Pub Date : 2024-11-15DOI: 10.1016/j.lana.2024.100942
Joseph Y. Ting , Shikha Gupta-Bhatnagar , Julie Choudhury , Eugene W. Yoon , Guillaume Ethier , Rebecca Sherlock , Jennifer Toye , Marc Beltempo , Prakesh S. Shah , Canadian Neonatal NetworkTM
<div><h3>Background</h3><div>Excessive antimicrobial exposure is associated with an increase in neonatal mortality, morbidities and adverse neurodevelopment. Canadian Neonatal Network has been promoting judicious antimicrobial use through the Evidence-based Practice for Improving Quality processes. Our objective was to evaluate the antimicrobial consumption among neonates in tertiary neonatal intensive care units (NICU) in Canada in the recent decade.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study including data from very preterm infants (born at <33 weeks gestational age) admitted to all NICUs in Canada between January 1, 2013, and December 31, 2022. Nationwide antimicrobial utilization rate (AUR) benchmarking started in 2016, and quality improvement initiatives were continued in the subsequent years to promote judicious use of antimicrobials across the network. AUR is defined as the number of days with ≥1 antimicrobial divided by the total patient days (PD). Culture-proven sepsis refers to a neonate with positive culture of pathogens in blood and/or cerebrospinal fluid. The outcomes were evaluated during pre- (2013–2017) and post-intervention periods (2018–2022). Interrupted time-series analysis was used, and comparison of AUR calculated per each 3-month time block and the slope changes were conducted across the pre- and post-intervention periods regarding total patients and subgroups.</div></div><div><h3>Findings</h3><div>A total of 41,253 infants were included, with 22,644 (55%) being male. The AUR was significantly lower among infants from the post- vs. those from the pre-intervention periods (152 vs. 184, p < 0.0001). Among 35,670 infants without culture-proven sepsis or necrotizing enterocolitis ≥ Stage 2, AUR was significantly lower in the post-intervention group vs. the pre-intervention group (110 vs. 136, p < 0.0001). Interrupted time-series showed significant reduction in AUR during both pre- and post-intervention periods among all infants with and without culture proven sepsis or necrotizing enterocolitis ≥ Stage 2 (all p < 0.0001), as well as those born at <29 weeks gestational age.</div></div><div><h3>Interpretation</h3><div>A comprehensive, network-wide quality improvement initiatives led to a significant and sustained reduction in antimicrobial use among preterm infants born at <33 weeks gestational age with and without culture-proven sepsis or necrotizing enterocolitis ≥ Stage 2.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>Canadian Institutes of Health Research</span> Project Grant 2019 (201903PJT-420294-CA2-CAAA-245530), matched funding from the <span>British Columbia Women's Health Foundation</span> and start-up funding from the Women and Children's Health Research Institute, <span>University of Alberta</span>. The coordinating center in Toronto is funded by the <span>Canadian Institutes of Health Research</span> grant for the Canadian Preterm Birth Net
背景过度接触抗菌药物与新生儿死亡率、发病率和不良神经发育的增加有关。加拿大新生儿网络（Canadian Neonatal Network）一直在通过 "改善质量的循证实践"（Evidence-based Practice for Improving Quality processes）促进抗菌药物的合理使用。我们的目的是评估近十年来加拿大三级新生儿重症监护病房（NICU）中新生儿的抗菌药物消耗情况。方法这是一项回顾性队列研究，包括2013年1月1日至2022年12月31日期间加拿大所有新生儿重症监护病房收治的极早产儿（胎龄33周时出生）的数据。全国范围内的抗菌药物使用率（AUR）基准测试始于 2016 年，随后几年继续开展质量改进活动，以促进整个网络合理使用抗菌药物。AUR 的定义是使用≥1 种抗菌药物的天数除以患者总天数（PD）。培养证实的败血症是指血液和/或脑脊液中病原体培养呈阳性的新生儿。对干预前（2013-2017 年）和干预后（2018-2022 年）的结果进行了评估。采用间断时间序列分析法，比较了干预前和干预后每个 3 个月时间块计算的 AUR 以及患者总数和亚组的斜率变化。与干预前相比，干预后婴儿的AUR明显降低（152 vs. 184, p < 0.0001）。在 35,670 名没有经培养证实的败血症或坏死性小肠结肠炎≥第二阶段的婴儿中，干预后组的 AUR 明显低于干预前组（110 vs. 136，p < 0.0001）。间断时间序列显示，在干预前和干预后，所有经培养证实患有或未患有败血症或坏死性小肠结肠炎≥第 2 阶段的婴儿以及胎龄为 29 周的婴儿的 AUR 均明显下降（均为 p<0.0001）。释义 一项全面的、全网范围的质量改进措施使胎龄 33 周的早产儿中，无论是否有经培养证实的败血症或坏死性小肠结肠炎≥第 2 阶段，抗菌药物的使用量都有了显著而持续的减少。资金来源本研究得到了加拿大卫生研究院2019年项目资助（201903PJT-420294-CA2-CAAA-245530）、不列颠哥伦比亚省妇女健康基金会的对等资助以及阿尔伯塔大学妇女儿童健康研究所的启动资金的支持。多伦多的协调中心由加拿大卫生研究院为加拿大早产儿网络（PBN 150642）提供资助。
