JAMMI最新文献

Background: Environmental surveillance of SARS-CoV-2 via wastewater has become an invaluable tool for population-level surveillance. Built environment sampling may provide complementary spatially refined detection for viral surveillance in congregate settings such as universities.

Methods: We conducted a prospective environmental surveillance study at the University of Ottawa between September 2021 and April 2022. Floor surface samples were collected twice weekly from six university buildings and analyzed for the presence of SARS-CoV-2 using quantitative PCR. A Poisson regression was used to model the campus-wide COVID-19 cases predicted from the fraction of floor swabs positive for SARS-CoV-2 RNA, building CO₂ levels, Wi-Fi usage, and SARS-CoV-2 RNA levels in city wastewater. Building-level cases were modelled using viral copies detected in floor samples as a predictor.

Results: Over the 32-week study period, we collected 554 floor swabs at six university buildings. Overall, 13% of swabs were PCR positive for SARS-CoV-2, with positivity ranging between 4.8% and 32.7% among buildings. Both floor swab positivity (Spearman r = 0.74, 95% CI 0.53 to 0.87) and city wastewater signal (Spearman r = 0.50, 95% CI 0.18 to 0.73) positively correlated with on-campus COVID-19 cases. In addition, built environment detection was a predictor of cases linked to individual university buildings.

Conclusions: Detection of SARS-CoV-2 RNA on floors and viral RNA levels in city-wide wastewater were strongly associated with the incidence of COVID-19 cases on a university campus. These data suggest a potential role for institutional built environment sampling, used together with wastewater surveillance, for predicting COVID-19 cases at both campus-wide and building-level scales.

Background: Understanding the microbiology and optimal pharmacotherapy of patients with community-onset sepsis is key to improving outcomes. Yet, empiric therapies prescribed in Canadian emergency departments as they relate to microbial etiology and focus of infection are inadequately described.

Methods: We performed a post hoc analysis of the FABLED cohort study, which quantified the effect of antimicrobials on blood culture yield in septic patients. Patients presenting with sepsis were enrolled in six Canadian emergency departments between 2013 and 2018. We characterized the appropriateness of empiric therapies relative to the pathogens isolated and focus of infection identified.

Results: The data of 315 patients with sepsis was analyzed. Broad-spectrum antibiotics were used in 68.6% of the cohort. Despite this, Pseudomonas was never isolated in any blood cultures, and drug-resistant organisms were only encountered in 4.8% of the cohort. Among patients with bacteremia (n = 100), 28% of patients received appropriate antibiotic therapy whereas the remainder received therapies that were either overly narrow (16%) or unnecessarily broad (56%) in spectrum. Among patients with an identified focus of infection (n = 266), 30.5% received appropriate empiric antibiotics. Prescribing patterns that were overly broad, overly narrow, or a combination of the two were observed in 39.8%, 7.5%, and 22.2% of patients, respectively. Thirty-day mortality was lowest among patients receiving appropriate therapy relative to the final pathogen isolated and presumed infectious focus.

Conclusions: Empiric therapies for septic patients in Canada were overly broad given the rare isolation of drug-resistant pathogens. Though likely confounded by severity of illness, optimal outcomes were observed when therapy was appropriate relative to the causative pathogen and infectious focus.

Background: With initial waves of COVID-19, many public health systems assumed each COVID-19 positive hospitalization was a direct cause from COVID-19 infection. Since January 2022, Alberta Health Services Communicable Disease Control Hospitalization Team (CDC-HT) implemented an admission criteria algorithm to adjudicate COVID-19 as a direct, contributing, or unrelated cause for all COVID-19 admissions in Alberta.

Methods: This quality improvement initiative sought to improve the admission algorithm's precision in reporting COVID-19 admissions. Patient hospitalization records from January-February 2022 with a positive COVID-19 test in the last 30 days were proportionally sampled in a geographically stratified manner across Alberta health zones. 261 patient records were sampled and determination of COVID-19 attribution by CDC-HT algorithm was compared to adjudication by a panel of infectious diseases physicians with extensive COVID-19 clinical experience.

