JAMMI最新文献

Syphilis, caused by the bacterium Treponema pallidum, is a centuries-old sexually transmitted disease that continues to be a significant global health concern. Despite the efficacy of penicillin the disease has seen a resurgence worldwide, including in Canada. In 2022, Canada reported 13,953 cases of infectious syphilis, representing a 109% increase since 2018, and 117 cases of congenital syphilis, a staggering 599% increase. Historically, gay and bisexual men who have sex with men have been predominantly affected; however, recent years have seen a significant rise in female cases, contributing to the increase in congenital syphilis. Syphilis diagnosis is complex, requiring specialized expertise. The Canadian Public Health Laboratory Network last updated its laboratory diagnosis guidelines in 2015. Given the advancements in diagnostic techniques and the pressing need for updated guidance, this document provides an overview of the syphilis-causing pathogen T. pallidum, its transmission, pathogenesis, and clinical manifestations. It also reviews the epidemiology of syphilis, highlighting recent trends in Canada, and discusses current and emerging serological laboratory diagnostic techniques. This updated guidance aims to equip health care professionals with the latest knowledge and recommended testing algorithms to accurately diagnose and manage syphilis, ultimately helping to address the rising rates of this disease and improve public health outcomes in Canada.

Background: Lyme disease (LD) is a multisystemic disease without a current approved human vaccine. Increasing infection rates have created pressure to improve the diagnosis and treatment of LD in Canada. This study aims to inform LD care through the exploration of health care practitioner (HCP) perspectives, experiences, beliefs, and knowledge of LD diagnosis and treatment.

Methods: Canadian HCPs took part in bilingual (English and French) semi-structured interviews to explore their experiences and perspectives related to LD diagnosis and treatment. Major themes within and between participants were identified using inductive thematic analysis and axial coding.

Results: A total of 43 HCPs working in LD-related fields participated in this study. Four major themes were identified; HCPs have: 1) Similar perspectives regarding antibiotic use, regional influences, and physician referral; 2) diverse perspectives on the use of serology testing and barriers for LD diagnosis and treatment between endemic and nonendemic regions; 3) challenges and disagreement toward diagnosing and treating chronic LD; and 4) trust in one (among several) LD guidelines, yet consult a variety of secondary sources for additional LD knowledge.

Discussion: The findings reveal a pressing need for greater consistency among HCPs regarding the diagnosis and treatment of LD in Canada. Variation can be attributed to diverse beliefs, perspectives, and approaches within LD practitioners generally, but is particularly evident when addressing, acknowledging, and defining chronic LD.

Background: Updated global tuberculosis (TB) guidelines recommend the novel oral 6-month bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) regimen for multidrug-resistant TB (MDR-TB) based on superior efficacy and reduced toxicity demonstrated in clinical trials. These trials were dominated by isolated pulmonary TB; thus, data for BPaLM effectiveness for extrapulmonary tuberculosis (EPTB) remains limited.

Methods: We describe the safe and effective use of BPaLM in a patient for the treatment of MDR-TB involving an extrapulmonary site.

Results: Bedaquiline and pretomanid were obtained through the Health Canada Special Access Program and from the manufacturers 3 weeks later. The patient with gastrointestinal and subclinical pulmonary TB tolerated the 6 months of BPaLM well with no treatment interruptions. There was sustained microbiological and clinical response at 6 months after treatment completion.

Conclusion: Shorter duration, improved effectiveness, and reduced toxicity suggests that BPaLM should be considered when determining the ideal treatment regimen for MDR-TB. A more streamlined process for the procurement of bedaquiline and pretomanid will help minimize treatment initiation delay and overall isolation period. Further research is also needed to clarify longer-term outcomes and optimal dosing of BPaLM for EPTB, especially in more severe forms of disease or with malabsorption concerns.

Introduction: Prospective audit and feedback (PAF) are an antimicrobial stewardship intervention that reduces use of broad-spectrum antimicrobials among in-patients. The objective of this study was to assess the impact of adherence to PAF recommendations on the duration of broad-spectrum antimicrobials and patient outcomes.

Methods: This retrospective cohort study included adult in-patients at two tertiary care hospitals in St. John's, Newfoundland and Labrador Canada. PAF included all prescriptions for piperacillin/tazobactam, meropenem, ertapenem, and imipenem, reviewed by an infectious disease specialist on day 3 of therapy, with recommendations provided in the electronic medical record. The primary outcome was duration of treatment following PAF. Secondary outcomes were time to all-cause mortality, time to readmission, length of stay, and time to Clostridiodes difficile infection. Adherence categories were compared.

Results: Of the recommendations, 394 out of 786 (50.1%) were completely followed, 18.3% were partially followed, and 31.6% were not followed. There were no significant differences in adherence category based on patient age (p = 0.48) or sex (p = 0.93). Adherence category was associated with a graded reduction in mean duration of target antimicrobial treatment following PAF (p < 0.001), and length of stay after PAF (p < 0.05). Adherence category was not associated with mortality (log-rank = 0.58), readmission rate (log-rank p = 0.33), C. difficile DNA (log-rank p = 0.24) or C. difficile toxin (log-rank p = 0.084).

