Cefiderocol may be a promising early treatment option for patients at high risk of carbapenem-resistant Gram-negative bacterial infections in the ICU.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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96
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Hsu RK, Brunet L, Lackey PC, Pierone G, Levis B, Fusco JS, Henegar C, Vannappagari V, Clark A, Fusco GP. Immunological and virological response to fostemsavir in routine US clinical care: An OPERA cohort study. HIV Med 2024. [PMID: 39183479 DOI: 10.1111/hiv.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Fostemsavir is a novel attachment inhibitor used with other antiretrovirals in heavily treatment-experienced (HTE) adults with multidrug-resistant HIV-1. Real-world immunological and virological responses were assessed in individuals starting fostemsavir in the OPERA cohort. METHODS Among adults with HIV-1 starting fostemsavir between 2 July 2020 and 1 September 2022, 6-month and 12-month changes in CD4 T-cell count and CD4%, and maintenance/achievement of viral load (VL) <50 copies/mL were described and stratified by baseline VL (suppressed: <50 copies/mL; viraemic: ≥50 copies/mL) and CD4 count (high: ≥350 cells/μL; low: <350 cells/μL). RESULTS Of 182 individuals starting fostemsavir, 64% were viraemic (34% low CD4, 30% high CD4) and 36% were suppressed (16% low CD4, 20% high CD4). The suppressed/low CD4 group had the largest median increases in CD4 count (6-month: 30 cells/μL [interquartile range {IQR} 9-66], 12-month: 66 cells/μL [IQR 17-125]), and CD4% (6-month: 1.0% [IQR -0.3-2.8], 12-month: 1.9% [IQR 1.3-3.9]). Regardless of baseline VL, those with a high baseline CD4 count experienced a greater variability in immunological response than those with low CD4 counts (12-month standard deviation range 172-231 cells/μL vs. 69-90 cells/μL). VL <50 copies/mL was maintained in most suppressed individuals; nearly half of the viraemic/high CD4 group and a third of the viraemic/low CD4 group achieved a VL <50 copies/mL at either timepoint. CONCLUSIONS After 6 or 12 months of fostemsavir use, virological response was low in viraemic individuals, although most suppressed individuals did maintain suppression. While immunological response varied across individuals, virologically suppressed HTE individuals with low CD4 counts may benefit from immunological improvements with fostemsavir.
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Affiliation(s)
- Ricky K Hsu
- NYU Langone Health, New York, New York, USA
- AIDS Healthcare Foundation, New York, New York, USA
| | | | - Philip C Lackey
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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97
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Gaurisha, Roy AA, Mutalik S, Dhas N. Unleashing the power of polymeric nanoparticles - Creative triumph against antibiotic resistance: A review. Int J Biol Macromol 2024:134977. [PMID: 39187099 DOI: 10.1016/j.ijbiomac.2024.134977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 08/08/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
Antibiotic resistance (ABR) poses a universal concern owing to the widespread use of antibiotics in various sectors. Nanotechnology emerges as a promising solution to combat ABR, offering targeted drug delivery, enhanced bioavailability, reduced toxicity, and stability. This comprehensive review explores concepts of antibiotic resistance, its mechanisms, and multifaceted approaches to combat ABR. The review provides an in-depth exploration of polymeric nanoparticles as advanced drug delivery systems, focusing on strategies for targeting microbial infections and contributing to the fight against ABR. Nanoparticles revolutionize antimicrobial approaches, emphasizing passive and active targeting. The role of various molecules, including small molecules, antimicrobial peptides, proteins, carbohydrates, and stimuli-responsive systems, is being explored in recent research works. The complex comprehension mechanisms of ABR and strategic use of nanotechnology present a promising avenue for advancing antimicrobial tactics, ensuring treatment efficacy, minimizing toxic effects, and mitigating development of ABR. Polymeric nanoparticles, derived from natural or synthetic polymers, are crucial in overcoming ABR. Natural polymers like chitosan and alginate exhibit inherent antibacterial properties, while synthetic polymers such as polylactic acid (PLA), polyethylene glycol (PEG), and polycaprolactone (PCL) can be engineered for specific antibacterial effects. This comprehensive study provides a valuable source of information for researchers, healthcare professionals, and policymakers engaged in the urgent quest to overcome ABR.
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Affiliation(s)
- Gaurisha
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka State 576104, India
| | - Amrita Arup Roy
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka State 576104, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka State 576104, India
| | - Namdev Dhas
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka State 576104, India.
