Andrew Purssell, Kennedy Leung, Pierre Giguère, J. B. Angel
Nucleoside analogue–resistant herpes simplex virus infections are increasingly observed especially in immunocompromised patients. Currently, other options for treatment such as foscarnet and cidofovir are limited by difficulty of administration and significant risk of toxicity. Our report describes use of pritelivir, a novel helicase-primase inhibitor, in the treatment of nucleoside analogue–refractory orolabial HSV-2 infection. In 2017, a 53-year-old male with HIV on therapy presented with swelling of the right upper lip and a solid lesion inferior to the right nostril. Biopsy revealed cytopathic effects and immunohistochemistry staining confirming herpes simplex virus infection. The patient received multiple treatment courses including nucleoside analogue therapy, topical and intravenous foscarnet and cidofovir, and topical imiquimod but these failed to establish a significant and durable therapeutic response. A swab of the lesion tested positive for HSV-2 via PCR. Subsequent genotyping revealed a M183X mutation in UL23 expected to convey resistance to acyclovir and penciclovir. The patient was started on oral pritelivir 400 mg once followed by 100 mg daily for 27 days, obtained through Health Canada's Special Access Program, resulting in near complete resolution of the lesion. Pritelivir is a novel helicase-primase inhibitor that appears to be an attractive option for management of resistant herpes simplex infections due to its unique mechanism, excellent oral bioavailability, and minimal toxicity. To our knowledge, this is the first described case of treatment of nucleoside analogue–resistant orolabial herpes simplex 2 infection with pritelivir and the first documented use of pritelivir in Canada.
{"title":"Pritelivir for the treatment of nucleoside analogue–resistant orolabial herpes simplex virus 2 in a person living with HIV","authors":"Andrew Purssell, Kennedy Leung, Pierre Giguère, J. B. Angel","doi":"10.3138/jammi-2023-0028","DOIUrl":"https://doi.org/10.3138/jammi-2023-0028","url":null,"abstract":"Nucleoside analogue–resistant herpes simplex virus infections are increasingly observed especially in immunocompromised patients. Currently, other options for treatment such as foscarnet and cidofovir are limited by difficulty of administration and significant risk of toxicity. Our report describes use of pritelivir, a novel helicase-primase inhibitor, in the treatment of nucleoside analogue–refractory orolabial HSV-2 infection. In 2017, a 53-year-old male with HIV on therapy presented with swelling of the right upper lip and a solid lesion inferior to the right nostril. Biopsy revealed cytopathic effects and immunohistochemistry staining confirming herpes simplex virus infection. The patient received multiple treatment courses including nucleoside analogue therapy, topical and intravenous foscarnet and cidofovir, and topical imiquimod but these failed to establish a significant and durable therapeutic response. A swab of the lesion tested positive for HSV-2 via PCR. Subsequent genotyping revealed a M183X mutation in UL23 expected to convey resistance to acyclovir and penciclovir. The patient was started on oral pritelivir 400 mg once followed by 100 mg daily for 27 days, obtained through Health Canada's Special Access Program, resulting in near complete resolution of the lesion. Pritelivir is a novel helicase-primase inhibitor that appears to be an attractive option for management of resistant herpes simplex infections due to its unique mechanism, excellent oral bioavailability, and minimal toxicity. To our knowledge, this is the first described case of treatment of nucleoside analogue–resistant orolabial herpes simplex 2 infection with pritelivir and the first documented use of pritelivir in Canada.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":" 347","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141823711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meika EI Richmond, William Hoang, M. Shuel, Joshua Titus, Paul Van Caeseele, Derek R Stein, R. Tsang
Syphilis infections are increasing in Canada, and traditional serological diagnostics pose barriers for vulnerable and marginalized populations at greatest risk. Point-of-care tests (POCTs) offer solutions, yet none were available in Canada until recently. The Chembio Dual Path Platform (DPP) Syphilis Screen & Confirm (SSC) is one of the first POCTs that helps distinguish active infection from non-infectious syphilis. This study evaluates the reliability of the Chembio DPP SSC to diagnose syphilis infection. One hundred clinical samples with known syphilis serology (chemiluminescent microparticle immunoassay [CMIA] and rapid plasma regain [RPR]) results were used to evaluate the Chembio DPP SSC. CMIA–ve (n = 20), CMIA+ve RPR–ve (n = 40), and CMIA+ve RPR+ve (n = 40) samples represented negative, past, and presumed active infection, respectively. Samples were used in two formats: serum and simulated blood. Two laboratory technicians read the test visually, and with the manufacturer's DPP Micro Reader, in blinded fashion. Overall sensitivity of the Chembio DPP