Conclusions: Adherence to PAF reduces antimicrobial use and length of stay without creating harms, such as readmission. This shows that PAF can be beneficial, and future research should be tailored to increasing adherence to PAF recommendations.

Background: Tularemia is a zoonotic disease of the Northern Hemisphere caused by Francisella tularensis. Given its diverse animal reservoir and wide range of transmission modes, a thorough history of potential exposure is paramount. In the right context, fever combined with skin eruption and lymphadenopathy should raise the possibility of tularemia. Additionally, health care providers should be mindful that F. tularensis is a risk group 3 pathogen and a category A bioterrorism agent and presents a risk for laboratory personnel due to its aerosolization potential, low infectious dose, and fatality rate ranging from 2% to 60%.

Method: Retrospective single chart review.

Results: We describe a 65-year-old man with tularemia working as a bear-hunting guide whose management was delayed despite a fairly typical presentation due to lack of awareness regarding this disease. This case also demonstrates the need for safer referral practices and improved communications with the laboratory to ensure personnel are taking the appropriate measures while handling patient samples to avoid potentially serious consequences.

Conclusion: The diagnosis was confirmed from a neck mass biopsy and the patient made a complete recovery with appropriate antibiotic treatment.

Introduction: Treatment of acute bacterial skin and skin structure infections (ABSSSIs) with intravenous (IV) antibiotics is difficult in marginalized populations, such as people who inject drugs, due to issues such as unstable housing or mental health conditions. These factors often require extended hospital admissions for IV antibiotics. Dalbavancin, a novel lipoglycopeptide antibiotic effective against gram-positive bacteria, lasts over 14 days and may be suitable for patients who struggle with traditional IV antibiotic administration.

Methods: This was a case series in which we reviewed 19 patients referred to our cellulitis clinic in London, Ontario, Canada, between February 1 and July 30, 2023, who received a single dose of IV dalbavancin for ABSSSIs as out-patients. Those who were enrolled had severe infections requiring IV antibiotics, with psychosocial factors pre-cluding out-patient IV therapy, or were at high risk of non-adherence to oral antibiotics.

Results: The median age of patients was 43 (range 36-56 years); they were mostly male (74%), unemployed (89%), and with unstable housing (58%). Positive outcomes were observed in 13 out of 19 (68%) patients; 3 out of 19 had indeterminate outcomes (could not be reached for follow-up but were not admitted to any institution within our catchment area) and 3 out of 19 had negative outcomes (needed further antibiotics following dalbavancin).

Conclusion: Our experience shows that a single IV dose of dalbavancin is effective in treating ABSSSIs in patients with complex psychosocial factors, as positive outcomes were observed in most patients. Dalbavancin eliminates the need for indwelling IV access and may reduce hospital admissions for patients for whom traditional antibiotic regimens may be challenging.

Background: Global reports suggest heightened Mycoplasma pneumoniae (Mp) activity during the fall of 2023. However, it is unclear how testing strategy changes and preventative measures implemented during the COVID-19 pandemic influenced these conclusions. The objective of this study was to summarize the effects of implementing a new respiratory testing method (Luminex NxTAG Respiratory Pathogen Panel [RPP]) on the rate of detection of three types of atypical bacteria (AB) (Mp, Legionella pneumophila [Lp], and Chlamydophila pneumoniae [Cp]) in British Columbia (BC), as well as to summarize case detections throughout the province during and after the COVID-19 pandemic to determine if there were emerging concerns regarding Mp infections in BC as seen in other jurisdictions.

Methods: We analyzed 2013-2023 laboratory testing data from the provincial lab in BC, divided into periods before syndromic testing, after syndromic testing was implemented (via xTAG RPP), during the COVID-19 pandemic, and after the pandemic.

Results: Following introduction of the Luminex NxTAG RPP, detection of Mp and Cp cases increased 11-fold and 4-fold, respectively, while Lp detection was not significantly affected. Relatively few cases of Mp were recorded during the COVID-19 pandemic, although following relaxation of COVID-19 pandemic mitigation measures, Mp resurgent activity was observed that remained within expected levels.

Conclusions: Detection of AB in BC increased following implementation of the Luminex NxTAG RPP, decreased during the COVID-19 pandemic, and returned to seasonal circulation after the pandemic.

Background: Vancomycin resistant Enterococcus faecium (VRE) bacteremia and infective endocarditis (IE) are difficult to treat and associated with high mortality.

Methods: We describe a case of a 78-year-old male with VRE prosthetic valve endocarditis treated with combined daptomycin/ampicillin. We review published literature on the treatment of VRE IE and summarize other published case reports of daptomycin combination therapy.

Results: Prompt clearance of bacteremia was achieved. Cardiac valve replacement surgery was pursued but was followed by post-operative complications and ultimately the patient did not survive.

Conclusion: There is limited published literature on the treatment of VRE IE and an optimal antibiotic regimen has not been established. This case adds to the growing body of literature demonstrating the use of daptomycin and beta-lactam combination therapy for VRE bacteremia and endocarditis. Combination therapy may be an appropriate choice for select cases; however, reports of treatment failure warrant caution.