Jing Chen, Ju-Young Shin, Sungho Bea, Byong Duk Ye, Dong-Gun Lee, Hyungwoo Kim, Won Suk Choi, Sumitra Shantakumar
Background Chronic conditions (CC) may increase the risk of herpes zoster (HZ) infection, leading to a greater healthcare burden in these individuals compared to those without CCs. It is therefore clinically important to quantify HZ disease burden in individuals with and without CCs, given the rapidly ageing population in the Republic of Korea (ROK). Methods This retrospective cohort study examines the trends in incidence rates (IRs) and incidence rate ratios (IRRs) in individuals with CCs aged ≥18 years using the National Health Insurance Service National Sample Cohort (NHIS-NSC) database from 2010–2019. These patients were stratified by age groups, sex, HZ complications, and CCs. The annual average number of HZ patients, IRs and IRRs were calculated for individuals with and without CCs. Results In total, 729,347 patients with HZ were eligible for the study. HZ IRs were highest in patients with diabetes, followed by chronic obstructive pulmonary disease, chronic kidney disease, asthma, and chronic liver disease, with HZ IRRs following a similar trend. Overall, HZ IRs generally increased with age, typically peaking at 60–64 or 65–69 years and were similar for females and males. HZ IRs were highest among patients without complications, followed by HZ with other, cutaneous, ocular, and neurologic complications across all CCs. For each of the CCs, HZ IRs were consistently higher than that of the non-CC population regardless of sex. Conclusions The findings of this study reiterate the importance of HZ prevention for healthy ageing, especially for CCs populations at increased risk of HZ in the ROK.
{"title":"Burden of Herpes Zoster in Individuals with Chronic Conditions in the Republic of Korea: A Nationwide Population-Based Database Study","authors":"Jing Chen, Ju-Young Shin, Sungho Bea, Byong Duk Ye, Dong-Gun Lee, Hyungwoo Kim, Won Suk Choi, Sumitra Shantakumar","doi":"10.1093/ofid/ofae535","DOIUrl":"https://doi.org/10.1093/ofid/ofae535","url":null,"abstract":"Background Chronic conditions (CC) may increase the risk of herpes zoster (HZ) infection, leading to a greater healthcare burden in these individuals compared to those without CCs. It is therefore clinically important to quantify HZ disease burden in individuals with and without CCs, given the rapidly ageing population in the Republic of Korea (ROK). Methods This retrospective cohort study examines the trends in incidence rates (IRs) and incidence rate ratios (IRRs) in individuals with CCs aged ≥18 years using the National Health Insurance Service National Sample Cohort (NHIS-NSC) database from 2010–2019. These patients were stratified by age groups, sex, HZ complications, and CCs. The annual average number of HZ patients, IRs and IRRs were calculated for individuals with and without CCs. Results In total, 729,347 patients with HZ were eligible for the study. HZ IRs were highest in patients with diabetes, followed by chronic obstructive pulmonary disease, chronic kidney disease, asthma, and chronic liver disease, with HZ IRRs following a similar trend. Overall, HZ IRs generally increased with age, typically peaking at 60–64 or 65–69 years and were similar for females and males. HZ IRs were highest among patients without complications, followed by HZ with other, cutaneous, ocular, and neurologic complications across all CCs. For each of the CCs, HZ IRs were consistently higher than that of the non-CC population regardless of sex. Conclusions The findings of this study reiterate the importance of HZ prevention for healthy ageing, especially for CCs populations at increased risk of HZ in the ROK.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
William M Garneau, Joyce L Jones, Gabriella M Dashler, Nathan Kwon, Matthew M Hamill, Elizabeth A Gilliams, David S Rudolph, Jeanne C Keruly, Eili Y Klein, Nae-Yuh Wang, Bhakti Hansoti, Kelly A Gebo
Background Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care. Methods We conducted an observational study of patients undergoing mpox testing between June 1, 2022 – December 15, 2022. We assessed concomitant STI testing, sexual history, and anogenital exam and a composite outcome of all three, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic). Results Of 276 patients included, over half (62.7%) were evaluated in the ED. Sexual history, anogenital exam and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox, and syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in ID clinic had higher odds ratio of completing all three measures (aOR 3.6 [95% CI 1.4-9.3]) compared to PCP setting adjusted for age, gender and MSM status. Cisgender men who have sex with men, transgender males and transgender females had higher odds ratio of completing all three measures compared to cisgender females (aOR 4.0 [95% CI 1.9-8.4]) adjusted for age and venue of care. Conclusions Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients.
