Pub Date : 2024-09-27DOI: 10.1016/j.jinf.2024.106296
Maisie Vollans , Julie Day , Susie Cant , Jordan Hood , A. Marm Kilpatrick , Laura D. Kramer , Alexander Vaux , Jolyon Medlock , Thomas Ward , Robert S. Paton
West Nile Virus (WNV) is a mosquito-borne pathogen that primarily infects birds. Infections can spillover to humans and cause a spectrum of clinical symptoms, including WNV neuroinvasive disease. The extrinsic incubation period (EIP) is the time taken for a mosquito to become infectious following the ingestion of an infected blood meal. Characterising how the EIP varies with temperature is an essential part of predicting the impact and transmission dynamics of WNV. We re-analyse existing experimental data using Bayesian time delay models, allowing us to account for variation in how quickly individual mosquitoes developed disseminated WNV infections. In these experiments, cohorts of Culex pipiens mosquitoes were infected with WNV and kept under different temperature conditions, being checked for disseminated infection at defined timepoints. We find that EIPs are best described with a Weibull distribution and become shorter log-linearly with temperature. Under 18°C, less than 1% of infected Cx. pipiens had a disseminated infection after 5 days, compared to 9.73% (95% CrI: 7.97 to 11.54) at 25°C and 42.20% (95% CrI: 38.32 to 46.60) at 30°C. In the hottest experimental temperature treatment (32°C), the EIP50 was estimated at 3.78 days (CrI: 3.42 to 4.15) compared to over 100 days in the coolest treatment (15°C). The variance of EIPs was found to be much larger at lower temperatures than higher temperatures, highlighting the importance of characterising the time delay distribution associated with the EIP. We additionally demonstrate a competitive advantage of WNV strain WN02 over NY99, where the former infects mosquitoes more quickly at colder temperatures than the latter. This research contributes crucial parameters to the WNV literature, providing essential insights for modellers and those planning interventions.
{"title":"Modelling the temperature dependent extrinsic incubation period of West Nile Virus using Bayesian time delay models","authors":"Maisie Vollans , Julie Day , Susie Cant , Jordan Hood , A. Marm Kilpatrick , Laura D. Kramer , Alexander Vaux , Jolyon Medlock , Thomas Ward , Robert S. Paton","doi":"10.1016/j.jinf.2024.106296","DOIUrl":"10.1016/j.jinf.2024.106296","url":null,"abstract":"<div><div>West Nile Virus (WNV) is a mosquito-borne pathogen that primarily infects birds. Infections can spillover to humans and cause a spectrum of clinical symptoms, including WNV neuroinvasive disease. The extrinsic incubation period (EIP) is the time taken for a mosquito to become infectious following the ingestion of an infected blood meal. Characterising how the EIP varies with temperature is an essential part of predicting the impact and transmission dynamics of WNV. We re-analyse existing experimental data using Bayesian time delay models, allowing us to account for variation in how quickly individual mosquitoes developed disseminated WNV infections. In these experiments, cohorts of <em>Culex pipiens</em> mosquitoes were infected with WNV and kept under different temperature conditions, being checked for disseminated infection at defined timepoints. We find that EIPs are best described with a Weibull distribution and become shorter log-linearly with temperature. Under 18°C, less than 1% of infected <em>Cx. pipiens</em> had a disseminated infection after 5 days, compared to 9.73% (95% CrI: 7.97 to 11.54) at 25°C and 42.20% (95% CrI: 38.32 to 46.60) at 30°C. In the hottest experimental temperature treatment (32°C), the EIP<sub>50</sub> was estimated at 3.78 days (CrI: 3.42 to 4.15) compared to over 100 days in the coolest treatment (15°C). The variance of EIPs was found to be much larger at lower temperatures than higher temperatures, highlighting the importance of characterising the time delay distribution associated with the EIP. We additionally demonstrate a competitive advantage of WNV strain WN02 over NY99, where the former infects mosquitoes more quickly at colder temperatures than the latter. This research contributes crucial parameters to the WNV literature, providing essential insights for modellers and those planning interventions.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 6","pages":"Article 106296"},"PeriodicalIF":14.3,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1016/j.jinf.2024.106294
Valentina Mazzotta , Fulvia Mazzaferri , Simone Lanini , Massimo Mirandola , Alessandro Cozzi Lepri , Alessandra Vergori , Alessia Savoldi , Andrea Santoro , Gaia Maccarrone , Ilaria Mastrorosa , Omar Simonetti , Federico De Zottis , Emanuele Nicastri , Giulia Rosini , Laura Rovigo , Lorenzo Tavernaro , Loredana Sarmati , Carlo Tascini , Enrico Girardi , Anna Maria Cattelan , Evelina Tacconelli
<div><h3>Background</h3><div>The clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves.</div></div><div><h3>Methods</h3><div>The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500 mg of intravenous sotrovimab (SOT) or 600 mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100 mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI. Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixed effects logistic model. These trials are registered with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021–004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2).</div></div><div><h3>Findings</h3><div>Between March 2022 and February 2023, 991 patients (SOT = 332, TGM/CGM = 327, NMV/r = 332) were enrolled in 15 Italian centers. The overall mean age was 66 years; 482 participants (48.80%) were male, and 856 were vaccinated with at least a primary course (86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35–1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p = 0.015) and 2.42 (95% CI 0.19 to infinity; p = 0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032–1.83; p = 0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the