{"title":"Antimicrobial utilisation patterns between 2013 and 2022 in Canadian neonates born at less than 33 weeks gestation: a retrospective cohort study","authors":"Joseph Y. Ting , Shikha Gupta-Bhatnagar , Julie Choudhury , Eugene W. Yoon , Guillaume Ethier , Rebecca Sherlock , Jennifer Toye , Marc Beltempo , Prakesh S. Shah , Canadian Neonatal NetworkTM","doi":"10.1016/j.lana.2024.100942","DOIUrl":"10.1016/j.lana.2024.100942","url":null,"abstract":"<div><h3>Background</h3><div>Excessive antimicrobial exposure is associated with an increase in neonatal mortality, morbidities and adverse neurodevelopment. Canadian Neonatal Network has been promoting judicious antimicrobial use through the Evidence-based Practice for Improving Quality processes. Our objective was to evaluate the antimicrobial consumption among neonates in tertiary neonatal intensive care units (NICU) in Canada in the recent decade.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study including data from very preterm infants (born at <33 weeks gestational age) admitted to all NICUs in Canada between January 1, 2013, and December 31, 2022. Nationwide antimicrobial utilization rate (AUR) benchmarking started in 2016, and quality improvement initiatives were continued in the subsequent years to promote judicious use of antimicrobials across the network. AUR is defined as the number of days with ≥1 antimicrobial divided by the total patient days (PD). Culture-proven sepsis refers to a neonate with positive culture of pathogens in blood and/or cerebrospinal fluid. The outcomes were evaluated during pre- (2013–2017) and post-intervention periods (2018–2022). Interrupted time-series analysis was used, and comparison of AUR calculated per each 3-month time block and the slope changes were conducted across the pre- and post-intervention periods regarding total patients and subgroups.</div></div><div><h3>Findings</h3><div>A total of 41,253 infants were included, with 22,644 (55%) being male. The AUR was significantly lower among infants from the post- vs. those from the pre-intervention periods (152 vs. 184, p < 0.0001). Among 35,670 infants without culture-proven sepsis or necrotizing enterocolitis ≥ Stage 2, AUR was significantly lower in the post-intervention group vs. the pre-intervention group (110 vs. 136, p < 0.0001). Interrupted time-series showed significant reduction in AUR during both pre- and post-intervention periods among all infants with and without culture proven sepsis or necrotizing enterocolitis ≥ Stage 2 (all p < 0.0001), as well as those born at <29 weeks gestational age.</div></div><div><h3>Interpretation</h3><div>A comprehensive, network-wide quality improvement initiatives led to a significant and sustained reduction in antimicrobial use among preterm infants born at <33 weeks gestational age with and without culture-proven sepsis or necrotizing enterocolitis ≥ Stage 2.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>Canadian Institutes of Health Research</span> Project Grant 2019 (201903PJT-420294-CA2-CAAA-245530), matched funding from the <span>British Columbia Women's Health Foundation</span> and start-up funding from the Women and Children's Health Research Institute, <span>University of Alberta</span>. The coordinating center in Toronto is funded by the <span>Canadian Institutes of Health Research</span> grant for the Canadian Preterm Birth Net","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100942"},"PeriodicalIF":7.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.lana.2024.100936
Emanuel Krebs , Deirdre Weymann , Cheryl Ho , Ian Bosdet , Janessa Laskin , Howard J. Lim , Stephen Yip , Aly Karsan , Timothy P. Hanna , Samantha Pollard , Dean A. Regier
Background
Multi-gene panel sequencing streamlines treatment selection for advanced non-small cell lung cancer (NSCLC). Implementation continues to be uneven across jurisdictions, partly due to uncertain clinical and economic impacts. In British Columbia (BC), Canada, the public healthcare system reimbursed a multi-gene panel in September 2016. This study determined the population-level cost-effectiveness of publicly reimbursed multi-gene panel sequencing compared to single-gene testing for advanced NSCLC.
