JAMMI最新文献

[This corrects the article DOI: 10.3138/jammi-2024-0018.].

Background: The impact of the COVID-19 pandemic on antimicrobial use in Canadian hospitals is not well characterized. We explored the relationship between the COVID-19 pandemic and Canadian hospital antimicrobial purchasing (AMP)-a proxy for consumption.

Methods: Hospital-level AMP data were obtained from IQVIA, a health analytics company, and matched with inpatient patient-day denominator data from 28 hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Monthly AMP was measured using defined daily doses (DDDs) per 1,000 patient-days. Segmented linear regression with hospital-level clustering assessed for step and slope changes in AMP between pre-pandemic (January 1, 2018 - February 29, 2020) and pandemic (March 1, 2020 - December 31, 2021) periods.

Results: Although we found an initial increase in AMP with the onset of the pandemic (+42 DDDs/1,000 patient-days [pd]) followed by a decreasing trend in AMP during the pandemic (-5 DDDs/1,000 pd per month), neither was statistically significant. Changes in trends varied across antimicrobial classes/subclasses, with decreases in broad-spectrum penicillins (-2 DDDs/1,000 pd per month, p < .001) and macrolides/lincosamides (-2 DDDs/1,000 pd per month, p < .001) and an increase in carbapenems (1 DDD/1,000 pd per month, p < .001). These results coincided with decreases in piperacillin/tazobactam (p = .003) and azithromycin (p = .001) and an increase in meropenem (p < .001).

Conclusions: We observed a transient increase in overall AMP with the onset of the pandemic (March 2020) in this exploratory analysis of a sample of 28 hospitals. Changes in trends varied by antimicrobial class/subclass and individual agent. Further work is needed to discern contributors to these trends, such as changes in inpatient characteristics and treatment guidelines.

Background: The Oral Versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial demonstrated the efficacy of highly bioavailable oral antibiotic therapy for the treatment of osteoarticular infections. However, there continues to be significant variability in practice. This study aimed to assess changes in oral antibiotic use in the treatment of diabetic foot osteomyelitis (DFO) at a large academic hospital.

Methods: We conducted a retrospective cohort study of adult patients admitted to Sunnybrook Health Sciences Centre from January 1, 2016, to December 31, 2022, with a diagnosis of DFO. The primary outcome was the proportion of patients who received definitive oral antibiotic treatment during two timeframes (Pre-OVIVA publication: January 1, 2016, through February 28, 2019, and post-OVIVA publication: March 1, 2019, to December 31, 2022). Patients were excluded if they had another indication for long-term intravenous antibiotics, if they did not receive antibiotic treatment for osteomyelitis, or if they underwent amputation without the need for postoperative antibiotics.

Results: A total of 145 patients were included in the analysis. (65 patients pre-OVIVA and 80 patients post-OVIVA). The majority of patients had a history of peripheral arterial disease (59%) and gangrene (66%) present on hospital admission. Use of definitive oral antibiotic therapy increased from 10.8% in the pre-OVIVA period to 21.2% in the post-OVIVA period (p = 0.14).

Conclusions: There was a trend toward increased definitive oral antibiotic therapy for DFO, but overall use remained low. Further studies are needed to explore the factors influencing the selection of oral antibiotic therapy in this population.

Background: Alterations in smell (anosmia) and taste (dysgeusia) are common with SARS-CoV-2. The study objective was to evaluate for concordance in anosmia and dysgeusia among household members affected by COVID-19.

Methods: A retrospective cohort study of individuals followed by the COVIDEO program at Sunnybrook Health Sciences Centre was performed for patients ≥4 years old diagnosed with COVID-19 between April 1, 2020, to December 31, 2020. Households were identified, and index cases were selected based on the first subject assessed by COVIDEO. Controls for each household contact were identified from the COVIDEO database by matching age (within 10 years) and date of diagnosis (closest within 3 months thereafter). Concordance of anosmia and dysgeusia was determined between index cases and household contacts compared to nonhousehold controls.

Results: A total of 353 households were identified: 963 subjects (353 index cases, 600 household contacts) and 600 controls. Median age was 30 years (interquartile range [IQR]: 16, 49), and 50% (475/953) were women. Prevalence of anosmia and dysgeusia were 23.6% and 22.7%, respectively. Anosmia concordance was 64.3% between index cases and nonhousehold controls, compared to 65.7% (p = 0.09) between index cases and nongenetically related household members, and 69.4% (p = 0.74) between index cases and genetically related household members. In multivariate analysis, anosmia was more likely to be reported with longer time from symptom onset (OR 1.06 per day [95% CI 1.02 to 1.1]), and with rhinorrhea (OR 2.2 [95% CI 1.6 to 3.0]), or dyspnea (OR 2.4 [95% CI 1.3 to 4.4]).

Conclusions: There was no significant difference in anosmia and dysgeusia concordance between genetically related and unrelated household members or non-household controls.

Background: Our understanding of health care-associated infection (HAI), antimicrobial resistant organism (ARO), and antimicrobial use (AMU) surveillance activities across Canadian long-term care homes (LTCHs) is limited, in part because nationwide surveillance in this setting has yet to be established.

Methods: To address this knowledge gap, the Canadian Nosocomial Infection Surveillance Program administered a 12-item cross-sectional survey to LTCHs across all provinces and territories in English and French. LTCHs were defined as government-licensed homes for individuals with medical needs who require 24-hour onsite access to registered nurse care and/or treatment.