SSC to distinguish presumed active infection from non-infectious syphilis (past infection and no infection) with visual reads were 52.50% (serum) and 55.00% (simulated blood). Sensitivity increased using the DPP Micro Reader to 90.00% (serum) and 97.50% (simulated blood). Specificity with visual reads were 98.33% (serum) and 95.00% (simulated blood) compared to Micro Reader results of 88.30% (serum) and 80.00% (simulated blood). For the non-treponemal portion of the POCT with visual reads, the sensitivity increased with increasing RPR titers. Low RPR titers <1:4 only had a sensitivity of 42.86% (serum) and 14.29% (simulated blood). The laboratory evaluation of the Chembio DPP SSC shows promise in detecting active syphilis, particularly in samples with RPR titers >1:4. However, the need for the Micro Reader for more accurate results is a limitation of the POCT, and financial constraints may pose barriers to some users. Further field evaluation is warranted.
{"title":"Laboratory evaluation of the Chembio DPP Syphilis Screen & Confirm point-of-care test on serum and simulated blood samples","authors":"Meika EI Richmond, William Hoang, M. Shuel, Joshua Titus, Paul Van Caeseele, Derek R Stein, R. Tsang","doi":"10.3138/jammi-2023-0035","DOIUrl":"https://doi.org/10.3138/jammi-2023-0035","url":null,"abstract":"Syphilis infections are increasing in Canada, and traditional serological diagnostics pose barriers for vulnerable and marginalized populations at greatest risk. Point-of-care tests (POCTs) offer solutions, yet none were available in Canada until recently. The Chembio Dual Path Platform (DPP) Syphilis Screen & Confirm (SSC) is one of the first POCTs that helps distinguish active infection from non-infectious syphilis. This study evaluates the reliability of the Chembio DPP SSC to diagnose syphilis infection. One hundred clinical samples with known syphilis serology (chemiluminescent microparticle immunoassay [CMIA] and rapid plasma regain [RPR]) results were used to evaluate the Chembio DPP SSC. CMIA–ve (n = 20), CMIA+ve RPR–ve (n = 40), and CMIA+ve RPR+ve (n = 40) samples represented negative, past, and presumed active infection, respectively. Samples were used in two formats: serum and simulated blood. Two laboratory technicians read the test visually, and with the manufacturer's DPP Micro Reader, in blinded fashion. Overall sensitivity of the Chembio DPP SSC to distinguish presumed active infection from non-infectious syphilis (past infection and no infection) with visual reads were 52.50% (serum) and 55.00% (simulated blood). Sensitivity increased using the DPP Micro Reader to 90.00% (serum) and 97.50% (simulated blood). Specificity with visual reads were 98.33% (serum) and 95.00% (simulated blood) compared to Micro Reader results of 88.30% (serum) and 80.00% (simulated blood). For the non-treponemal portion of the POCT with visual reads, the sensitivity increased with increasing RPR titers. Low RPR titers <1:4 only had a sensitivity of 42.86% (serum) and 14.29% (simulated blood). The laboratory evaluation of the Chembio DPP SSC shows promise in detecting active syphilis, particularly in samples with RPR titers >1:4. However, the need for the Micro Reader for more accurate results is a limitation of the POCT, and financial constraints may pose barriers to some users. Further field evaluation is warranted.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":"121 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David C. Alexander, Muhammad Morshed, Derek R Stein, Jared Bullard, Keith MacKenzie, R. Tsang
In Canada, the recent resurgence of infectious syphilis and rising rates of congenital syphilis have renewed interest in direct detection methods for the laboratory diagnosis of syphilis. The Canadian Public Health Laboratory Network (CPHLN) has previously published a series of guidelines for the diagnosis of syphilis in Canada, including the use of direct tests. In the decade since those guidelines were published, laboratory practice has changed. This systematized review combined a literature search (MEDLINE) of methods for direct detection of Treponema pallidum with an informal survey of current testing practices in Canadian public health laboratories. Direct testing methods have favourable performance characteristics for detection of early syphilis and congenital cases. Although no government licensed commercial nucleic acid amplification test (NAAT) for syphilis is available in Canada, laboratory-developed tests have been implemented in multiple Canadian jurisdictions. Clinical specimens with the highest yield of positive NAAT results for syphilis include genital ulcers, skin lesions, and oral swabs from primary and secondary syphilis patients. For investigation of congenital syphilis, nasopharyngeal, placenta, umbilical cord, blood, and skin lesions are specimens of choice for direct detection of T. pallidum by NAAT. This update on the status of direct testing highlights the importance of NAAT for the detection of T. pallidum, the reduced role of microscopy-based methods, and the emergence of DNA and genome sequencing as tools for phylogenetic analysis and molecular epidemiology.
