COVID-19–associated mucormycosis (CAM) affected over 50,000 people during the second wave of the pandemic in India. Epidemiological aspects of CAM were reported, but there is a lack of published literature on mortality and its determinants in CAM and other fungal infections. The present study investigated patterns and determinants of mortality in these patients. The retrospective study reviewed case records of 390 patients, with at least 1 year of follow-up, for information related to demographics, epidemiology, clinical features, laboratory investigations, and treatment. The association between categorical variables was studied using the chi-square test of independence and logistic regression between 2 groups of those who survived and those who died during hospitalization or after discharge. A total of 157 (40%) patients did not survive; of these, 112 (29%) died during hospitalization and 45 (11%) had postdischarge mortality. The risk of mortality was associated with higher age, use of corticosteroids (odds ratio, 1.38; 95% confidence interval, 0.87–2.16), visual acuity <3/60 at presentation, palate involvement, and abnormal levels of white blood cells and red blood cells. The demographic, clinical, laboratory, and microbiological parameters may be predictors of mortality in patients of rhino-orbital-cerebral mucormycosis.
{"title":"Determinants of Mortality in COVID-19–Associated Opportunistic Fungal Infections","authors":"P. Rewri, Surya Mani Pandey, Rohit Singal, Ritika Khatri, Mamta Bishnoi","doi":"10.1097/ipc.0000000000001384","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001384","url":null,"abstract":"\u0000 \u0000 \u0000 COVID-19–associated mucormycosis (CAM) affected over 50,000 people during the second wave of the pandemic in India. Epidemiological aspects of CAM were reported, but there is a lack of published literature on mortality and its determinants in CAM and other fungal infections. The present study investigated patterns and determinants of mortality in these patients.\u0000 \u0000 \u0000 \u0000 The retrospective study reviewed case records of 390 patients, with at least 1 year of follow-up, for information related to demographics, epidemiology, clinical features, laboratory investigations, and treatment. The association between categorical variables was studied using the chi-square test of independence and logistic regression between 2 groups of those who survived and those who died during hospitalization or after discharge.\u0000 \u0000 \u0000 \u0000 A total of 157 (40%) patients did not survive; of these, 112 (29%) died during hospitalization and 45 (11%) had postdischarge mortality. The risk of mortality was associated with higher age, use of corticosteroids (odds ratio, 1.38; 95% confidence interval, 0.87–2.16), visual acuity <3/60 at presentation, palate involvement, and abnormal levels of white blood cells and red blood cells.\u0000 \u0000 \u0000 \u0000 The demographic, clinical, laboratory, and microbiological parameters may be predictors of mortality in patients of rhino-orbital-cerebral mucormycosis.\u0000","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-14DOI: 10.1097/ipc.0000000000001385
Song Hyeon Jeon, Taeyeon Kim, Nam Kyung Jeon
The overuse and misuse of antibiotics are a major public health concern, contributing to the rise of antibiotic-resistant bacteria. This study aimed to determine the prevalence of inappropriate antibiotic prescription for acute uncomplicated cystitis (AUC) in primary care clinics in Korea and identify contributing factors. Data from 20- to 64-year-old female AUC patients in the Health Insurance Review and Assessment Service–National Patient Sample were analyzed. Four categories of inappropriate antibiotic use were evaluated: inappropriate selection, duration, use of parenteral antibiotics, and multiple oral antibiotics. Multiple logistic regression was used to determine the impact of factors on inappropriate prescriptions. Of the 3125 patients, 2285 (73.1%) received inappropriate antibiotics. The most common categories were the use of parenteral antibiotics. Health care facility–dependent factors were the primary contributors to inappropriate prescription. Urology-specialized clinics had more than double the rate of inappropriate prescription compared with other clinics. More than 70% of AUC patients received inappropriate antibiotics in Korean outpatient clinics. The data highlight the urgent need for antimicrobial stewardship in the outpatient setting, with AUC as a “high-priority condition.”
