1
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Bresee LC, Lamont N, Ocampo W, Holroyd-Leduc J, Sabuda D, Leal J, Dalton B, Kaufman J, Missaghi B, Kim J, Larios OE, Henderson E, Raman M, Fletcher JR, Faris P, Kraft S, Shen Y, Louie T, Conly JM. Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection. BMC Health Serv Res 2023; 23:1386. [PMID: 38082421 PMCID: PMC10714625 DOI: 10.1186/s12913-023-10350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). METHODS We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. RESULTS A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. CONCLUSIONS Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
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Affiliation(s)
- Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Nicole Lamont
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Wrechelle Ocampo
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Deana Sabuda
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jenine Leal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bruce Dalton
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jaime Kaufman
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Joseph Kim
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Oscar E Larios
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Elizabeth Henderson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jared R Fletcher
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Scott Kraft
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Ye Shen
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Thomas Louie
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - John M Conly
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- AGW5 - Special Services Bldg, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, Canada, T2N 2T9.
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2
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Rennert-May E, Chew D, Cannon K, Zhang Z, Smith S, King T, Exner DV, Larios OE, Leal J. The economic burden of cardiac implantable electronic device infections in Alberta, Canada: a population-based study using validated administrative data. Antimicrob Resist Infect Control 2023; 12:140. [PMID: 38053198 PMCID: PMC10698885 DOI: 10.1186/s13756-023-01347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIED) are being inserted with increasing frequency. Severe surgical site infections (SSI) that occur after device implantation substantially impact patient morbidity and mortality and can result in multiple hospital admissions and repeat surgeries. It is important to understand the costs associated with these infections as well as healthcare utilization. Therefore, we conducted a population-based study in the province of Alberta, Canada to understand the economic burden of these infections. METHODS A cohort of adult patients in Alberta who had CIEDs inserted or generators replaced between January 1, 2011 and December 31, 2019 was used. A validated algorithm of International Classification of Diseases (ICD) codes to identify complex (deep/organ space) SSIs that occurred within the subsequent year was applied to the cohort. The overall mean 12-month inpatient and outpatient costs for the infection and non-infection groups were assessed. In order to control for variables that may influence costs, propensity score matching was completed and incremental costs between those with and without infection were calculated. As secondary outcomes, number of outpatient visits, hospitalizations and length of stay were assessed. RESULTS There were 26,049 procedures performed during our study period, of which 320 (1.23%) resulted in SSIs. In both unadjusted costs and propensity score matched costs the infection group was associated with increased costs. Overall mean cost was $145,312 in the infection group versus $34,264 in the non-infection group. The incremental difference in those with infection versus those without in the propensity score match was $90,620 (Standard deviation $190,185). Approximately 70% of costs were driven by inpatient hospitalizations. Inpatients hospitalizations, length of stay and outpatient visits were all increased in the infection group. CONCLUSIONS CIED infections are associated with increased costs and are a burden to the healthcare system. This highlights a need to recognize increasing SSI rates and implement measures to minimize infection risk. Further studies should endeavor to apply this work to full economic evaluations to better understand and identify cost-effective infection mitigation strategies.
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Affiliation(s)
- Elissa Rennert-May
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada.
| | - Derek Chew
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Kristine Cannon
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Zuying Zhang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Stephanie Smith
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Teagan King
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Derek V Exner
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Oscar E Larios
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Jenine Leal
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
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3
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Rennert-May E, Leal J, MacDonald MK, Cannon K, Smith S, Exner D, Larios OE, Bush K, Chew D. Validating administrative data to identify complex surgical site infections following cardiac implantable electronic device implantation: a comparison of traditional methods and machine learning. Antimicrob Resist Infect Control 2022; 11:138. [DOI: 10.1186/s13756-022-01174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/23/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac implantable electronic device (CIED) surgical site infections (SSIs) have been outpacing the increases in implantation of these devices. While traditional surveillance of these SSIs by infection prevention and control would likely be the most accurate, this is not practical in many centers where resources are constrained. Therefore, we explored the validity of administrative data at identifying these SSIs.
Methods
We used a cohort of all patients with CIED implantation in Calgary, Alberta where traditional surveillance was done for infections from Jan 1, 2013 to December 31, 2019. We used this infection subgroup as our “gold standard” and then utilized various combinations of administrative data to determine which best optimized the sensitivity and specificity at identifying infection. We evaluated six approaches to identifying CIED infection using administrative data, which included four algorithms using International Classification of Diseases codes and/or Canadian Classification of Health Intervention codes, and two machine learning models. A secondary objective of our study was to assess if machine learning techniques with training of logistic regression models would outperform our pre-selected codes.