在加拿大，近期传染性梅毒的重新抬头和先天性梅毒发病率的上升，再次引起了人们对梅毒实验室诊断直接检测方法的关注。加拿大公共卫生实验室网络（Canadian Public Health Laboratory Network，CPHLN）曾发布了一系列加拿大梅毒诊断指南，其中包括直接检测法的使用。在这些指南发布后的十年间，实验室实践发生了变化。本系统化综述结合了对直接检测苍白螺旋体特雷玻尼马方法的文献检索（MEDLINE）和对加拿大公共卫生实验室当前检测方法的非正式调查。直接检测方法在检测早期梅毒和先天性梅毒病例方面具有良好的性能特点。虽然加拿大没有政府许可的梅毒商业核酸扩增检测（NAAT），但实验室开发的检测方法已在加拿大多个辖区使用。梅毒核酸扩增试验阳性率最高的临床标本包括生殖器溃疡、皮损以及原发性和继发性梅毒患者的口腔拭子。在调查先天性梅毒时，鼻咽、胎盘、脐带、血液和皮肤病变是通过 NAAT 直接检测苍白螺旋体的首选标本。本报告对直接检测的现状进行了更新，强调了 NAAT 对检测苍白螺旋体的重要性、显微镜方法作用的减弱，以及 DNA 和基因组测序作为系统发生学分析和分子流行病学工具的出现。
{"title":"An update on the status of direct testing for Treponema pallidum subspecies pallidum for the laboratory diagnosis of syphilis in Canada","authors":"David C. Alexander, Muhammad Morshed, Derek R Stein, Jared Bullard, Keith MacKenzie, R. Tsang","doi":"10.3138/jammi-2023-0032","DOIUrl":"https://doi.org/10.3138/jammi-2023-0032","url":null,"abstract":"In Canada, the recent resurgence of infectious syphilis and rising rates of congenital syphilis have renewed interest in direct detection methods for the laboratory diagnosis of syphilis. The Canadian Public Health Laboratory Network (CPHLN) has previously published a series of guidelines for the diagnosis of syphilis in Canada, including the use of direct tests. In the decade since those guidelines were published, laboratory practice has changed. This systematized review combined a literature search (MEDLINE) of methods for direct detection of Treponema pallidum with an informal survey of current testing practices in Canadian public health laboratories. Direct testing methods have favourable performance characteristics for detection of early syphilis and congenital cases. Although no government licensed commercial nucleic acid amplification test (NAAT) for syphilis is available in Canada, laboratory-developed tests have been implemented in multiple Canadian jurisdictions. Clinical specimens with the highest yield of positive NAAT results for syphilis include genital ulcers, skin lesions, and oral swabs from primary and secondary syphilis patients. For investigation of congenital syphilis, nasopharyngeal, placenta, umbilical cord, blood, and skin lesions are specimens of choice for direct detection of T. pallidum by NAAT. This update on the status of direct testing highlights the importance of NAAT for the detection of T. pallidum, the reduced role of microscopy-based methods, and the emergence of DNA and genome sequencing as tools for phylogenetic analysis and molecular epidemiology.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":"111 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"If a tree falls in the forest: Publication inflation in infectious diseases","authors":"Kevin B. Laupland, Y. Keynan","doi":"10.3138/jammi-2024-0209","DOIUrl":"https://doi.org/10.3138/jammi-2024-0209","url":null,"abstract":"","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana C. Blanchard, Stephanie Zahradnik, Sandra Isabel, Kayur Mehta, Mohsin Ali, Adriana Airo, L. Streitenberger, Renee Freeman, Yvonne CW Yau, Aaron Campigotto, Manal Tadros, Michelle Science
The epidemiology of carbapenemase-producing Enterobacterales (CPE) in hospitalized children in low endemicity settings is not well known. We aim to describe it in a large tertiary paediatric health care centre in Canada. A repeated point-prevalence study including all inpatients was conducted at the Hospital for Sick Children, Toronto, for surveillance purposes over 3 days serially in April 2017, April 2019, and April 2022. Patients in the emergency department and medical day units were excluded. Stools or rectal swabs were analyzed for CPE identification, with confirmatory testing at the provincial reference laboratory. We detected CPE colonization in 0.4% (1/242), 0.7% (2/278), and 0.9% (2/220) of inpatients in 2017, 2019, and 2022, respectively. Identified CPE included OXA-48-like and NDM beta-lactamases in Escherichia coli and Klebsiella pneumoniae. All patients with CPE colonization had a history of travel or hospitalization outside of Canada, including in the Middle East and Asia. CPE colonization in children hospitalized in this Canadian hospital was detected. A history of prolonged travel or hospitalization outside of Canada are risk factors that should be considered in targeted screening programs.