{"title":"Evaluation of Empirical Antibiotic Therapy in Women With Acute Cystitis Visiting Outpatient Clinic in South Korea","authors":"Song Hyeon Jeon, Taeyeon Kim, Nam Kyung Jeon","doi":"10.1097/ipc.0000000000001385","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001385","url":null,"abstract":"\u0000 \u0000 The overuse and misuse of antibiotics are a major public health concern, contributing to the rise of antibiotic-resistant bacteria. This study aimed to determine the prevalence of inappropriate antibiotic prescription for acute uncomplicated cystitis (AUC) in primary care clinics in Korea and identify contributing factors.\u0000 \u0000 \u0000 \u0000 Data from 20- to 64-year-old female AUC patients in the Health Insurance Review and Assessment Service–National Patient Sample were analyzed. Four categories of inappropriate antibiotic use were evaluated: inappropriate selection, duration, use of parenteral antibiotics, and multiple oral antibiotics. Multiple logistic regression was used to determine the impact of factors on inappropriate prescriptions.\u0000 \u0000 \u0000 \u0000 Of the 3125 patients, 2285 (73.1%) received inappropriate antibiotics. The most common categories were the use of parenteral antibiotics. Health care facility–dependent factors were the primary contributors to inappropriate prescription. Urology-specialized clinics had more than double the rate of inappropriate prescription compared with other clinics.\u0000 \u0000 \u0000 \u0000 More than 70% of AUC patients received inappropriate antibiotics in Korean outpatient clinics. The data highlight the urgent need for antimicrobial stewardship in the outpatient setting, with AUC as a “high-priority condition.”\u0000","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141341617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-14DOI: 10.1097/ipc.0000000000001381
Shukla Das, G. Rai, Chhavi Gupta, Neelima Gupta, Vipin Arora, Praveen Kumar Singh, Subhashree Mohapatra, M. Ansari, Zaki H. Hakami, S. Dar
Fungal infections are a major health challenge especially in immunocompromised patients. Mucormycosis, a severe, frequently fatal fungal infection, has a unique predisposition to infect patients with diabetes. The infection is caused by organisms belonging to the order Mucorales, among which Rhizopus species are the most common. Uncontrolled diabetes complicated by diabetic ketoacidosis is one of the major risk factors for upsurge in mucormycosis cases. The defense mechanisms, involving macrophages and neutrophils for phagocytosis, are compromised in diabetes. In 2 cases of rhino-orbital-cerebral mucormycosis with underlying diabetes, we observed a marked immune imbalance, with elevated Th17 and diminished T regulatory cells. Recovery of CD4+CD25+ T cells after treatment indicated a favorable phenotype outcome; though high circulating CD4+CD161+ can be detrimental to the patient predisposing to future relapse(s). Mucorale specific T cells contributing to human immune responses against the fungi can be investigated to identify a surrogate diagnostic marker of invasive mucormycosis.