背景 在 2022 年疫情爆发期间，疑似麻风病人在不同地点接受了评估。我们推测，不同医疗机构的诊疗模式可能有所不同。方法 我们对 2022 年 6 月 1 日至 2022 年 12 月 15 日期间接受水痘检测的患者进行了一项观察性研究。我们评估了同时进行的性传播感染检测、性生活史和肛门生殖器检查，以及三者的综合结果，并按地点进行了分层。就诊地点定义为 ED（急诊科或急诊室）、ID（传染病诊所）或 PCP（初级保健或其他门诊诊所）。结果 在纳入的 276 名患者中，一半以上（62.7%）是在急诊室接受评估的。根据记录，与急诊室或初级保健中心相比，ID 诊所的性史、肛门生殖器检查和 STI 检测率更高。20.4%的麻疹患者被诊断出患有性传播感染，梅毒是麻疹患者中最常见的性传播感染（17.5%）。经年龄、性别和 MSM 身份调整后，与初级保健医生相比，在 ID 诊所接受评估的患者完成所有三项措施的几率更高（aOR 3.6 [95% CI 1.4-9.3]）。经年龄和医疗地点调整后，与同性女性相比，同性男性同性恋者、变性男性和变性女性完成所有三项测量的几率更高（aOR 4.0 [95% CI 1.9-8.4]）。结论 不同临床机构的护理有所不同。ID 诊所的评估比其他场所更全面。性传播疾病合并感染率很高。梅毒是最常见的性传播疾病。为确保患者获得最佳治疗效果，必须努力实现护理标准化。
{"title":"Differences in mpox evaluation by clinical care site: practice patterns across an academic medical system during the 2022 epidemic","authors":"William M Garneau, Joyce L Jones, Gabriella M Dashler, Nathan Kwon, Matthew M Hamill, Elizabeth A Gilliams, David S Rudolph, Jeanne C Keruly, Eili Y Klein, Nae-Yuh Wang, Bhakti Hansoti, Kelly A Gebo","doi":"10.1093/ofid/ofae512","DOIUrl":"https://doi.org/10.1093/ofid/ofae512","url":null,"abstract":"Background Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care. Methods We conducted an observational study of patients undergoing mpox testing between June 1, 2022 – December 15, 2022. We assessed concomitant STI testing, sexual history, and anogenital exam and a composite outcome of all three, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic). Results Of 276 patients included, over half (62.7%) were evaluated in the ED. Sexual history, anogenital exam and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox, and syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in ID clinic had higher odds ratio of completing all three measures (aOR 3.6 [95% CI 1.4-9.3]) compared to PCP setting adjusted for age, gender and MSM status. Cisgender men who have sex with men, transgender males and transgender females had higher odds ratio of completing all three measures compared to cisgender females (aOR 4.0 [95% CI 1.9-8.4]) adjusted for age and venue of care. Conclusions Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth M Boos, Maxwell Holtmann, Jack DeHovitz, James M Tesoriero, Redd Driver, Charles Gonzalez
Administrative data may provide incomplete understanding of pandemic disease impact. Medical record review-based assessments of COVID-19-related causes of death (COD) among people living with diagnosed HIV in New York State identified more COVID-19-related COD compared to Vital Statistics and offer a deeper understanding of the pandemic’s impact on this population.