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98
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Purswani MU, Jacobson DL, DiMeglio LA, Yao TJ, Kopp JB, Van Dyke RB, Yu W, Siberry GK. Phosphaturia in HIV-Exposed Uninfected Neonates Associated with Maternal Use of Tenofovir Disoproxil Fumarate in Late Pregnancy. J Pediatric Infect Dis Soc 2024; 13:396-405. [PMID: 38820092 DOI: 10.1093/jpids/piae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 05/29/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is often used in treating pregnant women living with HIV. Third-trimester TDF exposure is associated with a 12% reduction in bone mineral content in HIV-exposed uninfected (HEU) neonates. The potential mechanisms underlying this observation are unknown. METHODS The TDF study enrolled newborns of gestational age ≥36 weeks from the Surveillance Monitoring for Antiretroviral Therapy and Toxicities study based on in utero TDF exposure (TDF use ≥8 weeks in the third trimester vs none). Blood and urine samples were collected cross-sectionally within 30 days of birth to assess renal function (serum creatinine, serum phosphate, eGFR, percent tubular reabsorption of phosphate [PTRP]), and bone turnover (serum parathyroid hormone, 25-OH vitamin D [25(OH)D], and urinary cross-linked N-telopeptide of type 1 collagen). For each biomarker, a LOESS plot was fit using values at age at specimen collection; regression lines over age were fit among samples collected from 4 to 30 days, to compare slopes by TDF exposure. RESULTS Among 141 neonates, 77 were TDF-exposed and 64 TDF-unexposed. Between age 4 and 30 days, PTRP decreased more rapidly in the TDF-exposed compared to the unexposed group with slopes of -0.58 vs -0.08/day (difference -0.50/day [95% CI -0.88, -0.11]). Slopes for 25(OH)D were similar in both groups, but serum levels were lower in TDF-exposed neonates (median [IQR]: 22 [19, 29] vs 26 [22, 37] ng/mL). No differences were observed for other biomarkers. CONCLUSIONS Third-trimester in utero exposure to TDF is associated with increased urinary loss of phosphate and lower serum concentrations of 25(OH)D in HEU neonates.
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Affiliation(s)
- Murli U Purswani
- Division of Pediatric Infectious Disease, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeffrey B Kopp
- Kidney Disease Section, NIDDK, NIH, Bethesda, Maryland, USA
| | - Russell B Van Dyke
- Section of Pediatric Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Wendy Yu
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - George K Siberry
- Prevention Care and Treatment Division, Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, USA
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Beck E, Bausch-Jurken MT, Van de Velde N, Wang X, Malmenäs M. A Response to: A Letter to the Editor Regarding 'Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework'. Infect Dis Ther 2024:10.1007/s40121-024-01020-2. [PMID: 39180646 DOI: 10.1007/s40121-024-01020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 08/26/2024] Open
Affiliation(s)
- Ekkehard Beck
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA.
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Gupta C, Lee SSJ, Sahu M, Mukherjee S, Wu KS. Ceftazidime-avibactam versus other antimicrobial agents for treatment of Multidrug-resistant Pseudomonas aeruginosa: a systematic review and meta-analysis. Infection 2024:10.1007/s15010-024-02371-1. [PMID: 39180705 DOI: 10.1007/s15010-024-02371-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 08/06/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVES Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a life-threatening infection with limited treatment options. This is the first meta-analysis of recently published data to compare the clinical outcomes of ceftazidime-avibactam (CAZ-AVI) with other antimicrobial agents in treating MDR-PA infections. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase and the Cochrane Library have been systematically reviewed, for publications in the English language, from database inception to July 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies comparing CAZ-AVI outcomes with other antimicrobial agents were included. In-hospital mortality & 30-day mortality were assessed as the main outcomes. DATA EXTRACTION AND SYNTHESIS Literature screening, data extraction, and the quality evaluation of studies were conducted by two researchers independently, with disagreements resolved by another researcher. The Newcastle-Ottawa Scale was used to assess the bias risk for the included studies. Review Manager V.5.4 was employed for the meta-analysis. RESULTS The meta-analysis included four retrospective studies, enrolling 1934 patients. The CAZ-AVI group demonstrated significantly lower in-hospital mortality (risk ratio (RR) = 0.60, 95% CI:0.37-0.97, I2 = 74%, p = 0.04) in three studies with 1444 patients and lower 30-day mortality, in 438 patients from three studies (RR = 0.54, 95% CI:0.28-1.05, I2 = 67%, p = 0.07). No significant difference in clinical success, microbiological success, length of hospital, and ICU stay was observed. CONCLUSIONS This meta-analysis demonstrated that CAZ-AVI treatment significantly lowered in-hospital mortality compared with other antimicrobial agents in MDR-PA infections. However, the analysis only included a few observational studies and high-quality, randomized controlled trials are needed to investigate further the scope of CAZ-AVI in MDR-PA infections.
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Affiliation(s)
- Chhavi Gupta
- Department of Infectious Disease, Yashoda Superspeciality Hospital, Kaushambi, India.
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Monalisa Sahu
- Department of Infectious Disease, Yashoda Hospital, Hyderabad, Telangana, India
| | - Sudipta Mukherjee
- Consultant & Head, Department of Critical Care Medicine, Tata Medical Center, Kolkata, India
| | - Kuan-Sheng Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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