{"title":"Epidemiology of carbapenemase-producing Enterobacterales carriage in a paediatric tertiary health care centre of Ontario, Canada","authors":"Ana C. Blanchard, Stephanie Zahradnik, Sandra Isabel, Kayur Mehta, Mohsin Ali, Adriana Airo, L. Streitenberger, Renee Freeman, Yvonne CW Yau, Aaron Campigotto, Manal Tadros, Michelle Science","doi":"10.3138/jammi-2023-0037","DOIUrl":"https://doi.org/10.3138/jammi-2023-0037","url":null,"abstract":"The epidemiology of carbapenemase-producing Enterobacterales (CPE) in hospitalized children in low endemicity settings is not well known. We aim to describe it in a large tertiary paediatric health care centre in Canada. A repeated point-prevalence study including all inpatients was conducted at the Hospital for Sick Children, Toronto, for surveillance purposes over 3 days serially in April 2017, April 2019, and April 2022. Patients in the emergency department and medical day units were excluded. Stools or rectal swabs were analyzed for CPE identification, with confirmatory testing at the provincial reference laboratory. We detected CPE colonization in 0.4% (1/242), 0.7% (2/278), and 0.9% (2/220) of inpatients in 2017, 2019, and 2022, respectively. Identified CPE included OXA-48-like and NDM beta-lactamases in Escherichia coli and Klebsiella pneumoniae. All patients with CPE colonization had a history of travel or hospitalization outside of Canada, including in the Middle East and Asia. CPE colonization in children hospitalized in this Canadian hospital was detected. A history of prolonged travel or hospitalization outside of Canada are risk factors that should be considered in targeted screening programs.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":" 842","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141823481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrick Benoit, Stephanie Wang, Catherine Wang, Arpita Chakravarti, Julian A Villalba, I. Ali, Shantanu Roy, Sarah GH Sapp, Sarah Reagan-Steiner, Kristoff Nelson, Romain Cayrol, Me-Linh Luong, Sophie Grand'Maison, Michaël Desjardins
Free-living amoebas (FLA) can cause severe and fatal central nervous system infections that are difficult to diagnose. We present the case of a 74-year-old immunocompetent woman admitted for focal neurological symptoms with enhancing lesions in the right cerebellar hemisphere. A first cerebral biopsy showed granulomatous inflammation, but no microorganisms were identified. After transient clinical improvement, she eventually deteriorated 4 months after initial presentation, with an MRI confirming multiple new masses affecting all cerebral lobes. A second brain biopsy revealed granulomatous and acute inflammation with organisms containing a large central nucleus with prominent karyosome, consistent with free-living amoebas. Immunohistochemical and polymerase chain reaction assays performed at CDC were positive for Acanthamoeba spp., confirming the diagnosis of granulomatous amoebic encephalitis (GAE) caused by Acanthamoeba spp. The patient was treated with combination therapy recommended by CDC, but unfortunately died a few days later. Upon histopathological rereview, amoebic cysts and trophozoites were identified by histochemical and immunohistochemical methods in the first cerebral biopsy. FLA infections can be challenging to diagnose because of the low incidence, the non-specific clinical and radiological presentation, the lack of accessible diagnostic tools, and clinicians’ unfamiliarity. This case highlights the importance of recognizing FLA as a potential cause of granulomatous encephalitis, even in the absence of risk factors, as early treatment might be associated with favorable outcomes in case reports. When suspected, CDC laboratories offer tests to confirm the diagnosis promptly.