真菌感染是一项重大的健康挑战，尤其是对免疫力低下的患者而言。粘孢子菌病是一种严重的、经常致命的真菌感染，对糖尿病患者有独特的易感性。这种感染是由属于粘菌目（Mucorales）的微生物引起的，其中最常见的是根瘤菌（Rhizopus）。不受控制的糖尿病并发糖尿病酮症酸中毒是导致粘孢子菌病病例激增的主要风险因素之一。糖尿病患者的巨噬细胞和中性粒细胞吞噬防御机制受到损害。在两例伴有糖尿病的鼻眶脑粘液瘤病例中，我们观察到明显的免疫失衡，Th17 细胞升高，T调节细胞减少。治疗后 CD4+CD25+ T 细胞的恢复表明表型结果良好；但高循环 CD4+CD161+ 可能对患者不利，易导致未来复发。可以研究有助于人类对真菌产生免疫反应的粘孢子菌特异性 T 细胞，以确定侵袭性粘孢子菌病的替代诊断标志物。
{"title":"Mucormycosis in Diabetes","authors":"Shukla Das, G. Rai, Chhavi Gupta, Neelima Gupta, Vipin Arora, Praveen Kumar Singh, Subhashree Mohapatra, M. Ansari, Zaki H. Hakami, S. Dar","doi":"10.1097/ipc.0000000000001381","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001381","url":null,"abstract":"\u0000 Fungal infections are a major health challenge especially in immunocompromised patients. Mucormycosis, a severe, frequently fatal fungal infection, has a unique predisposition to infect patients with diabetes. The infection is caused by organisms belonging to the order Mucorales, among which Rhizopus species are the most common. Uncontrolled diabetes complicated by diabetic ketoacidosis is one of the major risk factors for upsurge in mucormycosis cases. The defense mechanisms, involving macrophages and neutrophils for phagocytosis, are compromised in diabetes. In 2 cases of rhino-orbital-cerebral mucormycosis with underlying diabetes, we observed a marked immune imbalance, with elevated Th17 and diminished T regulatory cells. Recovery of CD4+CD25+ T cells after treatment indicated a favorable phenotype outcome; though high circulating CD4+CD161+ can be detrimental to the patient predisposing to future relapse(s). Mucorale specific T cells contributing to human immune responses against the fungi can be investigated to identify a surrogate diagnostic marker of invasive mucormycosis.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141342979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-14DOI: 10.1097/ipc.0000000000001380
Melis Deniz, Hande Şenol, Tuğba Erat, H. Arı, Ümit Altuğ, E. Kıral
Much of the knowledge regarding pediatric healthcare-associated infections is based on studies conducted in adults. Here, we investigated clinical risk factors and etiologic organisms, focusing on antibiotic and antifungal resistance in pediatric patients with nosocomial bloodstream infections (nBSIs) in pediatric intensive care units (PICUs). A retrospective evaluation was conducted on pediatric patients with nBSI in the PICUs of a tertiary referral hospital. A total of 69 nBSI episodes in 65 patients were observed during the study period. Of these, a total of 40 (57.97%) were caused by Gram-negative bacteria, 6 (8.7%) by Gram-positive bacteria, and 23 (33.33%) by Candida species. The rankings of Gram-negative bacteria were Klebsiella pneumoniae (37.5%), Acinetobacter baumannii (22.5%), and Serratia marcescens (12.5%). Carbapenem resistance was found to be common among K. pneumoniae (40%) and all Acinetobacter species. Most children (54.41%) had spent >28 days in the PICU at the time of diagnosis of nBSI. The presence of central venous catheters was significantly associated with fungal nBSI (P = 0.047). A high rate of antimicrobial resistance was observed among pathogens. A central venous catheter was associated with fungemia in children hospitalized in PICUs. Prolonged hospital stay before the diagnosis of BSI and the use of medical devices were found to be common in fungal infections.