Results
We determined that all of the pre-selected algorithms performed well at identifying CIED infections but the machine learning model was able to produce the optimal method of identification with an area under the receiver operating characteristic curve (AUC) of 96.8%. The best performing pre-selected algorithm yielded an AUC of 94.6%.
Conclusions
Our findings suggest that administrative data can be used to effectively identify CIED infections. While machine learning performed the most optimally, in centers with limited analytic capabilities a simpler algorithm of pre-selected codes also has excellent yield. This can be valuable for centers without traditional surveillance to follow trends in SSIs over time and identify when rates of infection are increasing. This can lead to enhanced interventions for prevention of SSIs.
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4
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Doyle D, Lang R, Larios OE. Atypical presentation of right-sided native valve infective endocarditis. J Assoc Med Microbiol Infect Dis Can 2021; 6:163-167. [PMID: 36341033 PMCID: PMC9608695 DOI: 10.3138/jammi-2020-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/04/2020] [Indexed: 06/16/2023]
Abstract
A previously healthy 55-year-old man presented to hospital with 10 days of progressive dyspnea with fever, night sweats, and a productive cough and no history of recreational drug use or occupational or animal exposures. His wife had developed similar symptoms 2 weeks earlier but had since recovered. Physical exam revealed a new systolic murmur best heard at the left lower sternal border. Transesophageal echocardiogram demonstrated severe tricuspid regurgitation with a small vegetation. Blood cultures were positive for non-typeable Haemophilus influenzae. This case illustrates the necessity of both timely and proficient diagnosis of H. influenzae infection and the unique challenges associated with detecting H. influenzae-related pathology. Clinicians should be aware of the variable presentations of Haemophilus infection, including respiratory infection, neurological infection, and infective endocarditis. Given the fastidious nature of H. influenzae and variability between subtype pathogenicity, microbiology laboratories require tools to culture and differentiate Haemophilus species.
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Affiliation(s)
- Daniel Doyle
- Department of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oscar E Larios
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Doolan CP, Louie T, Lata C, Larios OE, Stokes W, Kim J, Brown K, Beck P, Deardon R, Pillai DR. Latent class analysis for the diagnosis of Clostridioides difficile infection. Clin Infect Dis 2020; 73:e2673-e2679. [PMID: 33053174 DOI: 10.1093/cid/ciaa1553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is an opportunistic disease that lacks a gold standard test. Nucleic acid amplification tests (NAATs) such as real-time PCR demonstrate excellent an limit of detection (LOD) whereas antigenic methods are able to detect free toxin. Latent class analysis (LCA) provides an unbiased statistical approach to resolving true disease. METHODS A cross-sectional study was conducted with suspected CDI patients (n=96). Four commercial real-time PCR tests, toxin antigen detection by enzyme immunoassay (EIA), toxigenic culture, and fecal calprotectin were performed. CDI clinical diagnosis was determined by consensus majority of three experts. LCA was performed using laboratory and clinical variables independent of any gold standard. RESULTS Six LCA models were generated to determine CDI probability using four variables including toxin EIA, toxigenic culture, clinical diagnosis, and fecal calprotectin levels. Three defined zones as a function of real-time PCR cycle threshold (Ct) were identified using LCA: CDI likely (>90% probability), equivocal (<90% and >10%), CDI unlikely (<10%). A single model comprising toxigenic culture, clinical diagnosis, and toxin EIA showed the best fitness. The following Ct cut-offs for four commercial test platforms were obtained using this model to delineate three CDI probability zones: [GeneXpert ® : 24.00, 33.61], [Simplexa ® 28.97, 36.85], [Elite MGB ® 30.18, 37.43], and [BD Max ™ 27.60, 34.26]. CONCLUSION The clinical implication of applying LCA to CDI is to report Ct values assigned to probability zones based on the commercial real-time PCR platform. A broad range of equivocation suggests clinical judgement is essential to the confirmation of CDI.