Results: Of 261 sampled COVID-19 admissions, blinded physician adjudication determined 39.9% were direct-cause, 17.2% contributing-cause, and 37.6% unrelated-cause. Within the same cohort the CDC-HT admission algorithm adjudicated 42.9% direct-cause, 24.5% contributing-cause, and 30.3% unrelated-cause. Cohen's kappa was 0.475, providing only moderate agreement. The majority of discrepancy was from over-attribution of unrelated hospitalizations as contributing cause. Implementation of this algorithm in Alberta throughout 2022 showed a fluctuating proportion of direct plus contributing COVID-19 hospitalizations as low as 40%.

Conclusion: There was misattribution bias in COVID-19 hospitalization determination using the admission algorithm. The findings from this analysis led to improvements in the algorithm to improve precision. Public health jurisdictions should review their COVID-19 hospitalization reporting approaches to ensure validity and consideration of incidental cases.

Introduction: During the COVID-19 pandemic, social media became increasingly relied upon for health information in Canada. By analyzing georeferenced tweets using natural language processing, we aimed to understand regional discussions and concerns about school closures, masking, vaccines, and lockdowns during the pandemic's first two years.

Methods: Using Twitter's application programming interface, we collected English-language tweets with keywords related to COVID-19 posted between January 1, 2020 and February 22, 2022 from Canadian users.

Results: Out of all retained tweets, 2,851,951 (47.9%) were about vaccines, 1,344,008 (22.6%) about lockdowns, 1,011,909 (17%) about schooling, and 752,014 (12.6%) about masking. Tweets on schooling received the most engagement, with the highest rates of likes (17.3%), retweets (18.7%), replies (10%), and quotes (6.8%). The most common emotions expressed were trust, fear, and anticipation, with lockdown tweets showing greater fear and sadness. Overall, sentiment was negative, particularly regarding lockdowns in the Northwest Territories and Alberta.

Discussion: During the COVID-19 pandemic, Twitter became an essential tool for analyzing public sentiment regarding government actions. Users showed the most interest in vaccines, followed by lockdowns, schooling, and masking, with the highest engagement on schooling tweets. Our analysis of sentiment, emotion, and content revealed valuable insights into public beliefs about COVID-19 in Canada, highlighting regional differences and shifts in sentiment, particularly negative reactions to school closures as government recommendations evolved. Our study adds to the growing evidence supporting the use of natural language processing for real-time analysis of social media content to early identify public health concerns.

Background: New strategies are needed to increase access to hepatitis C virus (HCV) testing. This study evaluated the feasibility of HCV rapid testing in community pharmacies in Quebec (Canada) and assessed knowledge transfer (KT).

Methods: PHARMA-C was a 6-month (February to September 2022) prospective KT study. Community pharmacists (CPs) were recruited and trained to identify HCV risk factors, conduct rapid antibody tests (OraQuickHCV), and pre- and post-test counselling, and link positive cases to care. Health care users (HUs) were included according to HCV risk factors. An advisory committee and focus groups provided guidance, feedback, and identified barriers and facilitators to improve the program. A pre- and post-intervention questionnaire was completed by CPs to assess feasibility and KT. HUs completed a satisfaction survey.

Results: A total of 32 CPs were included and 16 performed 101 HCV tests. Two positive cases were identified and linked to care. Comparison of pre- and post-intervention surveys shows that pharmacists felt more confident in identifying HCV risk factors, communicating information to patients related to HCV, and performing the HCV screening test at the end of the intervention. HCV screening in pharmacies was considered feasible by 77.8% of CPs. The intervention lasted approximately 22 minutes. The main barriers to implementation were lack of time and fear of stigmatizing HUs. Promotional material and training were the main facilitators.

Conclusion: HCV point-of-care testing by CPs is feasible in Quebec. Expanding pharmacists' scope of practice to include HCV screening and increasing pharmacists' role in the HCV care cascade is encouraged in order to further efforts toward HCV elimination.

Background: Rothia aeria is a gram-positive bacterium that is considered a member of the normal human oral flora. Serious infections due to this organism are rare, with only eight case reports of endocarditis due to R. aeria published worldwide in the English language literature.