Methods
Our population-based retrospective study design used patient-level linked administrative health databases. We considered adult BC residents with a panel-eligible lung cancer diagnosis between September 2016 and December 2018. Using a machine learning approach, we conducted 1:1 genetic algorithm matching of recipients receiving multi-gene panel sequencing to controls receiving single-gene testing, maximising balance on observed demographic and clinical characteristics. Following matching, we estimated mean three-year survival time and costs (public healthcare payer perspective; 2021 CAD) and calculated the incremental net monetary benefit (INMB) for life-years gained (LYG) at conventional willingness-to-pay thresholds using inverse probability of censoring weighted linear regression and nonparametric bootstrapping.
Findings
We matched 858 panel-eligible advanced NSCLC patients to controls, achieving balance for the 16 included covariates. Average test turnaround times were 18.6 days for multi-gene panel sequencing and 7.0 days for single-gene testing. After matching, mean incremental costs were $3529 (95% CI: −$4268, $10,942) and mean incremental LYG were 0.08 (95% CI: −0.04, 0.18). Among the 1000 bootstrap samples, 14.5% had lower costs and increased survival and 78.6% had higher costs and increased survival. The INMB was $523 (95% CI: −$6256, $7023) at $50,000/LYG, with a 57.5% probability of being cost-effective, and $4575 (95% CI: −$5468, $14,064) at $100,000/LYG, with an 84.0% probability of being cost-effective.
Interpretation
Using population-based real-world data, we found a moderate to high probability that panel-based testing to inform targeted treatment for NSCLC would be cost-effective at higher thresholds.
Funding
This research was supported by Genome British Columbia/Genome Canada (G05CHS) and the Terry Fox Research Institute.
{"title":"Real-world cost-effectiveness of multi-gene panel sequencing to inform therapeutic decisions for advanced non-small cell lung cancer: a population-based study","authors":"Emanuel Krebs , Deirdre Weymann , Cheryl Ho , Ian Bosdet , Janessa Laskin , Howard J. Lim , Stephen Yip , Aly Karsan , Timothy P. Hanna , Samantha Pollard , Dean A. Regier","doi":"10.1016/j.lana.2024.100936","DOIUrl":"10.1016/j.lana.2024.100936","url":null,"abstract":"<div><h3>Background</h3><div>Multi-gene panel sequencing streamlines treatment selection for advanced non-small cell lung cancer (NSCLC). Implementation continues to be uneven across jurisdictions, partly due to uncertain clinical and economic impacts. In British Columbia (BC), Canada, the public healthcare system reimbursed a multi-gene panel in September 2016. This study determined the population-level cost-effectiveness of publicly reimbursed multi-gene panel sequencing compared to single-gene testing for advanced NSCLC.</div></div><div><h3>Methods</h3><div>Our population-based retrospective study design used patient-level linked administrative health databases. We considered adult BC residents with a panel-eligible lung cancer diagnosis between September 2016 and December 2018. Using a machine learning approach, we conducted 1:1 genetic algorithm matching of recipients receiving multi-gene panel sequencing to controls receiving single-gene testing, maximising balance on observed demographic and clinical characteristics. Following matching, we estimated mean three-year survival time and costs (public healthcare payer perspective; 2021 CAD) and calculated the incremental net monetary benefit (INMB) for life-years gained (LYG) at conventional willingness-to-pay thresholds using inverse probability of censoring weighted linear regression and nonparametric bootstrapping.</div></div><div><h3>Findings</h3><div>We matched 858 panel-eligible advanced NSCLC patients to controls, achieving balance for the 16 included covariates. Average test turnaround times were 18.6 days for multi-gene panel sequencing and 7.0 days for single-gene testing. After matching, mean incremental costs were $3529 (95% CI: −$4268, $10,942) and mean incremental LYG were 0.08 (95% CI: −0.04, 0.18). Among the 1000 bootstrap samples, 14.5% had lower costs and increased survival and 78.6% had higher costs and increased survival. The INMB was $523 (95% CI: −$6256, $7023) at $50,000/LYG, with a 57.5% probability of being cost-effective, and $4575 (95% CI: −$5468, $14,064) at $100,000/LYG, with an 84.0% probability of being cost-effective.</div></div><div><h3>Interpretation</h3><div>Using population-based real-world data, we found a moderate to high probability that panel-based testing to inform targeted treatment for NSCLC would be cost-effective at higher thresholds.</div></div><div><h3>Funding</h3><div>This research was supported by <span>Genome British Columbia</span>/<span>Genome Canada</span> (G05CHS) and the <span>Terry Fox Research Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100936"},"PeriodicalIF":7.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.lana.2024.100946