{"title":"Brainstorm: A case of granulomatous encephalitis","authors":"Patrick Benoit, Stephanie Wang, Catherine Wang, Arpita Chakravarti, Julian A Villalba, I. Ali, Shantanu Roy, Sarah GH Sapp, Sarah Reagan-Steiner, Kristoff Nelson, Romain Cayrol, Me-Linh Luong, Sophie Grand'Maison, Michaël Desjardins","doi":"10.3138/jammi-2023-0036","DOIUrl":"https://doi.org/10.3138/jammi-2023-0036","url":null,"abstract":"Free-living amoebas (FLA) can cause severe and fatal central nervous system infections that are difficult to diagnose. We present the case of a 74-year-old immunocompetent woman admitted for focal neurological symptoms with enhancing lesions in the right cerebellar hemisphere. A first cerebral biopsy showed granulomatous inflammation, but no microorganisms were identified. After transient clinical improvement, she eventually deteriorated 4 months after initial presentation, with an MRI confirming multiple new masses affecting all cerebral lobes. A second brain biopsy revealed granulomatous and acute inflammation with organisms containing a large central nucleus with prominent karyosome, consistent with free-living amoebas. Immunohistochemical and polymerase chain reaction assays performed at CDC were positive for Acanthamoeba spp., confirming the diagnosis of granulomatous amoebic encephalitis (GAE) caused by Acanthamoeba spp. The patient was treated with combination therapy recommended by CDC, but unfortunately died a few days later. Upon histopathological rereview, amoebic cysts and trophozoites were identified by histochemical and immunohistochemical methods in the first cerebral biopsy. FLA infections can be challenging to diagnose because of the low incidence, the non-specific clinical and radiological presentation, the lack of accessible diagnostic tools, and clinicians’ unfamiliarity. This case highlights the importance of recognizing FLA as a potential cause of granulomatous encephalitis, even in the absence of risk factors, as early treatment might be associated with favorable outcomes in case reports. When suspected, CDC laboratories offer tests to confirm the diagnosis promptly.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":"105 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141352102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel Wong, Jennifer Ziegler, Dhiraj S Bal, Sylvain A Lother, Premal Patel, Barret Rush
Sepsis secondary to obstructive uropathy is a urological emergency that requires urgent decompression using placement of a percutaneous nephrostomy tube (PCN) or retrograde ureteric stent (RUS). Whether selection of PCN or RUS impacts mortality remains uncertain. We conducted a retrospective cohort analysis using the 2006–2014 Nationwide Inpatient Sample (NIS) of 34,009 patients with sepsis and obstructive uropathy who were treated with RUS or PCN. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, need for mechanical ventilation and dialysis. Multivariate logistic regression and propensity matched analyses were used to evaluate the effect of PCN or RUS on in-hospital mortality. A total of 9,828 (28.9%) patients were treated with PCN and 24,181 (71.1%) with RUS. The unadjusted mortality for PCN versus RUN patients was 5.3% compared with 2.8%. Those treated with PCN had a higher likelihood of requiring mechanical ventilation or hemodialysis. In the multivariate logistic regression analysis, RUS had lower odds of mortality compared to PCN (OR 0.72, 95% CI 0.63–0.83, p < 0.01). After propensity score matching, the mortality for the RUS group was 3.4% and 4.0% in the PCN group ( p = 0.19). There were no significant differences in mortality for patients treated with PCN or RUS after propensity matching. Method of decompression should be guided by local practice. Further prospective randomized trials are needed.