{"title":"The Etiologic Organisms, Risk Factors, and Outcomes of Nosocomial Bloodstream Infections in Pediatric Patients","authors":"Melis Deniz, Hande Şenol, Tuğba Erat, H. Arı, Ümit Altuğ, E. Kıral","doi":"10.1097/ipc.0000000000001380","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001380","url":null,"abstract":"\u0000 \u0000 Much of the knowledge regarding pediatric healthcare-associated infections is based on studies conducted in adults. Here, we investigated clinical risk factors and etiologic organisms, focusing on antibiotic and antifungal resistance in pediatric patients with nosocomial bloodstream infections (nBSIs) in pediatric intensive care units (PICUs).\u0000 \u0000 \u0000 \u0000 A retrospective evaluation was conducted on pediatric patients with nBSI in the PICUs of a tertiary referral hospital.\u0000 \u0000 \u0000 \u0000 A total of 69 nBSI episodes in 65 patients were observed during the study period. Of these, a total of 40 (57.97%) were caused by Gram-negative bacteria, 6 (8.7%) by Gram-positive bacteria, and 23 (33.33%) by Candida species. The rankings of Gram-negative bacteria were Klebsiella pneumoniae (37.5%), Acinetobacter baumannii (22.5%), and Serratia marcescens (12.5%). Carbapenem resistance was found to be common among K. pneumoniae (40%) and all Acinetobacter species. Most children (54.41%) had spent >28 days in the PICU at the time of diagnosis of nBSI. The presence of central venous catheters was significantly associated with fungal nBSI (P = 0.047).\u0000 \u0000 \u0000 \u0000 A high rate of antimicrobial resistance was observed among pathogens. A central venous catheter was associated with fungemia in children hospitalized in PICUs. Prolonged hospital stay before the diagnosis of BSI and the use of medical devices were found to be common in fungal infections.\u0000","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141340535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-14DOI: 10.1097/ipc.0000000000001383
John S. Bradley, Dario Cattaneo, M. Kantecki, Teresa Dalla Costa
Ceftaroline has been reported to show efficacy in limited adult clinical case studies including a report of a patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection of a ventriculopleural shunt, and in 2 reports for use as a salvage therapy in a case of an epidural abscess infected with MRSA, as well as a case of methicillin-resistant Staphylococcus epidermidis (MRSE) ventriculostomy-related infection. The pharmacokinetic (PK) and pharmacodynamic (PD) properties of ceftaroline in healthy adults and neurosurgical patients have been assessed to develop population PK models used to perform simulations to evaluate the probability of target attainment of different ceftaroline dosing regimens for central nervous system (CNS) infections. Results from the simulations indicated that the penetration of ceftaroline into the cerebrospinal fluid was dependent on the degree of meningeal inflammation, suggesting that inflammation associated with infection would provide adequate antibiotic exposure, similar to other β-lactam antibiotics. Ceftaroline has a potential, unique role as a β-lactam antibiotic in the treatment of MRSA and coagulase negative staphylococci causing CNS infections as an alternative to vancomycin, the current standard of care. Support for treatment of CNS infections may be derived from further cerebrospinal fluid PK studies followed by PK/PD modeling prior to the conduct of prospective phase 2/3 clinical studies aimed at assessing the efficacy and safety of ceftaroline for the treatment of pediatric CNS infections. Ceftaroline's penetration enhanced by meningeal inflammation suggests that the drug could be a candidate to treat MRSA CNS infections.
{"title":"Ceftaroline Fosamil as a Potential Treatment for Central Nervous System Infections in Children","authors":"John S. Bradley, Dario Cattaneo, M. Kantecki, Teresa Dalla Costa","doi":"10.1097/ipc.0000000000001383","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001383","url":null,"abstract":"\u0000 Ceftaroline has been reported to show efficacy in limited adult clinical case studies including a report of a patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection of a ventriculopleural shunt, and in 2 reports for use as a salvage therapy in a case of an epidural abscess infected with MRSA, as well as a case of methicillin-resistant Staphylococcus epidermidis (MRSE) ventriculostomy-related infection. The pharmacokinetic (PK) and pharmacodynamic (PD) properties of ceftaroline in healthy adults and neurosurgical patients have been assessed to develop population PK models used to perform simulations