Elizabet L. Estallo , María Soledad López , Francisco Ludueña-Almeida , Magali I. Madelón , Federico Layún , Michael A. Robert
{"title":"Increased risks of mosquito-borne disease emergence in temperate regions of South America","authors":"Elizabet L. Estallo , María Soledad López , Francisco Ludueña-Almeida , Magali I. Madelón , Federico Layún , Michael A. Robert","doi":"10.1016/j.lana.2024.100946","DOIUrl":"10.1016/j.lana.2024.100946","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100946"},"PeriodicalIF":7.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.lana.2024.100939
J. Luis Espinoza
{"title":"Candidate drug repurposing for malaria: perspectives for optimising clinical trials","authors":"J. Luis Espinoza","doi":"10.1016/j.lana.2024.100939","DOIUrl":"10.1016/j.lana.2024.100939","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100939"},"PeriodicalIF":7.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.lana.2024.100944
Joshua E. Lane , Rodrigo Ribeiro-Rodrigues
{"title":"Education and awareness of Chagas disease in the United States","authors":"Joshua E. Lane , Rodrigo Ribeiro-Rodrigues","doi":"10.1016/j.lana.2024.100944","DOIUrl":"10.1016/j.lana.2024.100944","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100944"},"PeriodicalIF":7.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.lana.2024.100947
Raphael Mendonça Guimarães , Camila Drumond Muzi
{"title":"Overlap and predominance of cancer over cardiovascular deaths: insights about the epidemiological transition in Brazil","authors":"Raphael Mendonça Guimarães , Camila Drumond Muzi","doi":"10.1016/j.lana.2024.100947","DOIUrl":"10.1016/j.lana.2024.100947","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100947"},"PeriodicalIF":7.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-13DOI: 10.1016/j.lana.2024.100938
Victor Santana Santos , Jamile Rodrigues Cosme de Holanda , Ruy Dantas Silveira Gois-Neto , Ethel Leonor Noia Maciel , Fernanda Dockhorn Costa Johansen , José Nildo de Barros Silva-Júnior , Wesley Adson Costa Coelho Correio , José Roberto Lapa e Silva , José Rodrigo Santos Silva , Ricardo Queiroz Gurgel , Tom Wingfield
Background
Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country.
Methods
We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively.
Findings
A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9).
Interpretation
In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated.
Funding
Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.
{"title":"Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort study","authors":"Victor Santana Santos , Jamile Rodrigues Cosme de Holanda , Ruy Dantas Silveira Gois-Neto , Ethel Leonor Noia Maciel , Fernanda Dockhorn Costa Johansen , José Nildo de Barros Silva-Júnior , Wesley Adson Costa Coelho Correio , José Roberto Lapa e Silva , José Rodrigo Santos Silva , Ricardo Queiroz Gurgel , Tom Wingfield","doi":"10.1016/j.lana.2024.100938","DOIUrl":"10.1016/j.lana.2024.100938","url":null,"abstract":"<div><h3>Background</h3><div>Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country.</div></div><div><h3>Methods</h3><div>We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national <em>Sistema de Informação de Agravos de Notificação</em> (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively.</div></div><div><h3>Findings</h3><div>A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9).</div></div><div><h3>Interpretation</h3><div>In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated.</div></div><div><h3>Funding</h3><div><span>Department of Health and Social Care</span> (DHSC), the <span>Foreign, Commonwealth & Development Office</span> (FCDO), the <span>Medical Research Council</span> (MRC) and <span>Wellcome, UK</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100938"},"PeriodicalIF":7.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.lana.2024.100943
Kasim Allel , Anne Peters , Hassan Haghparast-Bidgoli , Maria Spencer-Sandino , Jose Conejeros , Patricia Garcia , Koen B. Pouwels , Laith Yakob , Jose M. Munita , Eduardo A. Undurraga
Background
Antibiotic-resistant bloodstream infections (ARB BSI) cause an enormous disease and economic burden. We assessed the impact of ARB BSI caused by high- and critical-priority pathogens in hospitalised Chilean patients compared to BSI caused by susceptible bacteria.