{"title":"The Value of Medical Chart Reviews: A Methodological Approach to Supplement Mortality Data During Pandemic Outbreaks","authors":"Elizabeth M Boos, Maxwell Holtmann, Jack DeHovitz, James M Tesoriero, Redd Driver, Charles Gonzalez","doi":"10.1093/ofid/ofae543","DOIUrl":"https://doi.org/10.1093/ofid/ofae543","url":null,"abstract":"Administrative data may provide incomplete understanding of pandemic disease impact. Medical record review-based assessments of COVID-19-related causes of death (COD) among people living with diagnosed HIV in New York State identified more COVID-19-related COD compared to Vital Statistics and offer a deeper understanding of the pandemic’s impact on this population.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Do Van Dong, Sébastien Boutin, Vu Viet Sang, Nguyen Dang Manh, Nghiem Xuan Hoan, Hoang Xuan Quang, Tran Thi Lien, Van Dinh Trang, Nguyen Trong The, Le Thi Kieu Linh, Kristina Schmauder, Viola Ueltzhöffer, Nourhane Hafza, Susanne Hauswaldt, Jan Rupp, Peter G Kremsner, Le Huu Song, Dennis Nurjadi, Silke Peter, Thirumalaisamy P Velavan
Introduction Central nervous system (CNS) infections pose significant health challenges, particularly in low- and middle-income countries (LMICs), due to high morbidity and mortality rates. Rapid and accurate diagnosis is essential for effective treatment to prevent adverse outcomes. Traditional culture-based diagnostics are often slow and lack specificity. This study evaluates the BioFire® FilmArray® Meningitis/Encephalitis (FAME) Panel against standard diagnostics in Vietnam to assess its clinical impact and suitability for local epidemiology. Methods We conducted a prospective study involving 330 patients with suspected CNS infections at four hospitals in northern Vietnam from July 2022 to April 2023. CSF samples were analysed using routine culture methods and FAME. We compared pathogen detection rates and assessed the potential clinical impact of FAME results on patient management. Results Of the 330 CSF specimens, 64 (19%) were positive by either conventional diagnostics (n=48) and/or FAME (n=33). The agreement between FAME and conventional diagnostics was 87%. Key pathogens Mycobacterium tuberculosis (n=7), Klebsiella pneumoniae (n=5), Streptococcus suis (n=5), Epstein-Barr virus (n=3), Acinetobacter baumannii (n=1), and Trichosporon asahii (n=1) were not detected by FAME. Classical meningitis parameters-clinical symptoms, altered glucose, protein, and pleocytosis- were good predictors of FAME positivity, indicating their utility in optimizing local diagnostic algorithms. Conclusion FAME complements traditional diagnostics by offering rapid and broad pathogen detection, crucial for timely and appropriate therapy. However, its effectiveness varies with local epidemiology, and it should not replace conventional methods entirely. Tailoring diagnostic panels to regional pathogen prevalence is recommended to enhance diagnostic accuracy and clinical outcomes in LMICs.
{"title":"Optimisation of the diagnosis of Central Nervous System infections in Vietnamese hospitals: Results from a retrospective multicentre study","authors":"Do Van Dong, Sébastien Boutin, Vu Viet Sang, Nguyen Dang Manh, Nghiem Xuan Hoan, Hoang Xuan Quang, Tran Thi Lien, Van Dinh Trang, Nguyen Trong The, Le Thi Kieu Linh, Kristina Schmauder, Viola Ueltzhöffer, Nourhane Hafza, Susanne Hauswaldt, Jan Rupp, Peter G Kremsner, Le Huu Song, Dennis Nurjadi, Silke Peter, Thirumalaisamy P Velavan","doi":"10.1093/ofid/ofae531","DOIUrl":"https://doi.org/10.1093/ofid/ofae531","url":null,"abstract":"Introduction Central nervous system (CNS) infections pose significant health challenges, particularly in low- and middle-income countries (LMICs), due to high morbidity and mortality rates. Rapid and accurate diagnosis is essential for effective treatment to prevent adverse outcomes. Traditional culture-based diagnostics are often slow and lack specificity. This study evaluates the BioFire® FilmArray® Meningitis/Encephalitis (FAME) Panel against standard diagnostics in Vietnam to assess its clinical impact and suitability for local