to evaluate the probability of target attainment of different ceftaroline dosing regimens for central nervous system (CNS) infections. Results from the simulations indicated that the penetration of ceftaroline into the cerebrospinal fluid was dependent on the degree of meningeal inflammation, suggesting that inflammation associated with infection would provide adequate antibiotic exposure, similar to other β-lactam antibiotics. Ceftaroline has a potential, unique role as a β-lactam antibiotic in the treatment of MRSA and coagulase negative staphylococci causing CNS infections as an alternative to vancomycin, the current standard of care. Support for treatment of CNS infections may be derived from further cerebrospinal fluid PK studies followed by PK/PD modeling prior to the conduct of prospective phase 2/3 clinical studies aimed at assessing the efficacy and safety of ceftaroline for the treatment of pediatric CNS infections. Ceftaroline's penetration enhanced by meningeal inflammation suggests that the drug could be a candidate to treat MRSA CNS infections.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-06DOI: 10.1097/ipc.0000000000001387
Yoshitaka Seki, S. Uchiyama, Yuma Matsui, Yuri Baba, Yasuhiro Kamii, Wakako Shinohara, Kazushi Yoshida, Akihiro Ichikawa, Koji Yoshikawa, Jun Araya
There are several reports of breakthrough infections of severe acute respiratory syndrome coronavirus 2 in vaccinated individuals and reinfections in previously infected individuals. Although the coronavirus disease (COVID-19) pandemic has increased the incidence of infections at healthcare facilities, the association between the increase in community spread and absence rate of hospital workers due to COVID-19 infection-related sick leave has not yet been fully elucidated. We reviewed the case files of patients with COVID-19 diagnosed at the Jikei University Katsushika Medical Center, Tokyo, Japan, between January 1, 2022, and February 28, 2023. The obtained data was used to determine the number of COVID-19 admissions and absence rate of hospital workers due to COVID-19 infection-related sick leave during the sixth to eighth wave of the COVID-19 pandemic. Of 1899 patients with confirmed COVID-19, 397 (20.9%) were hospital workers. Of the 397 patients, 71, 156, and 119 contracted the infection during the sixth (January–March 2022), seventh (July–September 2022), and eighth wave (November 2022–February 2023), respectively. The absence rate of hospital workers due to COVID-19 was 6.3%, excluding leaves of absence due to close contact in the seventh wave, which had the highest number of infections. Given the difficulty of maintaining a usual work schedule during the COVID-19 outbreak, it may be necessary to re-evaluate the backgrounds of healthcare workers at high risk of contracting COVID-19 and to make aggressive adjustments to their work schedules by distributing assignments and restricting leave.
{"title":"Sick Leave and Absence Rate of Hospital Workers During the Sixth to Eighth Wave of COVID-19 in Japan","authors":"Yoshitaka Seki, S. Uchiyama, Yuma Matsui, Yuri Baba, Yasuhiro Kamii, Wakako Shinohara, Kazushi Yoshida, Akihiro Ichikawa, Koji Yoshikawa, Jun Araya","doi":"10.1097/ipc.0000000000001387","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001387","url":null,"abstract":"\u0000 \u0000 \u0000 There are several reports of breakthrough infections of severe acute respiratory syndrome coronavirus 2 in vaccinated individuals and reinfections in previously infected individuals. Although the coronavirus disease (COVID-19) pandemic has increased the incidence of infections at healthcare facilities, the association between the increase in community spread and absence rate of hospital workers due to COVID-19 infection-related sick leave has not yet been fully elucidated.\u0000 \u0000 \u0000 \u0000 We reviewed the case files of patients with COVID-19 diagnosed at the Jikei University Katsushika Medical Center, Tokyo, Japan, between January 1, 2022, and February 28, 2023. The obtained data was used to determine the number of COVID-19 admissions and absence rate of hospital workers due to COVID-19 infection-related sick leave during the sixth to eighth wave of the COVID-19 pandemic.\u0000 \u0000 \u0000 \u0000 Of 1899 patients with confirmed COVID-19, 397 (20.9%) were hospital workers. Of the 397 patients, 71, 156, and 119 contracted the infection during the sixth (January–March 2022), seventh (July–September 2022), and eighth wave (November 2022–February 2023), respectively. The absence rate of hospital workers due to COVID-19 was 6.3%, excluding leaves of absence due to close contact in the seventh wave, which had the highest number of infections.