{"title":"Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves","authors":"Valentina Mazzotta , Fulvia Mazzaferri , Simone Lanini , Massimo Mirandola , Alessandro Cozzi Lepri , Alessandra Vergori , Alessia Savoldi , Andrea Santoro , Gaia Maccarrone , Ilaria Mastrorosa , Omar Simonetti , Federico De Zottis , Emanuele Nicastri , Giulia Rosini , Laura Rovigo , Lorenzo Tavernaro , Loredana Sarmati , Carlo Tascini , Enrico Girardi , Anna Maria Cattelan , Evelina Tacconelli","doi":"10.1016/j.jinf.2024.106294","DOIUrl":"10.1016/j.jinf.2024.106294","url":null,"abstract":"<div><h3>Background</h3><div>The clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves.</div></div><div><h3>Methods</h3><div>The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500 mg of intravenous sotrovimab (SOT) or 600 mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100 mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI. Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixed effects logistic model. These trials are registered with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021–004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2).</div></div><div><h3>Findings</h3><div>Between March 2022 and February 2023, 991 patients (SOT = 332, TGM/CGM = 327, NMV/r = 332) were enrolled in 15 Italian centers. The overall mean age was 66 years; 482 participants (48.80%) were male, and 856 were vaccinated with at least a primary course (86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35–1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p = 0.015) and 2.42 (95% CI 0.19 to infinity; p = 0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032–1.83; p = 0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the ","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106294"},"PeriodicalIF":14.3,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.jinf.2024.106284
Xingwen Chen , John Balliew , Cici X. Bauer , Jennifer Deegan , Anna Gitter , Blake M. Hanson , Anthony W. Maresso , Michael J. Tisza , Catherine L. Troisi , Janelle Rios , Kristina D. Mena , Eric Boerwinkle , Fuqing Wu
Objectives
Rapid evolution of SARS-CoV-2 has resulted in the emergence of numerous variants, posing significant challenges to public health surveillance. Clinical genome sequencing, while valuable, has limitations in capturing the full epidemiological dynamics of circulating variants in the general population. This study aimed to monitor the SARS-CoV-2 variant community dynamics and evolution using receptor-binding domain (RBD) amplicon sequencing of wastewater samples.
Methods
We sequenced wastewater from El Paso, Texas, over 17 months, compared the sequencing data with clinical genome data, and performed biodiversity analysis to reveal SARS-CoV-2 variant dynamics and evolution.
Results
We identified 91 variants and observed waves of dominant variants transitioning from BA.2 to BA.2.12.1, BA.4&5, BQ.1, and XBB.1.5. Comparison with clinical genome sequencing data revealed earlier detection of variants and identification of unreported outbreaks. Our results also showed strong consistency with clinical data for dominant variants at the local, state, and national levels. Alpha diversity analyses revealed significant seasonal variations, with the highest diversity observed in winter. By segmenting the outbreak into lag, growth, stationary, and decline phases, we found higher variant diversity during the lag phase, likely due to lower inter-variant competition preceding outbreak growth.
Conclusions
Our findings underscore the importance of low transmission periods in facilitating rapid mutation and variant evolution. Our approach, integrating RBD amplicon sequencing with wastewater surveillance, demonstrates effectiveness in tracking viral evolution and understanding variant emergence, thus enhancing public health preparedness.
{"title":"Revealing patterns of SARS-CoV-2 variant emergence and evolution using RBD amplicon sequencing of wastewater","authors":"Xingwen Chen , John Balliew , Cici X. Bauer , Jennifer Deegan , Anna Gitter , Blake M. Hanson , Anthony W. Maresso , Michael J. Tisza , Catherine L. Troisi , Janelle Rios , Kristina D. Mena , Eric Boerwinkle , Fuqing Wu","doi":"10.1016/j.jinf.2024.106284","DOIUrl":"10.1016/j.jinf.2024.106284","url":null,"abstract":"<div><h3>Objectives</h3><div>Rapid evolution of SARS-CoV-2 has resulted in the emergence of numerous variants, posing significant challenges to public health surveillance. Clinical genome sequencing, while valuable, has limitations in capturing the full epidemiological dynamics of circulating variants in the general population. This study aimed to monitor the SARS-CoV-2 variant community dynamics and evolution using receptor-binding domain (RBD) amplicon sequencing of wastewater samples.</div></div><div><h3>Methods</h3><div>We sequenced wastewater from El Paso, Texas, over 17 months, compared the sequencing data with clinical genome data, and performed biodiversity analysis to reveal SARS-CoV-2 variant dynamics and evolution.</div></div><div><h3>Results</h3><div>We identified 91 variants and observed waves of dominant variants transitioning from BA.2 to BA.2.12.1, BA.4&5, BQ.1, and XBB.1.5. Comparison with clinical genome sequencing data revealed earlier detection of variants and identification of unreported outbreaks. Our results also showed strong consistency with clinical data for dominant variants at the local, state, and national levels. Alpha diversity analyses revealed significant seasonal variations, with the highest diversity observed in winter. By segmenting the outbreak into lag, growth, stationary, and decline phases, we found higher variant diversity during the lag phase, likely due to lower inter-variant competition preceding outbreak growth.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the importance of low transmission periods in facilitating rapid mutation and variant evolution. Our approach, integrating RBD amplicon sequencing with wastewater surveillance, demonstrates effectiveness in tracking viral evolution and understanding variant emergence, thus enhancing public health preparedness.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106284"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.jinf.2024.106290
Nannan Xu , Xiaoai Zhang , Hui Liu , Yintao Xu , Huixia Lu , Lianhui Zhao , Yishan He , Meiqi Zhang , Jingtao Zhang , Guangqian Si , Ziyi Wang , Muxin Chen , Yuchun Cai , Yi Zhang , Qiang Wang , Yuwan Hao , Yuanyuan Li , Zhengbin Zhou , Yunhai Guo , Caiyun Chang , Wei Liu
Background
Trypanosomiasis continues to pose a global threat to human health, with human infection mainly caused by Trypanosoma brucei and Trypanosoma cruzi.