epidemiology. Methods We conducted a prospective study involving 330 patients with suspected CNS infections at four hospitals in northern Vietnam from July 2022 to April 2023. CSF samples were analysed using routine culture methods and FAME. We compared pathogen detection rates and assessed the potential clinical impact of FAME results on patient management. Results Of the 330 CSF specimens, 64 (19%) were positive by either conventional diagnostics (n=48) and/or FAME (n=33). The agreement between FAME and conventional diagnostics was 87%. Key pathogens Mycobacterium tuberculosis (n=7), Klebsiella pneumoniae (n=5), Streptococcus suis (n=5), Epstein-Barr virus (n=3), Acinetobacter baumannii (n=1), and Trichosporon asahii (n=1) were not detected by FAME. Classical meningitis parameters-clinical symptoms, altered glucose, protein, and pleocytosis- were good predictors of FAME positivity, indicating their utility in optimizing local diagnostic algorithms. Conclusion FAME complements traditional diagnostics by offering rapid and broad pathogen detection, crucial for timely and appropriate therapy. However, its effectiveness varies with local epidemiology, and it should not replace conventional methods entirely. Tailoring diagnostic panels to regional pathogen prevalence is recommended to enhance diagnostic accuracy and clinical outcomes in LMICs.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liam M Dalton, Carol A Kauffman, Blair Richards, Marisa H Miceli
Review of histoplasmosis and blastomycosis antigen testing for 39 patients hospitalized with these diseases found that there were significantly longer turnaround times between the time of specimen collection and receipt of positive test results among those patients who had worse outcomes.
{"title":"Evaluation of Turnaround Times for Antigen Testing in Hospitalized Patients with Histoplasmosis and Blastomycosis","authors":"Liam M Dalton, Carol A Kauffman, Blair Richards, Marisa H Miceli","doi":"10.1093/ofid/ofae521","DOIUrl":"https://doi.org/10.1093/ofid/ofae521","url":null,"abstract":"Review of histoplasmosis and blastomycosis antigen testing for 39 patients hospitalized with these diseases found that there were significantly longer turnaround times between the time of specimen collection and receipt of positive test results among those patients who had worse outcomes.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takahiro Matsuo, Sebastian Wurster, Ying Jiang, Jeffrey Tarrand, Scott E Evans, Dimitrios P Kontoyiannis
We retrospectively reviewed 64 cancer patients with pulmonary legionellosis (Legionella pneumophila in 73%). Nearly all patients received Legionella-active antibiotics, yet 30-day mortality was 23%. Independent predictors of 30-day mortality were hyponatremia, bilateral lung involvement, and SOFA score ≥5. Lung co-infections were common (31%) but did not significantly increase mortality.
{"title":"Determinant of 30-day Mortality of Pulmonary Legionellosis: Do Co-Infections Matter?","authors":"Takahiro Matsuo, Sebastian Wurster, Ying Jiang, Jeffrey Tarrand, Scott E Evans, Dimitrios P Kontoyiannis","doi":"10.1093/ofid/ofae529","DOIUrl":"https://doi.org/10.1093/ofid/ofae529","url":null,"abstract":"We retrospectively reviewed 64 cancer patients with pulmonary legionellosis (Legionella pneumophila in 73%). Nearly all patients received Legionella-active antibiotics, yet 30-day mortality was 23%. Independent predictors of 30-day mortality were hyponatremia, bilateral lung involvement, and SOFA score ≥5. Lung co-infections were common (31%) but did not significantly increase mortality.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radhika Sheth, Apoorva Bhaskara, Haley Brown, Cara D Varley, Amber Streifel, Marissa Maier, Monica K Sikka, Christopher Evans
We describe the epidemiology and incidence of infections following gender-affirming vaginoplasty. Urinary tract and surgical site infections were the most common infections with 17.5% and 5.5% incidence, respectively. We also identified a significant gap in Human Immunodeficiency Virus screening and prescription of pre-exposure prophylaxis.