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Affiliation(s)
- Cody P Doolan
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas Louie
- Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Oscar E Larios
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - William Stokes
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Kim
- Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kristen Brown
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Beck
- Clinical Section of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob Deardon
- Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, AB, Canada.,Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Dylan R Pillai
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
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6
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Aspinall AI, Shaheen AA, Kochaksaraei GS, Haslam B, Lee SS, Macphail G, Kapler J, Larios OE, Burak KW, Swain MG, Borman MA, Coffin CS. Real-world treatment of hepatitis C with second-generation direct-acting antivirals: initial results from a multicentre Canadian retrospective cohort of diverse patients. CMAJ Open 2018; 6:E12-E18. [PMID: 29305405 PMCID: PMC5963434 DOI: 10.9778/cmajo.20170059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND High hepatitis C cure rates have been observed in registration trials with second-generation direct-acting antivirals. Real-world data also indicate high sustained viral response (SVR) rates. Our objective was to determine real-world SVR rates for patients infected with hepatitis C virus (HCV) who were treated with second-generation direct-acting antivirals in the first 18 months of their availability in Canada. METHODS Four centres in Calgary contributed their treatment data for a diverse patient population including those who had or had not undergone liver transplantation, those coinfected with HIV and vulnerable populations. We included all patients documented to have started hepatitis C treatment with direct-acting antivirals between October 2014 and April 2016, with follow-up through October 2016. We used multivariate analysis to determine independent predictors of treatment failure. RESULTS Outcome data were available for 351 patients, of whom 326 (92.9%) achieved an SVR (193/206 [93.7%], 57/59 [96.6%] and 44/51 [86.3%] for genotypes 1a, 1b and 3, respectively, p = 0.2). Independent predictors of not achieving SVR were older age (adjusted odds ratio [OR] 0.95 [95% confidence interval (CI) 0.90-1.00]), male sex (adjusted OR 0.30 [95% CI 0.10-0.89]) and, in patients with genotype 1a infection, history of hepatocellular carcinoma (adjusted OR 0.13 [95% CI 0.03-0.53]). In the entire cohort, the presence of cirrhosis, genotype and hepatocellular carcinoma were not associated with a lower SVR rate. There were no differences in SVR rate according to treatment centre, HIV coinfection or liver transplantation. Among patients with genotype 3 infection, a significantly lower SVR rate was observed for those treated outside of standard of care than for those treated within standard of care (33.3% v. 89.6%, p = 0.04). De novo hepatocellular carcinoma developed in 12 patients (3.4%) despite successful direct-acting antiviral therapy. INTERPRETATION We report high SVR rates in a real-world diverse cohort of HCV-infected patients treated with second-generation direct-acting antivirals. The results highlight the importance of conducting real-world analyses to elucidate clinical factors associated with poorer outcomes that may not be identified in registration trials.
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Affiliation(s)
- Alex I Aspinall
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Abdel A Shaheen
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Golasa S Kochaksaraei
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Breean Haslam
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Samuel S Lee
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Gisela Macphail
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Jeff Kapler
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Oscar E Larios
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Kelly W Burak
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Mark G Swain
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Meredith A Borman
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
| | - Carla S Coffin
- Affiliations: Calgary Liver Unit (Aspinall, Shaheen, Kochaksaraei, Haslam, Lee, Burak, Swain, Borman, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary; Calgary Urban Project Society (Macphail); Southern Alberta Clinic (Kapler, Larios, Coffin), Alberta Health Services, Calgary, Alta
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Martin P, Williams V, Bush K, Dyck M, Hirji Z, Larios OE, Mcgeer A, Moore C, Weiss K, Simor AE. The Prevalence of Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococcus, Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae, Carbapenem-Resistant Enterobacteriaceae, and Clostridium difficile Infection in Canadian Hospitals. A Comparison of Survey Results. in 2010, 2012, and 2016. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Philippe Martin
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Kathryn Bush
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Myrna Dyck
- Infection Prevention and Control, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Zahir Hirji
- The Scarborough Hospital, Toronto, ON, Canada
| | - Oscar E. Larios
- Division of Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Allison Mcgeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada
- Faculty of Medicine: Lab Medicine & Pathobiology & Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Karl Weiss
- Department of Infectious Diseases and Microbiology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Andrew E. Simor
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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8
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Williams V, Simor AE, Kiss A, McGeer A, Hirji Z, Larios OE, Moore C, Weiss K. Is the prevalence of antibiotic-resistant organisms changing in Canadian hospitals? Comparison of point-prevalence survey results in 2010 and 2012. Clin Microbiol Infect 2015; 21:553-9. [PMID: 25677630 DOI: 10.1016/j.cmi.2015.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
A national point-prevalence survey for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and for Clostridium difficile infection (CDI) was done in Canadian hospitals in 2010. A follow-up survey was done in November 2012 to determine whether there were any changes in the prevalence of these organisms; we also determined the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs). Associations between prevalence and infection prevention and control policies were evaluated in logistic regression models. A total of 143 (67% of eligible facilities) hospitals with 29 042 adult inpatients participated in the survey, with representation from all 10 provinces; 132 hospitals participated in 2010 and 2012. There were no significant changes in the median prevalence of MRSA in 2010 (4.3%) compared to 2012 (3.9%), or of CDI in 2010 (0.8%) compared to 2012 (0.9%). A higher median prevalence of VRE was identified in 2012 (1.3%) compared to 2010 (0.5%) (p 0.04), despite decreased VRE screening in 2012. The median prevalence of ESBLs was 0.7% and was 0 for CREs; CREs were reported from only 10 hospitals (7.0%). A policy of routinely caring for patients with MRSA or VRE in a private isolation room was associated with lower prevalence of these organisms. Targeted screening of high-risk patients at admission was associated with lower MRSA prevalence; better hand hygiene compliance was associated with lower VRE prevalence. These data provide national prevalence rates for antibiotic-resistant organisms among adults hospitalized in Canadian hospitals. Certain infection prevention and control policies were associated with prevalence.