继发于梗阻性尿路病的败血症是一种泌尿科急症，需要通过放置经皮肾造瘘管（PCN）或逆行输尿管支架（RUS）进行紧急减压。选择 PCN 或 RUS 是否会影响死亡率仍不确定。我们利用 2006-2014 年全国住院患者样本 (NIS) 对 34009 名接受 RUS 或 PCN 治疗的脓毒症和梗阻性尿病患者进行了回顾性队列分析。主要结果是院内死亡率。次要结果包括住院时间、机械通气需求和透析需求。多变量逻辑回归和倾向匹配分析用于评估 PCN 或 RUS 对院内死亡率的影响。共有 9828 名患者（28.9%）接受了 PCN 治疗，24181 名患者（71.1%）接受了 RUS 治疗。PCN 与 RUN 相比，未经调整的死亡率分别为 5.3% 和 2.8%。接受 PCN 治疗的患者需要机械通气或血液透析的可能性更高。在多变量逻辑回归分析中，与 PCN 相比，RUS 的死亡率较低（OR 0.72，95% CI 0.63-0.83，P <0.01）。经过倾向评分匹配后，RUS 组的死亡率为 3.4%，PCN 组为 4.0% ( p = 0.19)。倾向匹配后，PCN 或 RUS 治疗患者的死亡率无明显差异。减压方法应根据当地实际情况而定。需要进一步开展前瞻性随机试验。
{"title":"Nephrostomy tube versus ureteral stent for obstructing septic calculi: A nationwide propensity score-matched analysis","authors":"Rachel Wong, Jennifer Ziegler, Dhiraj S Bal, Sylvain A Lother, Premal Patel, Barret Rush","doi":"10.3138/jammi-2023-0030","DOIUrl":"https://doi.org/10.3138/jammi-2023-0030","url":null,"abstract":"Sepsis secondary to obstructive uropathy is a urological emergency that requires urgent decompression using placement of a percutaneous nephrostomy tube (PCN) or retrograde ureteric stent (RUS). Whether selection of PCN or RUS impacts mortality remains uncertain. We conducted a retrospective cohort analysis using the 2006–2014 Nationwide Inpatient Sample (NIS) of 34,009 patients with sepsis and obstructive uropathy who were treated with RUS or PCN. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, need for mechanical ventilation and dialysis. Multivariate logistic regression and propensity matched analyses were used to evaluate the effect of PCN or RUS on in-hospital mortality. A total of 9,828 (28.9%) patients were treated with PCN and 24,181 (71.1%) with RUS. The unadjusted mortality for PCN versus RUN patients was 5.3% compared with 2.8%. Those treated with PCN had a higher likelihood of requiring mechanical ventilation or hemodialysis. In the multivariate logistic regression analysis, RUS had lower odds of mortality compared to PCN (OR 0.72, 95% CI 0.63–0.83, p < 0.01). After propensity score matching, the mortality for the RUS group was 3.4% and 4.0% in the PCN group ( p = 0.19). There were no significant differences in mortality for patients treated with PCN or RUS after propensity matching. Method of decompression should be guided by local practice. Further prospective randomized trials are needed.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":"47 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141269875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariana Saatchi, Michael Silverman, Salimah Z. Shariff, David M Patrick, Andrew M Morris, Jennifer N. Reid, M. Povitz, James McCormack, Fawziah Lalji
Urinary tract infections (UTI) are responsible for a significant portion of female, outpatient antibiotic prescriptions. Especially true in uncomplicated cases, where symptoms remain the cornerstone of diagnosis, ensuring the optimal choice of agent, dose and duration may mitigate future bacterial resistance, and lower the likelihood of adverse events and/or recurrence. This study is the first in Canada to examine the quality of antibiotic prescribing to females in the outpatient setting, for uncomplicated UTI–by agent, dose, and duration. All adult female residents of British Columbia with a physician record for cystitis from January 1, 2014 to December 31, 2018 were identified. Patients with a history of urologic abnormalities, spinal cord injury, catheter use, kidney transplant, as well as pregnant females, were excluded. Primary outcomes included the proportion of total episodes prescribed and the proportion of appropriate antibiotic use, examined using Poisson regression. A total of 182,162 episodes of cystitis were examined with 70% receiving an antibiotic prescription. The rate of cystitis-associated prescribing was 697 prescriptions per 1000 population. Overall, 35% of prescriptions were appropriate by guideline adherence, or clinical justification. Nitrofurantoin and trimethoprim-sulfamethoxazole, accounted for 71% of total antibiotic use. Seven days was the most commonly dispensed duration of therapy, followed by 5, then 10. Shortening length of therapy in line with clinical guidelines, and encouraging the use of first line agents, present clear, actionable targets for provincial stewardship efforts.