Methods: We report the case of a previously healthy 43-year-old man who presented with multiple acute subarachnoid hemorrhages secondary to cerebral mycotic aneurysms after several weeks of weight loss and headache, and we summarize previously published cases of endocarditis due to R. aeria.

Results: Blood cultures yielded filamentous gram-positive bacilli identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry as R. aeria. The patient was treated with antimicrobial therapy (initially aqueous penicillin G, then ceftriaxone) for 12 weeks with a good clinical response. Endocarditis was suspected but not definitively proven on echocardiography. There was no clear odontogenic source of infection.

Conclusion: This report of cerebral mycotic aneurysms secondary to possible endocarditis highlights the potential pathogenic nature of R. aeria infection, and supports the use of MALDI-TOF in rapid identification of uncommon bacterial pathogens.

Introduction: Candidemia is a common bloodstream infection with morbidity and mortality. Both the European Society of Clinical Microbiology and Infectious Diseases and Infectious Diseases Society of America have evidence-based recommendations for its management. While infectious diseases consultation (IDC) reduced mortality, effects on guideline concordance remain unclear.

Methods: We conducted a multicentre retrospective cohort study (2010-2018) in Canada to characterize the role of IDC in attaining evidence-based recommendations for adults with candidemia. Such recommendations include follow-up blood cultures to document blood clearance, prompt antifungal initiation and selection, source control, treatment duration determination, and ancillary investigations. We measured associations between IDC and adherence to evidence-based recommendations.

Results: Patients with candidemia who received IDC were more likely not to be left without antifungal therapy (26% versus 4.8%). Echocardiograms were more common in noncritically ill patients with IDC (64% versus 44%; P < 0.01) and in all critically ill patients, irrespective of IDC status (75% versus 63%; P = 0.08). In patients with uncomplicated candidemia, treatment duration ≥14 days was similar with or without IDC (78% versus 70%; P = 0.15). Patients with complicated candidemia and IDC were more likely treated for ≥42 days (an appropriate duration; 100% versus 47%; P = 0.06). Fluconazole (transition therapy) was not affected by IDC for critically ill (41% and 29%; P = 0.34) or noncritically ill patients (34% versus 24%; P = 0.51). Mortality rates at 30 and 60 days after candidemia diagnosis were lower in patients receiving IDC (P < 0.05).

Conclusions: Best practice guidelines were issued for patients with candidemia; adherence varied, but involvement of an infectious disease physician increased implementation and was associated with considerably decreased mortality.

Introduction: This study describes all antibiotics dispensed to long-term care (LTC)-dwelling women with a suspected or confirmed uncomplicated urinary tract infection (UTI) in health administrative data. The outcomes of ambulatory visits, hospitalizations, and dispensation of additional antibiotics were compared for those dispensed fluoroquinolones (FQs) and those dispensed other antibiotics.

Methods: This retrospective cohort study assessed administrative health data collected between January 2005 and March 2020 in Nova Scotia, Canada. Women aged 65 years or older who resided in LTC, identified with ICD 9 or 10 codes that represented an uncomplicated UTI and had an antibiotic dispensation within 5 days of the identified UTI code, were included. Antibiotic dispensations were reported descriptively and a Mann-Kendall test was used to assess change over time. A logistic regression model estimated the odds ratios for FQ compared to non-FQ recipients for all outcome events.

Results: There were 15,276 uncomplicated UTI events reported in 7,078 women. UTI events decreased significantly over time (1,387 in 2005 to 402 in 2019 [p < 0.001]). The most dispensed antibiotics were trimethoprim-sulfamethoxazole (25.8%), nitrofurantoin (25.5%), and ciprofloxacin (18.6 %). Compared to all other antibiotics, FQ dispensation was not associated with any difference in need for hospitalization. There was a reduced risk of subsequent antibiotic dispensation and follow-up ambulatory care visits for those dispensed FQs in the adjusted analysis.

Conclusions: A decline in antibiotic dispensations associated with uncomplicated UTI events was observed over the 15-year period. The findings support guideline recommendations to limit FQ prescribing for uncomplicated UTI, as few differences for the outcomes investigated were identified.