Results: Between June 1 and November 28, 2023, 770 of an estimated 2,076 LTCHs responded to the survey (37%). Of the respondents, 41% (318/770) were publicly funded, 67% (504/758) had between 51 and 200 long-term care beds, and 92% (694/758) reported having a designated person who leads infection prevention and control. The majority of LTCHs reported conducting outbreak surveillance (680/713, 95%) and surveillance for at least one type of HAI (672/740, 91%). The most common HAIs under surveillance were urinary tract infection (576/725, 79%), Clostridioides difficile infection (546/725, 75%), and gastroenteritis (545/725, 75%). Half of the LTCHs reported testing new residents for AROs via pre-admission or admission cultures (368/713, 52%). Almost two-thirds (441/703, 63%) reported monitoring systemic antibiotic use.

Conclusions: Despite differences in the scope of surveillance activities, mechanisms to measure the burden of HAIs and AROs in this setting exist and may provide the foundation for future national surveillance activities. Generalizability to all Canadian LTCHs is uncertain due to possible sampling, non-response, and social desirability biases.

Background: The rates of HIV and syphilis in Saskatchewan (SK) have been rising rapidly in recent years. The syndemic has raised concern for neurosyphilis, a complication that can occur at any stage of syphilis and is more common in people living with HIV (PLWH). Criteria published by the Public Health Agency of Canada recommends considering a lumbar puncture (LP) in patients with concomitant HIV and syphilis infection whose rapid plasma reagin (RPR) titre is ≥1:32 or whose CD4+ count is ≤350. We assessed whether this recommendation was met at 2 comparable clinical sites.

Methods: In this retrospective analysis, we compare rates of LP and corresponding syphilis treatment success at two clinics in Saskatoon, SK: a community-based primary care clinic and a tertiary care hospital-based infectious disease clinic.

Results: Of 193 syphilis cases across both sites, 128 cases met laboratory criteria for lumbar puncture. Rates of LP (9% primary care clinic and 19% infectious disease clinic) and syphilis treatment success (87% primary care clinic and 89% infectious disease clinic) were comparable between groups. When RPR titre was controlled for, clinic type did not statistically significantly affect the rates of lumbar puncture (p = 0.104) or syphilis treatment success (p = 0.068). A RPR titre ≥1:32 was positively associated with both treatment success (OR 2.596) and lumbar puncture (OR 4.495).

Conclusion: Results suggest that there is no difference in either the community or hospital-based clinic type for syphilis treatment success and that rates of lumbar puncture of patients meeting serologic criteria are low across diverse HIV patient groups and clinical settings.

Introduction: We measured anti-S immunoglobulin G (IgG) levels in a cohort of health care workers (HCWs) to explore factors affecting the levels of vaccine-induced IgG antibodies and their relationship with risk of incident SARS-CoV-2 infection throughout the first seven epidemic waves.

Methods: A convenience sample of HCWs from one acute care hospital and four long-term care homes had anti-S SARS-CoV-2 IgG antibody levels at the beginning of the pandemic (T1) and during Omicron waves 5-7 (T2). Poisson analysis was conducted to assess predicted levels of antibodies by covariates (health and social conditions), number, timing and type of vaccines, as well as history of previous SARS-CoV-2 infection. Antibody levels assessed between October 2021 and August 2022 were also analyzed in relation to incident cases of Omicron infections.

Results: Of the HCWs who provided one (n = 128) or two blood samples (n = 146), 53% were vaccine naïve at T1 and 1.4% were so at T2. The mean SARS-CoV-2 IgG concentration was 648 binding antibody units/mL at T1 and 1,913 binding antibody units/mL at T2. Income insufficiency and the presence of more than one chronic condition were associated with lower antibody levels at T2. Antibody levels were higher in HCWs with prior SARS-CoV-2 infection and increased with more vaccine doses received. Hybrid immunity elicited higher levels of antibodies in HCWs at T1 and T2. Waning of antibody levels over time was seen after vaccination with a third dose at T2. A correlation between antibody levels and subsequent risk of Omicron infection was not found.

Conclusions: Our results suggest that timing and prioritization of anti-SARS-CoV-2 vaccination needs to consider the health and socioeconomic factors of HCWs, and the waning effects of vaccines.

Background: Rifampin-resistant (RR) and multidrug-resistant (MDR) tuberculosis (TB) previously required treatment with a protracted course of toxic second-line TB drugs with suboptimal efficacy. Novel 6-month regimens of bedaquiline, pretomanid, linezolid with or without moxifloxacin (BPaL/M) are now recommended, but implementation in Canada is not well described.

Methods: We analyzed eight people with MDR or pre-extensively drug-resistant (pre-XDR) TB or rifamycin intolerance treated with BPaL/M in western Canada to inform expanded use.

Results: The mean times to confirm first- and second-line phenotypic TB susceptibility profiles were 5 and 11 weeks, respectively. Time to start an effective treatment regimen took on average 5 weeks from date of diagnosis, and time to start BPaL/M took 11 weeks due to medication approval, access, and delivery delays. The mean time to culture and smear conversion was 3 and 5 weeks, respectively, from the start of effective therapy. Individuals were isolated for a mean of 15 weeks with an average duration of hospitalization of 13 weeks. BPaL/M medications were associated with minor toxicity, including mild non-progressive peripheral neuropathy (3 cases, CTCAE grade 2) and blood transfusion for anemia (3 cases, CTCAE grade 3), all managed by linezolid dose adjustments. The mean total treatment duration was 8 months, and all individuals completed 6-month BPaL/M treatment with microbiological and clinical cure as of last follow-up (mean 8 months).

Conclusions: Six-month all-oral BPaL/M regimens appeared effective in these individuals, but delays in drug susceptibility testing and poor medication access led to prolonged isolation, hospitalizations, and overall treatment duration. To fully realize the patient and health system benefits of BPaL/M treatment in Canada, streamlining laboratory testing and medication access must be prioritized.