Methods
We conducted a retrospective cohort study from 2018 to 2022 in three Chilean hospitals and measured the association of ARB BSI with in-hospital mortality, length of hospitalisation (LOS), and intensive care unit (ICU) admission. We focused on BSI caused by Acinetobacter baumannii, Enterobacterales, Staphylococcus aureus, Enterococcus species, and Pseudomonas aeruginosa. We addressed confounding using propensity scores, inverse probability weighting, and multivariate regressions. We stratified by community- and hospital-acquired BSI and assessed total hospital and productivity costs.
Findings
We studied 1218 adult patients experiencing 1349 BSI episodes, with 47.3% attributed to ARB. Predominant pathogens were Staphylococcus aureus (33% Methicillin-resistant ‘MRSA’), Enterobacterales (50% Carbapenem-resistant ‘CRE’), and Pseudomonas aeruginosa (65% Carbapenem-resistant ‘CRPA’). Approximately 80% of BSI were hospital-acquired. ARB was associated with extended LOS (incidence risk ratio IRR = 1.14, 95% CI = 1.05–1.24), increased ICU admissions (odds ratio OR = 1.25; 1.07–1.46), and higher mortality (OR = 1.42, 1.20–1.68) following index blood culture across all BSI episodes. In-hospital mortality risk, adjusted for time-varying and fixed confounders, was 1.35-fold higher (1.16–1.58) for ARB patients, with higher hazard ratios for hospital-acquired MRSA and CRE at 1.37 and 1.48, respectively. Using a societal perspective and a 5% discount rate, we estimated excess costs for ARB at $12,600 per patient, with an estimated annual excess burden of 2270 disability-adjusted life years (DALYs) and $9.6 (5.0–16.4) million.
Interpretation
It is urgent to develop and implement interventions to reduce the burden of ARB BSIs, particularly from MRSA and CRE.
Funding
Agencia Nacional de Investigación y Desarrollo ANID, Chile.
{"title":"Excess burden of antibiotic-resistant bloodstream infections: evidence from a multicentre retrospective cohort study in Chile, 2018–2022","authors":"Kasim Allel , Anne Peters , Hassan Haghparast-Bidgoli , Maria Spencer-Sandino , Jose Conejeros , Patricia Garcia , Koen B. Pouwels , Laith Yakob , Jose M. Munita , Eduardo A. Undurraga","doi":"10.1016/j.lana.2024.100943","DOIUrl":"10.1016/j.lana.2024.100943","url":null,"abstract":"<div><h3>Background</h3><div>Antibiotic-resistant bloodstream infections (ARB BSI) cause an enormous disease and economic burden. We assessed the impact of ARB BSI caused by high- and critical-priority pathogens in hospitalised Chilean patients compared to BSI caused by susceptible bacteria.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study from 2018 to 2022 in three Chilean hospitals and measured the association of ARB BSI with in-hospital mortality, length of hospitalisation (LOS), and intensive care unit (ICU) admission. We focused on BSI caused by <em>Acinetobacter baumannii</em>, Enterobacterales, <em>Staphylococcus aureus</em>, Enterococcus species, and <em>Pseudomonas aeruginosa</em>. We addressed confounding using propensity scores, inverse probability weighting, and multivariate regressions. We stratified by community- and hospital-acquired BSI and assessed total hospital and productivity costs.</div></div><div><h3>Findings</h3><div>We studied 1218 adult patients experiencing 1349 BSI episodes, with 47.3% attributed to ARB. Predominant pathogens were <em>Staphylococcus aureus</em> (33% Methicillin-resistant ‘MRSA’), Enterobacterales (50% Carbapenem-resistant ‘CRE’), and <em>Pseudomonas aeruginosa</em> (65% Carbapenem-resistant ‘CRPA’). Approximately 80% of BSI were hospital-acquired. ARB was associated with extended LOS (incidence risk ratio IRR = 1.14, 95% CI = 1.05–1.24), increased ICU admissions (odds ratio OR = 1.25; 1.07–1.46), and higher mortality (OR = 1.42, 1.20–1.68) following index blood culture across all BSI episodes. In-hospital mortality risk, adjusted for time-varying and fixed confounders, was 1.35-fold higher (1.16–1.58) for ARB patients, with higher hazard ratios for hospital-acquired MRSA and CRE at 1.37 and 1.48, respectively. Using a societal perspective and a 5% discount rate, we estimated excess costs for ARB at $12,600 per patient, with an estimated annual excess burden of 2270 disability-adjusted life years (DALYs) and $9.6 (5.0–16.4) million.</div></div><div><h3>Interpretation</h3><div>It is urgent to develop and implement interventions to reduce the burden of ARB BSIs, particularly from MRSA and CRE.</div></div><div><h3>Funding</h3><div>Agencia Nacional de Investigación y Desarrollo <span>ANID</span>, Chile.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100943"},"PeriodicalIF":7.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-11DOI: 10.1016/j.lana.2024.100945