Methods
We present a 30-year-old pregnant woman with persistent high fever from Shandong Province, China. High-throughput sequencing revealed the presence of Trypanosoma dionisii in blood. We conducted an analysis of the patient’s clinical, epidemiological, and virological data.
Results
The patients exhibited fever, shortness of breath, chest tightness, accompanied by change in liver function and inflammatory response. She made a full recovery without any long-term effects. T. dionisii was detected in blood collected 23 days after onset of illness. The 18S rRNA gene sequence showed close similarity to T. dionisii found in bats from Japan, while the gGAPDH gene was closely related to T. dionisii from bats in Mengyin County, Shandong Province. Phylogenetic analysis demonstrated the current T. dionisii belongs to clade B within its species group. Positive anti-Trypanosoma IgG antibody was detected from the patient on Day 23, 66 and 122 after disease onset, as well as the cord blood and serum from the newborn. Retrospective screening of wild small mammals captured from Shandong Province revealed a prevalence rate of 0.54% (7/1304) for T. dionisii; specifically among 0.81% (5/620) of Apodemus agrarius, and 0.46% (2/438) of Mus musculus.
Conclusions
The confirmation of human infection with T. dionisii underscores its potential as a zoonotic pathogen, while the widespread presence of this parasite in rodent and bat species emphasizes the emerging threat it poses to human health.
{"title":"Clinical and epidemiological investigation of human infection with zoonotic parasite Trypanosoma dionisii in China","authors":"Nannan Xu , Xiaoai Zhang , Hui Liu , Yintao Xu , Huixia Lu , Lianhui Zhao , Yishan He , Meiqi Zhang , Jingtao Zhang , Guangqian Si , Ziyi Wang , Muxin Chen , Yuchun Cai , Yi Zhang , Qiang Wang , Yuwan Hao , Yuanyuan Li , Zhengbin Zhou , Yunhai Guo , Caiyun Chang , Wei Liu","doi":"10.1016/j.jinf.2024.106290","DOIUrl":"10.1016/j.jinf.2024.106290","url":null,"abstract":"<div><h3>Background</h3><div>Trypanosomiasis continues to pose a global threat to human health, with human infection mainly caused by <em>Trypanosoma brucei</em> and <em>Trypanosoma cruzi.</em></div></div><div><h3>Methods</h3><div>We present a 30-year-old pregnant woman with persistent high fever from Shandong Province, China. High-throughput sequencing revealed the presence of <em>Trypanosoma dionisii</em> in blood. We conducted an analysis of the patient’s clinical, epidemiological, and virological data.</div></div><div><h3>Results</h3><div>The patients exhibited fever, shortness of breath, chest tightness, accompanied by change in liver function and inflammatory response. She made a full recovery without any long-term effects. <em>T. dionisii</em> was detected in blood collected 23 days after onset of illness. The 18S rRNA gene sequence showed close similarity to <em>T. dionisii</em> found in bats from Japan, while the <em>gGAPDH</em> gene was closely related to <em>T. dionisii</em> from bats in Mengyin County, Shandong Province. Phylogenetic analysis demonstrated the current <em>T. dionisii</em> belongs to clade B within its species group. Positive anti-<em>Trypanosoma</em> IgG antibody was detected from the patient on Day 23, 66 and 122 after disease onset, as well as the cord blood and serum from the newborn. Retrospective screening of wild small mammals captured from Shandong Province revealed a prevalence rate of 0.54% (7/1304) for <em>T. dionisii</em>; specifically among 0.81% (5/620) of <em>Apodemus agrarius</em>, and 0.46% (2/438) of <em>Mus musculus</em>.</div></div><div><h3>Conclusions</h3><div>The confirmation of human infection with <em>T. dionisii</em> underscores its potential as a zoonotic pathogen, while the widespread presence of this parasite in rodent and bat species emphasizes the emerging threat it poses to human health.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106290"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.jinf.2024.106292
Lorena Vega-Piris , Silvia Galindo Carretero , José Luis Mayordomo , Mercedes Belén Rumayor Zarzuelo , Virginia Álvarez Río , Virtudes Gallardo García , Miriam García Vázquez , María del Carmen García Rodríguez , Luca Basile , Nieves López González-Coviella , Maria Isabel Barranco Boada , Olaia Pérez-Martínez , Ana Lameiras Azevedo , Carmen Quiñones Rubio , Jaume Giménez Duran , Ana Fernández Ibáñez , María Victoria García Rivera , Violeta Ramos Marín , Daniel Castrillejo , Luis Javier Viloria Raymundo , Susana Monge
Introduction
Our aim was to estimate the risk of pneumonia, admission to intensive care unit (ICU) or death in individuals ≥65 years old admitted to hospital with RSV, compared to influenza or COVID-19.