{"title":"Quality of antibiotic prescribing for outpatient cystitis in adult females","authors":"Ariana Saatchi, Michael Silverman, Salimah Z. Shariff, David M Patrick, Andrew M Morris, Jennifer N. Reid, M. Povitz, James McCormack, Fawziah Lalji","doi":"10.3138/jammi-2023-0031","DOIUrl":"https://doi.org/10.3138/jammi-2023-0031","url":null,"abstract":"Urinary tract infections (UTI) are responsible for a significant portion of female, outpatient antibiotic prescriptions. Especially true in uncomplicated cases, where symptoms remain the cornerstone of diagnosis, ensuring the optimal choice of agent, dose and duration may mitigate future bacterial resistance, and lower the likelihood of adverse events and/or recurrence. This study is the first in Canada to examine the quality of antibiotic prescribing to females in the outpatient setting, for uncomplicated UTI–by agent, dose, and duration. All adult female residents of British Columbia with a physician record for cystitis from January 1, 2014 to December 31, 2018 were identified. Patients with a history of urologic abnormalities, spinal cord injury, catheter use, kidney transplant, as well as pregnant females, were excluded. Primary outcomes included the proportion of total episodes prescribed and the proportion of appropriate antibiotic use, examined using Poisson regression. A total of 182,162 episodes of cystitis were examined with 70% receiving an antibiotic prescription. The rate of cystitis-associated prescribing was 697 prescriptions per 1000 population. Overall, 35% of prescriptions were appropriate by guideline adherence, or clinical justification. Nitrofurantoin and trimethoprim-sulfamethoxazole, accounted for 71% of total antibiotic use. Seven days was the most commonly dispensed duration of therapy, followed by 5, then 10. Shortening length of therapy in line with clinical guidelines, and encouraging the use of first line agents, present clear, actionable targets for provincial stewardship efforts.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":"28 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141270787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thanks to Our Peer Reviewers","authors":"","doi":"10.3138/jammi.8.4.rev","DOIUrl":"https://doi.org/10.3138/jammi.8.4.rev","url":null,"abstract":"","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139619635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy Brown, H. Jefferson, Peter Daley, William DT. Kent, Duncan Webster, Corey Adams
Prolonged intravenous (IV) antibiotic therapy may not be optimal for people who inject drugs (PWID) with infective endocarditis (IE) due to unique social and medical needs. The role of partial IV antibiotic therapy with continued oral (PO) antibiotic therapy is unclear. A systematic review was performed using EMBASE and MEDLINE databases. Included studies compared PO to IV antibiotic treatment for IE in PWID. Four studies met eligibility. Observational studies included full IV treatment groups and partial IV, partial PO treatment groups for severe injection related infections. PWID with IE comprised 41.0%–64.7% of the study populations but outcomes specific to IE were not separately reported. All-cause 90-day readmission rates were comparable between the IV treatment group (27.9%–31.5%) and partial IV, partial PO treatment group (24.8%–32.5%). 90-day mortality was non-significantly different between IV treatment (4.9%–10.7%) and partial IV, partial PO treatment groups (2.4%–13.0%). One small randomized clinical trial compared IV oxacillin or vancomycin with gentamicin to PO ciprofloxacin plus rifampin. The cure rates were 91% and 90%, respectively. There is limited evidence comparing IV treatment to partial IV, partial PO antibiotic treatment in PWID with IE. Observational studies suggest that PO antibiotic therapy after initial IV treatment may be equivalent to full IV treatment alone within specific parameters, but randomized trials are needed to inform recommendations. Substantial clinical and social benefits for PWID and advantages for the healthcare system will result if PO treatment strategies with equal efficacy can be implemented.