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Affiliation(s)
- V Williams
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - A E Simor
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - A Kiss
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Z Hirji
- The Scarborough Hospital, Toronto, Ontario, Canada
| | - O E Larios
- University of Calgary, Calgary, Alberta, Canada
| | - C Moore
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K Weiss
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
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Williams V, Simor AE, Kiss A, Mcgeer A, Han G, Hirji Z, Larios OE, Moore C, Weiss K. 902Hospital Characteristics and Infection Prevention and Control Strategies Associated with Methicillin-Resistant Staphylococcus aureus (MRSA) and Clostridium difficile Infection (CDI) in Canadian Hospitals. Open Forum Infect Dis 2014. [PMCID: PMC5781780 DOI: 10.1093/ofid/ofu052.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Alex Kiss
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Guanghong Han
- Provincial Infection Control Network of British Columbia, Vancouver, BC, Canada
| | - Zahir Hirji
- The Scarborough Hospital, Toronto, ON, Canada
| | | | | | - Karl Weiss
- Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
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Plourde M, Coelho A, Keynan Y, Larios OE, Ndao M, Ruest A, Roy G, Rubinstein E, Ouellette M. Genetic polymorphisms and drug susceptibility in four isolates of Leishmania tropica obtained from Canadian soldiers returning from Afghanistan. PLoS Negl Trop Dis 2012; 6:e1463. [PMID: 22272366 PMCID: PMC3260320 DOI: 10.1371/journal.pntd.0001463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease characterized by the presence of one or more lesions on the skin that usually heal spontaneously after a few months. Most cases of CL worldwide occur in Southwest Asia, Africa and South America, and a number of cases have been reported among troops deployed to Afghanistan. No vaccines are available against this disease, and its treatment relies on chemotherapy. The aim of this study was to characterize parasites isolated from Canadian soldiers at the molecular level and to determine their susceptibility profile against a panel of antileishmanials to identify appropriate therapies. METHODOLOGY/PRINCIPAL FINDINGS Parasites were isolated from skin lesions and characterized as Leishmania tropica based on their pulsed field gel electrophoresis profiles and pteridine reductase 1 (PTR1) sequences. Unusually high allelic polymorphisms were observed at several genetic loci for the L. tropica isolates that were characterized. The drug susceptibility profile of intracellular amastigote parasites was determined using an established macrophage assay. All isolates were sensitive to miltefosine, amphotericin B, sodium stibogluconate (Pentostam) and paromomycin, but were not susceptible to fluconazole. Variable levels of susceptibility were observed for the antimalarial agent atovaquone/proguanil (Malarone). Three Canadian soldiers from this study were successfully treated with miltefosine. CONCLUSIONS/SIGNIFICANCE This study shows high heterogeneity between the two L. tropica allelic versions of a gene but despite this, L. tropica isolated from Afghanistan are susceptible to several of the antileishmanial drugs available.
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Affiliation(s)
- Marie Plourde
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Adriano Coelho
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Yoav Keynan
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Oscar E. Larios
- Department of Medicine and Laboratory Medicine, Divisions of Infectious Diseases and Microbiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Momar Ndao
- National Reference Center for Parasitology, McGill University, Montreal General Hospital/Research Institute, Montréal, Québec, Canada
| | | | - Gaétan Roy
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Ethan Rubinstein
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marc Ouellette
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
- * E-mail:
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