Methods
We included hospitalised patients from Severe Acute Respiratory Infection Surveillance in Spain between 2021–2024, aged ≥65 years, laboratory confirmed for RSV, influenza or SARS-CoV-2. Using a binomial regression with logarithmic link, we estimated the relative risk (RR) of pneumonia, ICU admission and in-hospital mortality, in patients with RSV compared to influenza or SARS-CoV-2, adjusting for age, sex, season and comorbidities. We stratified the estimates by vaccination status for influenza or SARS-CoV2.
Results
Among patients unvaccinated for influenza or SARS-CoV-2, those with RSV had similar or lower risk of pneumonia [vs. influenza: RR= 0.91 (95% Confidence Interval: 0.72–1.16); vs. SARS-CoV-2: 0.81 (0.67–0.98)], ICU admission [vs. influenza: 0.93 (0.41–2.08); vs. SARS-CoV-2: 1.10 (0.61–1.99)] and mortality [vs. influenza: 0.64 (0.32–1.28); vs. SARS-CoV-2: 0.56 (0.30–1.04)]. Among the vaccinated, results were largely similar except for a higher risk of ICU admission with RSV [vs. influenza: 2.13(1.16–3.89); vs. SARS-CoV-2: 1.83 (1.02–3.28)]
Conclusions
RSV presented similar or lower intrinsic severity than influenza or SARS-CoV2. Among vaccinated patients, RSV was associated to higher ICU-admission, suggesting the potential for preventive RSV vaccination.
{"title":"Severity of respiratory syncytial virus compared with SARS-CoV-2 and influenza among hospitalised adults ≥65 years","authors":"Lorena Vega-Piris , Silvia Galindo Carretero , José Luis Mayordomo , Mercedes Belén Rumayor Zarzuelo , Virginia Álvarez Río , Virtudes Gallardo García , Miriam García Vázquez , María del Carmen García Rodríguez , Luca Basile , Nieves López González-Coviella , Maria Isabel Barranco Boada , Olaia Pérez-Martínez , Ana Lameiras Azevedo , Carmen Quiñones Rubio , Jaume Giménez Duran , Ana Fernández Ibáñez , María Victoria García Rivera , Violeta Ramos Marín , Daniel Castrillejo , Luis Javier Viloria Raymundo , Susana Monge","doi":"10.1016/j.jinf.2024.106292","DOIUrl":"10.1016/j.jinf.2024.106292","url":null,"abstract":"<div><h3>Introduction</h3><div>Our aim was to estimate the risk of pneumonia, admission to intensive care unit (ICU) or death in individuals ≥65 years old admitted to hospital with RSV, compared to influenza or COVID-19.</div></div><div><h3>Methods</h3><div>We included hospitalised patients from Severe Acute Respiratory Infection Surveillance in Spain between 2021–2024, aged ≥65 years, laboratory confirmed for RSV, influenza or SARS-CoV-2. Using a binomial regression with logarithmic link, we estimated the relative risk (RR) of pneumonia, ICU admission and in-hospital mortality, in patients with RSV compared to influenza or SARS-CoV-2, adjusting for age, sex, season and comorbidities. We stratified the estimates by vaccination status for influenza or SARS-CoV2.</div></div><div><h3>Results</h3><div>Among patients unvaccinated for influenza or SARS-CoV-2, those with RSV had similar or lower risk of pneumonia [vs. influenza: RR= 0.91 (95% Confidence Interval: 0.72–1.16); vs. SARS-CoV-2: 0.81 (0.67–0.98)], ICU admission [vs. influenza: 0.93 (0.41–2.08); vs. SARS-CoV-2: 1.10 (0.61–1.99)] and mortality [vs. influenza: 0.64 (0.32–1.28); vs. SARS-CoV-2: 0.56 (0.30–1.04)]. Among the vaccinated, results were largely similar except for a higher risk of ICU admission with RSV [vs. influenza: 2.13(1.16–3.89); vs. SARS-CoV-2: 1.83 (1.02–3.28)]</div></div><div><h3>Conclusions</h3><div>RSV presented similar or lower intrinsic severity than influenza or SARS-CoV2. Among vaccinated patients, RSV was associated to higher ICU-admission, suggesting the potential for preventive RSV vaccination.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106292"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.jinf.2024.106288
Sevastyan O. Rabdano , Ellina A. Ruzanova , Anastasiya E. Vertyachikh , Valeriya A. Teplykh , Alla B. Emelyanova , German O. Rudakov , Sergei A. Arakelov , Iuliia V. Pletyukhina , Nikita S. Saveliev , Anna A. Lukovenko , Liliya N. Fakhretdinova , Ariana S. Safi , Ekaterina N. Zhirenkina , Irina N. Polyakova , Natalia S. Belozerova , Vladislav V. Klykov , Arina P. Savelieva , Aleksey A. Ekimov , Konstantin V. Pokachalov , Vadim A. Merkulov , Veronika I. Skvortsova
Background
Despite the success of first-generation COVID-19 vaccines targeting the spike (S) protein, emerging SARS-CoV-2 variants have led to immune escape, reducing the efficacy of these vaccines. Additionally, some individuals are unable to mount an effective immune response to S protein-based vaccines. This has created a need for alternative vaccine strategies that are less susceptible to mutations and capable of providing broad and durable protection. This study aimed to evaluate the efficacy and safety of a novel COVID-19 vaccine based on the full-length recombinant nucleocapsid (N) protein of SARS-CoV-2.