由于独特的社会和医疗需求，对于感染性心内膜炎（IE）的注射吸毒者（PWID）来说，长时间静脉注射抗生素治疗可能并非最佳选择。部分静脉注射抗生素治疗和持续口服（PO）抗生素治疗的作用尚不明确。我们使用 EMBASE 和 MEDLINE 数据库进行了一项系统性综述。纳入的研究比较了针对吸毒者 IE 的口服和静脉注射抗生素治疗。有四项研究符合要求。观察性研究包括针对严重注射相关感染的完全静脉注射治疗组和部分静脉注射、部分 PO 治疗组。感染 IE 的吸毒者占研究人群的 41.0%-64.7% ，但未单独报告 IE 的具体结果。静脉注射治疗组（27.9%-31.5%）和部分静脉注射、部分口服药物治疗组（24.8%-32.5%）的全因 90 天再入院率相当。静脉注射治疗组（4.9%-10.7%）和部分静脉注射、部分口服药物治疗组（2.4%-13.0%）的 90 天死亡率无显著差异。一项小型随机临床试验比较了静脉注射氧氟沙星或万古霉素加庆大霉素与口服环丙沙星加利福平。治愈率分别为 91% 和 90%。在感染 IE 的吸毒者中，将静脉注射治疗与部分静脉注射、部分口服抗生素治疗进行比较的证据有限。观察性研究表明，在特定参数范围内，初始静脉注射治疗后的 PO 抗生素治疗可能等同于完全静脉注射治疗，但仍需进行随机试验，以便为建议提供依据。如果能够实施具有同等疗效的 PO 治疗策略，将为感染者带来巨大的临床和社会效益，并为医疗保健系统带来好处。
{"title":"Partial oral versus full intravenous antibiotic treatment of endocarditis in people who inject drugs: A systematic review","authors":"Amy Brown, H. Jefferson, Peter Daley, William DT. Kent, Duncan Webster, Corey Adams","doi":"10.3138/jammi-2023-0013","DOIUrl":"https://doi.org/10.3138/jammi-2023-0013","url":null,"abstract":"Prolonged intravenous (IV) antibiotic therapy may not be optimal for people who inject drugs (PWID) with infective endocarditis (IE) due to unique social and medical needs. The role of partial IV antibiotic therapy with continued oral (PO) antibiotic therapy is unclear. A systematic review was performed using EMBASE and MEDLINE databases. Included studies compared PO to IV antibiotic treatment for IE in PWID. Four studies met eligibility. Observational studies included full IV treatment groups and partial IV, partial PO treatment groups for severe injection related infections. PWID with IE comprised 41.0%–64.7% of the study populations but outcomes specific to IE were not separately reported. All-cause 90-day readmission rates were comparable between the IV treatment group (27.9%–31.5%) and partial IV, partial PO treatment group (24.8%–32.5%). 90-day mortality was non-significantly different between IV treatment (4.9%–10.7%) and partial IV, partial PO treatment groups (2.4%–13.0%). One small randomized clinical trial compared IV oxacillin or vancomycin with gentamicin to PO ciprofloxacin plus rifampin. The cure rates were 91% and 90%, respectively. There is limited evidence comparing IV treatment to partial IV, partial PO antibiotic treatment in PWID with IE. Observational studies suggest that PO antibiotic therapy after initial IV treatment may be equivalent to full IV treatment alone within specific parameters, but randomized trials are needed to inform recommendations. Substantial clinical and social benefits for PWID and advantages for the healthcare system will result if PO treatment strategies with equal efficacy can be implemented.","PeriodicalId":509806,"journal":{"name":"Journal of the Association of Medical Microbiology and Infectious Disease Canada","volume":"24 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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