\u0000 \u0000 \u0000 \u0000 Given the difficulty of maintaining a usual work schedule during the COVID-19 outbreak, it may be necessary to re-evaluate the backgrounds of healthcare workers at high risk of contracting COVID-19 and to make aggressive adjustments to their work schedules by distributing assignments and restricting leave.\u0000","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The coronavirus disease 2019 (COVID-19) pandemic has greatly shifted the attitude of the public and health care workers toward health care practices. Furthermore, this pandemic led to reduced diagnostic testing of various diseases worldwide. This study investigated the impact of the COVID-19 pandemic on health care practices, mainly focusing on sputum culture testing for pneumonia and how these changes affected antibiotic selection and health outcomes. We conducted a retrospective observational study at the Tokyo Medical University Ibaraki Medical Center between January 2018 and December 2021. We compared clinical outcomes during the pre–COVID-19 and post–COVID-19 periods. These outcomes included microbiological test implementation (eg, sputum culture test), length of hospital stay, and in-hospital mortality. Of the 698 patients, 384 (55.0%) were from the pre–COVID-19 period, and 314 (45.0%) were from the post–COVID-19 period. The post–COVID-19 period was associated with a lower ordering rate of sputum cultures (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50–0.93). Furthermore, the post–COVID-19 period was associated with increased use of narrow-spectrum antibiotics (OR, 1.57; 95% CI, 1.12–2.21) and a higher rate of in-hospital death (OR, 1.78; 95% CI, 1.16–2.73). The COVID-19 pandemic has prompted changes in health care–seeking behaviors, affecting health care providers' diagnostic practices and potentially influencing patient outcomes. Our study outlines the importance of adapting health care strategies during pandemics. Further studies are required to understand the complex interplay among pandemic situations, diagnostic procedures, and patient prognosis.
{"title":"Shifting Patterns of Sputum Culture Testing and Antibiotic Usage Among Patients With Pneumonia Before and After the COVID-19 Pandemic","authors":"Hiroshi Ito, Yuki Kitagawa, Toshiya Nakashima, Satoshi Kobanawa, Kento Uki, Jura Oshida, T. Kodama, Daiki Kobayashi","doi":"10.1097/ipc.0000000000001375","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001375","url":null,"abstract":"\u0000 The coronavirus disease 2019 (COVID-19) pandemic has greatly shifted the attitude of the public and health care workers toward health care practices. Furthermore, this pandemic led to reduced diagnostic testing of various diseases worldwide. This study investigated the impact of the COVID-19 pandemic on health care practices, mainly focusing on sputum culture testing for pneumonia and how these changes affected antibiotic selection and health outcomes. We conducted a retrospective observational study at the Tokyo Medical University Ibaraki Medical Center between January 2018 and December 2021. We compared clinical outcomes during the pre–COVID-19 and post–COVID-19 periods. These outcomes included microbiological test implementation (eg, sputum culture test), length of hospital stay, and in-hospital mortality. Of the 698 patients, 384 (55.0%) were from the pre–COVID-19 period, and 314 (45.0%) were from the post–COVID-19 period. The post–COVID-19 period was associated with a lower ordering rate of sputum cultures (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50–0.93). Furthermore, the post–COVID-19 period was associated with increased use of narrow-spectrum antibiotics (OR, 1.57; 95% CI, 1.12–2.21) and a higher rate of in-hospital death (OR, 1.78; 95% CI, 1.16–2.73). The COVID-19 pandemic has prompted changes in health care–seeking behaviors, affecting health care providers' diagnostic practices and potentially influencing patient outcomes. Our study outlines the importance of adapting health care strategies during pandemics. Further studies are required to understand the complex interplay among pandemic situations, diagnostic procedures, and patient prognosis.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-06DOI: 10.1097/ipc.0000000000001373
J. Roberti, Viviana Rodríguez, Mariana Seijo, Ana Paula Rodríguez, M. Guglielmino, F. Jorro-Barón, María de los Angeles Baigorria, Silvia Villa, Wanda Cornistein, Cecilia V. Ocampo, Liliana Clara, A. Colque, M. Staneloni, Pablo Piccinini, Paola Pidal, H. Bagnulo, Henry Albornoz, Carlos Vivas, Patrick Pike, E. García-Elorrio