Methods
We conducted a prospective, multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial (NCT05726084) in Russia. Participants (n = 5229) were adults aged 18 years and older, with a BMI of 18.5–30 kg/m², and without significant clinical abnormalities. They were randomized in a 2:1 ratio to receive a single intramuscular dose of either the N protein-based vaccine (50 µg) or placebo. Randomization was done through block randomization, and masking was ensured by providing visually identical formulations of vaccine and placebo. The primary outcome was the incidence of symptomatic COVID-19 confirmed by PCR more than 15 days after vaccination within a 180-day observation period, analyzed on an intention-to-treat basis.
Findings
Between May 18, 2023, and August 9, 2023, 5229 participants were randomized, with 3486 receiving the vaccine and 1743 receiving the placebo. Eight cases of PCR-confirmed symptomatic COVID-19 occurred in the vaccine group (0.23%) compared to 27 cases in the placebo group (1.55%), yielding a vaccine efficacy of 85.2% (95% CI: 67.4–93.3; p < 0.0001). Adverse events were mostly mild and included local injection site reactions. There were no vaccine-related serious adverse events.
Interpretation
The N protein-based COVID-19 vaccine demonstrated significant efficacy and a favorable safety profile, suggesting it could be a valuable addition to the global vaccination effort, particularly in addressing immune escape variants and offering an alternative for those unable to respond to S protein-based vaccines. These results support the continued development and potential deployment of N protein-based vaccines in the ongoing fight against COVID-19.
背景:尽管针对尖峰(S)蛋白的第一代 COVID-19 疫苗取得了成功,但新出现的 SARS-CoV-2 变种导致了免疫逃逸,降低了这些疫苗的效力。此外,有些人无法对基于 S 蛋白的疫苗产生有效的免疫反应。因此,我们需要不易受变异影响、能提供广泛持久保护的替代疫苗策略。本研究旨在评估基于 SARS-CoV-2 全长重组核壳(N)蛋白的新型 COVID-19 疫苗的有效性和安全性:我们在俄罗斯进行了一项前瞻性、多中心、随机、双盲、安慰剂对照的 3 期临床试验(NCT05726084)。参与者(5229 人)均为 18 岁及以上的成年人,体重指数在 18.5-30kg/m² 之间,无明显临床异常。他们按 2:1 的比例被随机分配接受单剂量肌肉注射 N 蛋白疫苗(50 微克)或安慰剂。随机分配采用区组随机法,并通过提供视觉上完全相同的疫苗和安慰剂配方来确保掩蔽。主要结果是在180天的观察期内,接种疫苗后15天以上经PCR确诊的无症状COVID-19的发生率:2023年5月18日至2023年8月9日期间,5229名参与者被随机分组,其中3486人接种疫苗,1743人接种安慰剂。疫苗组出现了8例经PCR确诊的无症状COVID-19(0.23%),而安慰剂组出现了27例(1.55%),疫苗有效率为85.2%(95% CI:67.4-93.3;p解释:基于N蛋白的COVID-19疫苗表现出显著的有效性和良好的安全性,这表明它可以成为全球疫苗接种工作的重要补充,特别是在应对免疫逃逸变异和为那些无法对基于S蛋白的疫苗产生反应的人提供替代疫苗方面。这些结果支持继续开发和潜在使用基于 N 蛋白的疫苗来对抗 COVID-19。
{"title":"N-protein vaccine is effective against COVID-19: Phase 3, randomized, double-blind, placebo-controlled clinical trial","authors":"Sevastyan O. Rabdano , Ellina A. Ruzanova , Anastasiya E. Vertyachikh , Valeriya A. Teplykh , Alla B. Emelyanova , German O. Rudakov , Sergei A. Arakelov , Iuliia V. Pletyukhina , Nikita S. Saveliev , Anna A. Lukovenko , Liliya N. Fakhretdinova , Ariana S. Safi , Ekaterina N. Zhirenkina , Irina N. Polyakova , Natalia S. Belozerova , Vladislav V. Klykov , Arina P. Savelieva , Aleksey A. Ekimov , Konstantin V. Pokachalov , Vadim A. Merkulov , Veronika I. Skvortsova","doi":"10.1016/j.jinf.2024.106288","DOIUrl":"10.1016/j.jinf.2024.106288","url":null,"abstract":"<div><h3>Background</h3><div>Despite the success of first-generation COVID-19 vaccines targeting the spike (S) protein, emerging SARS-CoV-2 variants have led to immune escape, reducing the efficacy of these vaccines. Additionally, some individuals are unable to mount an effective immune response to S protein-based vaccines. This has created a need for alternative vaccine strategies that are less susceptible to mutations and capable of providing broad and durable protection. This study aimed to evaluate the efficacy and safety of a novel COVID-19 vaccine based on the full-length recombinant nucleocapsid (N) protein of SARS-CoV-2.</div></div><div><h3>Methods</h3><div>We conducted a prospective, multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial (NCT05726084) in Russia. Participants (n = 5229) were adults aged 18 years and older, with a BMI of 18.5–30 kg/m², and without significant clinical abnormalities. They were randomized in a 2:1 ratio to receive a single intramuscular dose of either the N protein-based vaccine (50 µg) or placebo. Randomization was done through block randomization, and masking was ensured by providing visually identical formulations of vaccine and placebo. The primary outcome was the incidence of symptomatic COVID-19 confirmed by PCR more than 15 days after vaccination within a 180-day observation period, analyzed on an intention-to-treat basis.</div></div><div><h3>Findings</h3><div>Between May 18, 2023, and August 9, 2023, 5229 participants were randomized, with 3486 receiving the vaccine and 1743 receiving the placebo. Eight cases of PCR-confirmed symptomatic COVID-19 occurred in the vaccine group (0.23%) compared to 27 cases in the placebo group (1.55%), yielding a vaccine efficacy of 85.2% (95% CI: 67.4–93.3; p < 0.0001). Adverse events were mostly mild and included local injection site reactions. There were no vaccine-related serious adverse events.</div></div><div><h3>Interpretation</h3><div>The N protein-based COVID-19 vaccine demonstrated significant efficacy and a favorable safety profile, suggesting it could be a valuable addition to the global vaccination effort, particularly in addressing immune escape variants and offering an alternative for those unable to respond to S protein-based vaccines. These results support the continued development and potential deployment of N protein-based vaccines in the ongoing fight against COVID-19.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106288"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.jinf.2024.106286