{"title":"Infections Following Gender-affirming Vaginoplasty: A Single Center Experience","authors":"Radhika Sheth, Apoorva Bhaskara, Haley Brown, Cara D Varley, Amber Streifel, Marissa Maier, Monica K Sikka, Christopher Evans","doi":"10.1093/ofid/ofae526","DOIUrl":"https://doi.org/10.1093/ofid/ofae526","url":null,"abstract":"We describe the epidemiology and incidence of infections following gender-affirming vaginoplasty. Urinary tract and surgical site infections were the most common infections with 17.5% and 5.5% incidence, respectively. We also identified a significant gap in Human Immunodeficiency Virus screening and prescription of pre-exposure prophylaxis.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This retrospective matched cohort study investigated the protective effects of PPSV23 vaccination against pneumonia mortality and all-cause mortality in Japanese adults aged ≥65 years. We analyzed claims data, vaccination records, and death certificate records between October 2016 and December 2019 from 55,509 PPSV23 vaccinated individuals and 55,509 unvaccinated individuals. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of PPSV23 vaccination for mortality. The results showed that PPSV23 vaccination was significantly associated with a reduction in all-cause mortality (adjusted HR: 0.52, P<0.001), but not pneumonia mortality (adjusted HR: 0.70, P=0.374).
{"title":"Protective effects of 23-valent pneumococcal polysaccharide vaccination against mortality: The VENUS Study","authors":"Fumiko Murata, Megumi Maeda, Haruhisa Fukuda","doi":"10.1093/ofid/ofae530","DOIUrl":"https://doi.org/10.1093/ofid/ofae530","url":null,"abstract":"This retrospective matched cohort study investigated the protective effects of PPSV23 vaccination against pneumonia mortality and all-cause mortality in Japanese adults aged ≥65 years. We analyzed claims data, vaccination records, and death certificate records between October 2016 and December 2019 from 55,509 PPSV23 vaccinated individuals and 55,509 unvaccinated individuals. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of PPSV23 vaccination for mortality. The results showed that PPSV23 vaccination was significantly associated with a reduction in all-cause mortality (adjusted HR: 0.52, P&lt;0.001), but not pneumonia mortality (adjusted HR: 0.70, P=0.374).","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taylor Pasley, Christopher Baladad, Kathryn DeSear, Solmaz Karimi, Eric Rubido, Guy El Helou, Maureen Converse
Background Invasive Candidiasis (IC) is a significant factor for lung transplant recipient (LTR) mortality, especially in the immediate postoperative phase. Receipt of antifungal prophylaxis has demonstrated lower all-cause mortality. Methods This was a single-center, retrospective cohort study of LTR between August 2017 and August 2020. Included patients were adult LTR with positive Candida cultures pre-operatively (donor or recipient) or within 6 weeks postoperatively. Patients were divided into 2 cohorts—bridged and unbridged. The bridged cohort received micafungin in the postoperative period until therapeutic azole concentrations were achieved or up to 2 weeks, whichever was sooner. The primary outcome was a composite of proven or probable invasive candidiasis. Results A total of 117 patients were included in the study, with 68 in the unbridged cohort and 49 in the bridged cohort. There was more IC in the bridged cohort compared to the unbridged cohort (p = 0.011). Conclusion In combination with an azole antifungal, micafungin did not prevent IC in postoperative LTR with cultures positive for Candida species in this cohort. Larger prospective studies are needed to determine the ideal combination and duration of antifungal prophylaxis.