Surgical site infections (SSIs) are a major health care issue, with worse outcomes and higher costs in Latin America than in other countries. To reduce SSIs in colorectal surgery (CRS), we conducted a mixed-method study between May and December 2021, which included a literature review, Delphi expert consensus panel, and SSI reduction recommendations. The literature review identified 150 relevant articles, deriving 19 recommendations based on the GRADE framework. A panel of 14 experts from Argentina, Chile, and Uruguay, specializing in infection control, participated in a modified Delphi consensus process. They evaluated the recommendations using a Likert scale and assessed 13 criteria to reach consensus. After rounds of evaluation and expert discussions, 6 recommendations achieved consensus and were deemed appropriate for SSI prevention in CRS: presurgical bathing, surgical antibiotic prophylaxis, mechanical colon preparation, preincision antisepsis with alcohol and antisepsis, monitoring of hyperglycemic patients, and control of normothermia. Implementing such a multifaceted set of recommendations presents challenges, and a bundled approach has been suggested to improve the adherence to complex prevention strategies. Previous research has underscored the importance of effective implementation strategies, including engagement, education, execution, and evaluation, as well as fostering a culture of safety and readiness for change. This study offers expert recommendations for preventing SSIs in CRS, particularly in Latin America. These are crucial for regional health care organizations. Compliance with basic infection prevention measures remains a concern. A bundled approach was suggested to evaluate adherence to health care protocols in Argentina and Uruguay. Aligning guidelines and practices can increase patient safety and reduce the impact of SSIs on Latin American health care.
{"title":"Modified Delphi RAND/UCLA Consensus on Recommendations for Preventing Surgical Site Infections in Colorectal Surgery","authors":"J. Roberti, Viviana Rodríguez, Mariana Seijo, Ana Paula Rodríguez, M. Guglielmino, F. Jorro-Barón, María de los Angeles Baigorria, Silvia Villa, Wanda Cornistein, Cecilia V. Ocampo, Liliana Clara, A. Colque, M. Staneloni, Pablo Piccinini, Paola Pidal, H. Bagnulo, Henry Albornoz, Carlos Vivas, Patrick Pike, E. García-Elorrio","doi":"10.1097/ipc.0000000000001373","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001373","url":null,"abstract":"\u0000 Surgical site infections (SSIs) are a major health care issue, with worse outcomes and higher costs in Latin America than in other countries. To reduce SSIs in colorectal surgery (CRS), we conducted a mixed-method study between May and December 2021, which included a literature review, Delphi expert consensus panel, and SSI reduction recommendations. The literature review identified 150 relevant articles, deriving 19 recommendations based on the GRADE framework. A panel of 14 experts from Argentina, Chile, and Uruguay, specializing in infection control, participated in a modified Delphi consensus process. They evaluated the recommendations using a Likert scale and assessed 13 criteria to reach consensus. After rounds of evaluation and expert discussions, 6 recommendations achieved consensus and were deemed appropriate for SSI prevention in CRS: presurgical bathing, surgical antibiotic prophylaxis, mechanical colon preparation, preincision antisepsis with alcohol and antisepsis, monitoring of hyperglycemic patients, and control of normothermia. Implementing such a multifaceted set of recommendations presents challenges, and a bundled approach has been suggested to improve the adherence to complex prevention strategies. Previous research has underscored the importance of effective implementation strategies, including engagement, education, execution, and evaluation, as well as fostering a culture of safety and readiness for change. This study offers expert recommendations for preventing SSIs in CRS, particularly in Latin America. These are crucial for regional health care organizations. Compliance with basic infection prevention measures remains a concern. A bundled approach was suggested to evaluate adherence to health care protocols in Argentina and Uruguay. Aligning guidelines and practices can increase patient safety and reduce the impact of SSIs on Latin American health care.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/ipc.0000000000001367
Alexander Pomakov, Prishanya Pillai, Tyler Stephen, Kelly A. Russo, Ted Louie