C. McLeod , M. Dymock , K.L. Flanagan , M. Plebanski , H. Marshall , M.J. Estcourt , M.C. Tjiam , C.C. Blyth , K. Subbarao , F.L. Mordant , S. Nicholson , S.N. Faust , U. Wadia , R.B. Thornton , Z. Ellis , A. Mckenzie , J.A. Marsh , T.L. Snelling , P. Richmond
Objectives
PICOBOO is a randomised, adaptive trial evaluating the immunogenicity, reactogenicity, and safety of COVID-19 booster strategies. We report data for second boosters among individuals 50-<70 years old primed with AZD1222 (50-<70y-AZD1222) until Day 84.
Methods
Immunocompetent adults who received any first booster ≥three months prior were eligible. Participants were randomly allocated to BNT162b2, mRNA-1273 or NVX-CoV2373 1:1:1. The concentrations of ancestral anti-spike immunoglobulin were summarised as the geometric mean concentrations (GMC). Reactogenicity and safety outcomes were captured. Additional analyses including neutralising antibodies were performed on a subset. ACTRN12622000238774.
Results
Between Mar 2022 and Aug 2023, 743 participants were recruited and had D28 samples; 155 belonged to the 50-<70y-AZD1222 stratum. The mean adjusted GMCs (95% credible intervals) were 20,690 (17 555−23 883), 23,867 (20 144−27 604) and 8654 (7267−9962) U/mL at D28 following boosting with BNT162b2, mRNA-1273 and NVX-CoV2372, respectively, and 10,976 (8826−13 196), 15,779 (12 512−19 070) and 6559 (5220−7937) U/mL by D84. IgG against Omicron BA.5 was 2.7–2.9 times lower than the ancestral strain. Limited neutralisation against Omicron subvariants was found following all vaccines. Severe reactogenicity events were <4%.
Conclusions
All vaccines were immunogenic with more rapid waning after mRNA vaccines. These data support boosting with vaccines with greater specificity for circulating Omicron subvariants.
{"title":"The Platform Trial In COVID-19 Priming and BOOsting (PICOBOO): The immunogenicity, reactogenicity, and safety of different COVID-19 vaccinations administered as a second booster (fourth dose) in AZD1222 primed individuals aged 50-<70 years old","authors":"C. McLeod , M. Dymock , K.L. Flanagan , M. Plebanski , H. Marshall , M.J. Estcourt , M.C. Tjiam , C.C. Blyth , K. Subbarao , F.L. Mordant , S. Nicholson , S.N. Faust , U. Wadia , R.B. Thornton , Z. Ellis , A. Mckenzie , J.A. Marsh , T.L. Snelling , P. Richmond","doi":"10.1016/j.jinf.2024.106286","DOIUrl":"10.1016/j.jinf.2024.106286","url":null,"abstract":"<div><h3>Objectives</h3><div>PICOBOO is a randomised, adaptive trial evaluating the immunogenicity, reactogenicity, and safety of COVID-19 booster strategies. We report data for second boosters among individuals 50-<70 years old primed with AZD1222 (50-<70y-AZD1222) until Day 84.</div></div><div><h3>Methods</h3><div>Immunocompetent adults who received any first booster ≥three months prior were eligible. Participants were randomly allocated to BNT162b2, mRNA-1273 or NVX-CoV2373 1:1:1. The concentrations of ancestral anti-spike immunoglobulin were summarised as the geometric mean concentrations (GMC). Reactogenicity and safety outcomes were captured. Additional analyses including neutralising antibodies were performed on a subset. ACTRN12622000238774.</div></div><div><h3>Results</h3><div>Between Mar 2022 and Aug 2023, 743 participants were recruited and had D28 samples; 155 belonged to the 50-<70y-AZD1222 stratum. The mean adjusted GMCs (95% credible intervals) were 20,690 (17 555−23 883), 23,867 (20 144−27 604) and 8654 (7267−9962) U/mL at D28 following boosting with BNT162b2, mRNA-1273 and NVX-CoV2372, respectively, and 10,976 (8826−13 196), 15,779 (12 512−19 070) and 6559 (5220−7937) U/mL by D84. IgG against Omicron BA.5 was 2.7–2.9 times lower than the ancestral strain. Limited neutralisation against Omicron subvariants was found following all vaccines. Severe reactogenicity events were <4%.</div></div><div><h3>Conclusions</h3><div>All vaccines were immunogenic with more rapid waning after mRNA vaccines. These data support boosting with vaccines with greater specificity for circulating Omicron subvariants.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 6","pages":"Article 106286"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to evaluate the impact of the pandemic and post-pandemic periods on hospital admissions for LRTI, with a focus on patients with chronic respiratory disease (CRD).