{"title":"Bridging Echinocandin with Azole antifungal Therapy On Prevention Of Invasive Candidiasis Post Lung Transplantation","authors":"Taylor Pasley, Christopher Baladad, Kathryn DeSear, Solmaz Karimi, Eric Rubido, Guy El Helou, Maureen Converse","doi":"10.1093/ofid/ofae525","DOIUrl":"https://doi.org/10.1093/ofid/ofae525","url":null,"abstract":"Background Invasive Candidiasis (IC) is a significant factor for lung transplant recipient (LTR) mortality, especially in the immediate postoperative phase. Receipt of antifungal prophylaxis has demonstrated lower all-cause mortality. Methods This was a single-center, retrospective cohort study of LTR between August 2017 and August 2020. Included patients were adult LTR with positive Candida cultures pre-operatively (donor or recipient) or within 6 weeks postoperatively. Patients were divided into 2 cohorts—bridged and unbridged. The bridged cohort received micafungin in the postoperative period until therapeutic azole concentrations were achieved or up to 2 weeks, whichever was sooner. The primary outcome was a composite of proven or probable invasive candidiasis. Results A total of 117 patients were included in the study, with 68 in the unbridged cohort and 49 in the bridged cohort. There was more IC in the bridged cohort compared to the unbridged cohort (p = 0.011). Conclusion In combination with an azole antifungal, micafungin did not prevent IC in postoperative LTR with cultures positive for Candida species in this cohort. Larger prospective studies are needed to determine the ideal combination and duration of antifungal prophylaxis.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Dengue is a prevalent cause of acute febrile illness, predominantly in Asia, where it necessitates supportive care without the need for antibiotics. This study aims to evaluate antibiotics usage and analyze the hospitalization costs among adults infected with the dengue virus. Methods This retrospective cohort study was conducted at the Hospital for Tropical Diseases, Thailand, in 2022. Two independent reviewers assessed all adult cases with confirmed dengue from 2016 to 2021. Determinants of inappropriateness were analyzed using Poisson regression. Results The study included 249 participants with over half presenting with severe dengue or dengue with warning signs upon admission. The cumulative incidence of antibiotics use was 9.3% (95% confidence interval [CI]: 8.23–10.47), predominantly involving empirical treatment strategies. Ceftriaxone and doxycycline were the most frequently prescribed antibiotics. Notably, patients who received empirical antibiotics showed no definite or presumed bacterial infections. Among those who received definite strategies, inappropriate durations, including both short treatments and the overuse of broad-spectrum antibiotics, were observed. A private ward admission was identified as a significant predictor of inappropriate use, with an incidence rate ratio of 4.15 (95% CI: 1.16–14.82) compared to ICU admission. Direct medical costs did not differ significantly between appropriate and inappropriate uses. Conclusions The incidence of antibiotic use among dengue cases was moderate; however, inappropriate use by indications were mainly observed. Antimicrobial Stewardship (AMS) strategies should be encouraged, particularly in dengue with warning signs, admitted to general or private ward. Direct medical costs between appropriate and inappropriate uses were comparable.
{"title":"Evaluating Antibiotics Misuse and Cost Analysis among Hospitalized Dengue Virus Infected Adults: Insights from a Retrospective Cohort Study","authors":"Thundon Ngamprasertchai, Ashley Siribhadra, Chayanis Kositamongkol, Pittaya Piroonamornpun, Piyanan Pakdeewut, Viravarn Luvira, Saranath Lawpoolsri, Pinyo Rattanaumpawan","doi":"10.1093/ofid/ofae520","DOIUrl":"https://doi.org/10.1093/ofid/ofae520","url":null,"abstract":"Background Dengue is a prevalent cause of acute febrile illness, predominantly in Asia, where it necessitates supportive care without the need for antibiotics. This study aims to evaluate antibiotics usage and analyze the hospitalization costs among adults infected with the dengue virus. Methods This retrospective cohort study was conducted at the Hospital for Tropical Diseases, Thailand, in 2022. Two independent reviewers assessed all adult cases with confirmed dengue from 2016 to 2021. Determinants of inappropriateness were analyzed using Poisson regression. Results The study included 249 participants with over half presenting with severe dengue or dengue with warning signs upon admission. The cumulative incidence of antibiotics use was 9.3% (95% confidence interval [CI]: 8.23–10.47), predominantly involving empirical treatment strategies. Ceftriaxone and doxycycline were the most frequently prescribed antibiotics. Notably, patients who received empirical antibiotics showed no definite or presumed bacterial infections. Among those who received definite strategies, inappropriate durations, including both short treatments and the overuse of broad-spectrum antibiotics, were observed. A private ward admission was identified as a significant predictor of inappropriate use, with an incidence rate ratio of 4.15 (95% CI: 1.16–14.82) compared to ICU admission. Direct medical costs did not differ significantly between appropriate and inappropriate uses. Conclusions The incidence of antibiotic use among dengue cases was moderate; however, inappropriate use by indications were mainly observed. Antimicrobial Stewardship (AMS) strategies should be encouraged, particularly in dengue with warning signs, admitted to general or private ward. Direct medical costs between appropriate and inappropriate uses were comparable.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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