{"title":"Snapshots of ID Week 2023","authors":"Alexander Pomakov, Prishanya Pillai, Tyler Stephen, Kelly A. Russo, Ted Louie","doi":"10.1097/ipc.0000000000001367","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001367","url":null,"abstract":"","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141046082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/ipc.0000000000001360
Nicola Abrescia, Maurizio D'Abbraccio, M. De Marco, A. Maddaloni
The emergence of novel infectious agents with pandemic potential remains a critical global concern, as underscored by the COVID-19 pandemic. This study investigates the various factors contributing to the risk of new pandemics and proposes a framework for pandemic prevention and mitigation. We review the characteristics of several infectious agents, including influenza viruses, coronaviruses, filoviruses, paramyxoviruses, Lassa fever virus, Crimean-Congo hemorrhagic fever virus, and the yellow fever virus. These agents are discussed in terms of their transmission modes, reservoirs, potential for human-to-human spread, and historical outbreaks. We emphasize the importance of monitoring and early detection of these agents, especially those with localized outbreaks and zoonotic potential. Our analysis highlights the role of human activities in pandemic risk. Factors such as overuse of antibiotics, environmental changes (deforestation, wildlife habitat encroachment), climate change effects on disease vectors, and increasing global connectivity are examined as drivers of disease emergence. Furthermore, we propose a foursome of critical actions for pandemic prevention and response: early detection and rapid containment; restricting the transmission by social distancing, masking, quarantine, and elimination of vector, which are crucial even before the vaccine is available; global vaccine and treatment distribution; and robust health policy implementation. We emphasize the importance of international collaboration, information sharing, and preparedness to effectively combat pandemics. In conclusion, this commentary provides a comprehensive overview of infectious agents with pandemic potential and their associated risks. It calls for proactive measures to prevent and mitigate future pandemics, emphasizing the need for a global strategy that combines early detection, rapid response, and sustained public health infrastructure.
{"title":"Lessons From the Global SARS-CoV-2 Health Emergency for Potential Future Pandemics","authors":"Nicola Abrescia, Maurizio D'Abbraccio, M. De Marco, A. Maddaloni","doi":"10.1097/ipc.0000000000001360","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001360","url":null,"abstract":"\u0000 The emergence of novel infectious agents with pandemic potential remains a critical global concern, as underscored by the COVID-19 pandemic. This study investigates the various factors contributing to the risk of new pandemics and proposes a framework for pandemic prevention and mitigation.\u0000 We review the characteristics of several infectious agents, including influenza viruses, coronaviruses, filoviruses, paramyxoviruses, Lassa fever virus, Crimean-Congo hemorrhagic fever virus, and the yellow fever virus. These agents are discussed in terms of their transmission modes, reservoirs, potential for human-to-human spread, and historical outbreaks. We emphasize the importance of monitoring and early detection of these agents, especially those with localized outbreaks and zoonotic potential.\u0000 Our analysis highlights the role of human activities in pandemic risk. Factors such as overuse of antibiotics, environmental changes (deforestation, wildlife habitat encroachment), climate change effects on disease vectors, and increasing global connectivity are examined as drivers of disease emergence.\u0000 Furthermore, we propose a foursome of critical actions for pandemic prevention and response: early detection and rapid containment; restricting the transmission by social distancing, masking, quarantine, and elimination of vector, which are crucial even before the vaccine is available; global vaccine and treatment distribution; and robust health policy implementation. We emphasize the importance of international collaboration, information sharing, and preparedness to effectively combat pandemics.\u0000 In conclusion, this commentary provides a comprehensive overview of infectious agents with pandemic potential and their associated risks. It calls for proactive measures to prevent and mitigate future pandemics, emphasizing the need for a global strategy that combines early detection, rapid response, and sustained public health infrastructure.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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