Methods
From July 2013 to June 2023, monthly numbers of adult hospitalisations for LRTI (excluding SARS-CoV-2) were extracted from the French National Hospital Discharge Database. They were modelled by regressions with autocorrelated errors. Three periods were defined: (1) early pandemic and successive lockdowns; (2) gradual lifting of restrictions and widespread SARS-CoV-2 vaccination; (3) withdrawal of restriction measures.
Results
Pre-pandemic incidence was 96 (90.5 to 101.5) per 100,000 population. Compared with the pre-pandemic period, no more seasonality and significant reductions were estimated in the first two periods: −43.64% (−50.11 to −37.17) and −32.97% (−39.88 to −26.05), respectively. A rebound with a positive trend and a seasonal pattern was observed in period 3. Similar results were observed for CRD patients with no significant difference with pre-pandemic levels in the last period (−9.21%; −20.9% to 1.67%), albeit with differential changes according to the type of CRD.
Conclusions
COVID-19 pandemic containment measures contributed to changes in LRTI incidence, with a rapid increase and return to a seasonal pattern after their lifting, particularly in patients with CRD.
{"title":"Trends in hospitalisations for lower respiratory infections after the COVID-19 pandemic in France","authors":"Alexandre Sabaté-Elabbadi , Lucie Brolon , Christian Brun-Buisson , Didier Guillemot , Muriel Fartoukh , Laurence Watier","doi":"10.1016/j.jinf.2024.106287","DOIUrl":"10.1016/j.jinf.2024.106287","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the impact of the pandemic and post-pandemic periods on hospital admissions for LRTI, with a focus on patients with chronic respiratory disease (CRD).</div></div><div><h3>Methods</h3><div>From July 2013 to June 2023, monthly numbers of adult hospitalisations for LRTI (excluding SARS-CoV-2) were extracted from the French National Hospital Discharge Database. They were modelled by regressions with autocorrelated errors. Three periods were defined: (1) early pandemic and successive lockdowns; (2) gradual lifting of restrictions and widespread SARS-CoV-2 vaccination; (3) withdrawal of restriction measures.</div></div><div><h3>Results</h3><div>Pre-pandemic incidence was 96 (90.5 to 101.5) per 100,000 population. Compared with the pre-pandemic period, no more seasonality and significant reductions were estimated in the first two periods: −43.64% (−50.11 to −37.17) and −32.97% (−39.88 to −26.05), respectively. A rebound with a positive trend and a seasonal pattern was observed in period 3. Similar results were observed for CRD patients with no significant difference with pre-pandemic levels in the last period (−9.21%; −20.9% to 1.67%), albeit with differential changes according to the type of CRD.</div></div><div><h3>Conclusions</h3><div>COVID-19 pandemic containment measures contributed to changes in LRTI incidence, with a rapid increase and return to a seasonal pattern after their lifting, particularly in patients with CRD.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106287"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1016/j.jinf.2024.106283
Anthony D. Bai , Nick Daneman , Kevin A. Brown , J. Gordon Boyd , Sudeep S. Gill
Background
For bloodstream infections (BSI), treatment and research have focused on short term mortality. The objective of this study was to describe the 1-year mortality and morbidity in survivors of bloodstream infection when compared to patients with negative blood cultures.
Methods
We conducted a population-based retrospective cohort study using Ontario administrative databases. Patients were included if they had a blood culture taken from January 1, 2014, to December 31, 2021, and survived past 30 days from blood culture collection. They were followed for the subsequent year. Outcomes were compared among patients with BSI and those without BSI, including all-cause mortality, stroke, myocardial infarction (MI), congestive heart failure (CHF) exacerbation, new start dialysis and admission to a long-term care (LTC) facility. Prognostic factors were balanced using overlap weighting of propensity scores, and a survival or competing risk model was used to describe time-to-event.
Results
Of 981,341 patients undergoing blood culture testing, 99,080 (10.1%) patients had a BSI and 882,261 (89.9%) patients did not. Outcomes were all more common among those with BSI as compared to those without BSI, including all-cause mortality (16,764 [16.9%] vs. 84,480 [9.6%]), stroke (1016 [1.0%] vs. 4680 [0.5%]), MI (1043 [1.1%] vs. 4547 [0.5%]), CHF exacerbation (2643 [2.7%] vs. 13,200 [1.5%]), new start dialysis (1703 [1.7%] vs. 2749 [0.3%]), and LTC admission (4231 [4.3%] vs. 13,016 [1.5%]). BSI had an adjusted hazard ratio of 1.10 (95% CI 1.08–1.12, P < 0.0001) for mortality, subdistribution hazard ratio (sHR) of 1.27 (95% CI 1.19–1.37, P < 0.0001) for stroke, sHR of 1.18 (95% CI 1.10–1.26, P < 0.0001) for MI, sHR of 1.05 (95% CI 1.01–1.10, P = 0.0176) for CHF exacerbation, sHR of 3.42 (95% CI 3.21–3.64, P < 0.0001) for new start dialysis and sHR of 1.87 (95% CI 1.80–1.94, P < 0.0001) for LTC admission.