J. Adrián Rivera-Alcántara , Carlos A. Aguilar-Salinas , Alexandro J. Martagon
{"title":"Biobanking for health in Latin America: a call to action","authors":"J. Adrián Rivera-Alcántara , Carlos A. Aguilar-Salinas , Alexandro J. Martagon","doi":"10.1016/j.lana.2024.100945","DOIUrl":"10.1016/j.lana.2024.100945","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100945"},"PeriodicalIF":7.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.lana.2024.100933
Tassy Parker , Allyson Kelley , Lee Redeye , Marcello A. Maviglia
There are 574 federally recognized Tribes in the United States. Tribes have experienced increased rates of domestic violence (DV) due to structural determinants like gender violence, loss of control, discrimination, marginalization, oppression, and political violence. American Indian and Alaska Native girls and women experience the highest rates of DV and abuse in the US, yet policy change, funding, and advocacy has been slow to address high DV rates. In this commentary, we comprehensively review the structural determinants of DV in American Indian and Alaska Native populations. We review policies and the complexities of criminal jurisdiction in Tribal nations and provide key recommendations to build a new framework that addresses DV in American Indian Alaska Native women in the future. Less than half of federally recognized Tribes receive funding through the Family Violence Prevention and Services Act. Structural determinants explain why housing and funding are advocacy issues, where unequal access and differential effects lead to increased risk for DV. We advocate for future work that addresses the interplay of multiple structural determinants while advocating for funding and culturally safe research and support to address DV in American Indian Alaska Native populations.
{"title":"Domestic violence in American Indian and Alaska Native populations: a new framework for policy change and addressing the structural determinants of health","authors":"Tassy Parker , Allyson Kelley , Lee Redeye , Marcello A. Maviglia","doi":"10.1016/j.lana.2024.100933","DOIUrl":"10.1016/j.lana.2024.100933","url":null,"abstract":"<div><div>There are 574 federally recognized Tribes in the United States. Tribes have experienced increased rates of domestic violence (DV) due to structural determinants like gender violence, loss of control, discrimination, marginalization, oppression, and political violence. American Indian and Alaska Native girls and women experience the highest rates of DV and abuse in the US, yet policy change, funding, and advocacy has been slow to address high DV rates. In this commentary, we comprehensively review the structural determinants of DV in American Indian and Alaska Native populations. We review policies and the complexities of criminal jurisdiction in Tribal nations and provide key recommendations to build a new framework that addresses DV in American Indian Alaska Native women in the future. Less than half of federally recognized Tribes receive funding through the Family Violence Prevention and Services Act. Structural determinants explain why housing and funding are advocacy issues, where unequal access and differential effects lead to increased risk for DV. We advocate for future work that addresses the interplay of multiple structural determinants while advocating for funding and culturally safe research and support to address DV in American Indian Alaska Native populations.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100933"},"PeriodicalIF":7.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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