Conclusion
BSI survivors have substantial long-term mortality and morbidity including stroke, MI, new start dialysis and functional decline leading to LTC admission.
背景对于血流感染(BSI),治疗和研究的重点是短期死亡率。本研究旨在描述血流感染幸存者与血培养阴性患者相比的 1 年死亡率和发病率。在 2014 年 1 月 1 日至 2021 年 12 月 31 日期间进行过血培养并在血培养采集后 30 天内存活的患者均被纳入研究范围。随后一年对他们进行了随访。比较了有 BSI 和无 BSI 患者的结局,包括全因死亡率、中风、心肌梗死 (MI)、充血性心力衰竭 (CHF) 恶化、新开始透析和入住长期护理 (LTC) 机构。结果 在接受血液培养检测的 981,341 名患者中,99,080 名(10.1%)患者发生了 BSI,882,261 名(89.9%)患者没有发生 BSI。5%])、心肌梗死(1043 [1.1%] vs. 4547 [0.5%])、慢性阻塞性肺病恶化(2643 [2.7%] vs. 13,200 [1.5%])、新开始透析(1703 [1.7%] vs. 2749 [0.3%])和入住长期护理中心(4231 [4.3%] vs. 13,016 [1.5%])。BSI的调整后死亡率危险比为1.10(95% CI 1.08-1.12,P <0.0001),亚分布危险比(sHR)为1.27(95% CI 1.19-1.37,P <0.0001)。37, P < 0.0001),心肌梗死危险比(sHR)为 1.18 (95% CI 1.10-1.26, P < 0.0001),慢性阻塞性肺疾病恶化危险比(sHR)为 1.05 (95% CI 1.01-1.10, P = 0.0176),心肌梗死危险比(sHR)为 3.42 (95% CI 3.21-3.64, P < 0.0001);入住 LTC 的 sHR 为 1.87 (95% CI 1.80-1.94, P < 0.0001)。
{"title":"Long-term morbidity and mortality of patients who survived past 30 days from bloodstream infection: A population-based retrospective cohort study","authors":"Anthony D. Bai , Nick Daneman , Kevin A. Brown , J. Gordon Boyd , Sudeep S. Gill","doi":"10.1016/j.jinf.2024.106283","DOIUrl":"10.1016/j.jinf.2024.106283","url":null,"abstract":"<div><h3>Background</h3><div>For bloodstream infections (BSI), treatment and research have focused on short term mortality. The objective of this study was to describe the 1-year mortality and morbidity in survivors of bloodstream infection when compared to patients with negative blood cultures.</div></div><div><h3>Methods</h3><div>We conducted a population-based retrospective cohort study using Ontario administrative databases. Patients were included if they had a blood culture taken from January 1, 2014, to December 31, 2021, and survived past 30 days from blood culture collection. They were followed for the subsequent year. Outcomes were compared among patients with BSI and those without BSI, including all-cause mortality, stroke, myocardial infarction (MI), congestive heart failure (CHF) exacerbation, new start dialysis and admission to a long-term care (LTC) facility. Prognostic factors were balanced using overlap weighting of propensity scores, and a survival or competing risk model was used to describe time-to-event.</div></div><div><h3>Results</h3><div>Of 981,341 patients undergoing blood culture testing, 99,080 (10.1%) patients had a BSI and 882,261 (89.9%) patients did not. Outcomes were all more common among those with BSI as compared to those without BSI, including all-cause mortality (16,764 [16.9%] vs. 84,480 [9.6%]), stroke (1016 [1.0%] vs. 4680 [0.5%]), MI (1043 [1.1%] vs. 4547 [0.5%]), CHF exacerbation (2643 [2.7%] vs. 13,200 [1.5%]), new start dialysis (1703 [1.7%] vs. 2749 [0.3%]), and LTC admission (4231 [4.3%] vs. 13,016 [1.5%]). BSI had an adjusted hazard ratio of 1.10 (95% CI 1.08–1.12, P < 0.0001) for mortality, subdistribution hazard ratio (sHR) of 1.27 (95% CI 1.19–1.37, P < 0.0001) for stroke, sHR of 1.18 (95% CI 1.10–1.26, P < 0.0001) for MI, sHR of 1.05 (95% CI 1.01–1.10, P = 0.0176) for CHF exacerbation, sHR of 3.42 (95% CI 3.21–3.64, P < 0.0001) for new start dialysis and sHR of 1.87 (95% CI 1.80–1.94, P < 0.0001) for LTC admission.</div></div><div><h3>Conclusion</h3><div>BSI survivors have substantial long-term mortality and morbidity including stroke, MI, new start dialysis and functional decline leading to LTC admission.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106283"},"PeriodicalIF":14.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1016/j.jinf.2024.106281
Fergus Hamilton , Rebecca Evans , Peter Ghazal , Alasdair MacGowan
{"title":"Corrigendum to “Patients with transplantation have reduced mortality in bacteraemia: Analysis of data from a randomised trial” [J Infect 85 (2022) 17–23]","authors":"Fergus Hamilton , Rebecca Evans , Peter Ghazal , Alasdair MacGowan","doi":"10.1016/j.jinf.2024.106281","DOIUrl":"10.1016/j.jinf.2024.106281","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106281"},"PeriodicalIF":14.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}