IJID regions最新文献

Objectives

Methods

Results

Conclusions

Objectives

Methods

Results

Conclusions

Objectives

We used a multi-state model, which mitigates time-dependent bias, to estimate the mortality, length of stay (LOS), and costs of methicillin-resistant Staphylococcus aureus (MRSA) infections in Singapore.

Methods

We conducted a retrospective study in a hospital in Singapore from 2018 to 2022. Patients with MRSA infections were matched 1:1:3 to patients with MRSA colonization and patients without MRSA by age, gender, specialty, and intensive care admission, respectively. A multi-state model was used to derive excess LOS and mortality hazard ratios. The attributable cost of infections was estimated in 2022 Singapore dollars (SGDs) from the health care perspective.

Results

We matched 536 patients with MRSA infections to 536 patients with MRSA colonization, and to 1608 patients without MRSA. The excess LOS due to MRSA infection was 2.11 (95% confidence interval [CI] 2.05-2.17) days compared with MRSA colonization and 3.75 (95% CI 3.69-3.80) days compared with no MRSA, which translated to an excess cost of SGD $1825 and SGD $3238, respectively. Of the different MRSA infection types, pneumonia had the highest mortality risk (hazard ratio 4.13; 95% CI 2.28-7.50) compared with patients without MRSA.

Conclusions

MRSA infections increased hospital LOS and health care costs in Singapore. Our estimates can inform future economic analyses of management strategies against MRSA.

Objectives

Wastewater-based surveillance applied to SARS-CoV-2 viral load quantification for COVID-19 has become one of the most relevant complementary tools in epidemiologic prevention programs worldwide. However, this valuable decision-making tool still requires fine-tuning to produce comparable results between laboratories, especially when applied to the surveillance of megacities.

Methods

Six laboratories across Mexico and one from the United States executed an interlaboratory study to set up a singular standardized protocol considering method cost, installed infrastructure, materials available, and supply availability for SARS-CoV-2 quantification from five Mexico City sampling sites across this megacity.

Results

Comparable data from processing outcomes in the Mexican laboratories and in the external international laboratory serve as a validating data source. The Bland–Altman comparison showed consistency, with cycle threshold values within ±1.96 SD of SARS-CoV-2 genetic copies for the standard curve quantification, with a mismatch of two laboratories. In addition, MS2 bacteriophage recovery rates varied between 35% and 67% among all participating laboratories. Finally, the efficiency of viral genetic material recovered from all participating laboratories varied between 65% and 93% for the participating laboratories.

Conclusion

This work lays the foundation for extensive and continuous wastewater-based surveillance application across independent Mexican laboratories in a time- and resource-effective manner.

Objectives

Exudative pleural effusions have a broad etiology and usually necessitate further investigative workup, including invasive procedures. This study aimed to evaluate and compare the demographic, clinical, and biochemical characteristics of tuberculous, malignant, and chronic inflammatory pleural effusions.

Methods

This is a 2-year prospective cohort study of patients referred for medical thoracoscopy with an exudative pleural effusion.

Results

A total of 159 patients were enrolled in the study, with a mean age of 42.49 ± 13.8 years and the majority being males 121 (76.1%). As expected, patients with tuberculous effusions were significantly younger than those with non-tuberculous effusions (37.7 ± 10.9 vs 49.1 ± 14.9, P <0.001). Serum analysis showed significantly lower white blood cell count (7.5 × 10⁹/L ± 2.7 vs 9.0 × 10⁹/L ± 3.3, P = 0.004), higher total protein (76.2 g/dL ± 10.1 vs 70.2 g/dL ± 8.9, P <0.001), and higher median C-reactive protein (median 77.5, interquartile range 51-116 vs median 40.5, interquartile range 8-127, P <0.001) among tuberculous compared with non-tuberculosis effusions.

Conclusions

Our study validates previous findings showing similar results in patients with tuberculous pleural effusions. A predictive model incorporating different demographic and clinical/laboratory characteristics may be useful in the early etiologic characterization of exudative pleural effusion.

Objectives

To investigate the prevalence and risk factors associated with Helicobacter pylori infection in Vietnamese children.

Methods

Children under 16 years old with gastrointestinal symptoms underwent esophagogastroduodenoscopy and H. pylori infection was diagnosed using rapid urease test.

Results

A total of 246 children with gastrointestinal symptoms were included. The mean age was 8.4 ± 2.6 years. A total 81.3% tested positive for H. pylori. Children infected with H. pylori had a lower rate of nausea but a higher rate of lesions in the duodenal bulb and nodular lesions than children without H. pylori infection (26.5% vs 45.6%, P <0.01; 40.0% vs 23.9%; P = 0.04; and 68.5% vs 30.3%, P <0.0001, respectively). Compared with children aged under 5 years, children aged 11 years and older were four times more likely to be infected with H. pylori, with odds ratio (OR) 3.50, 95% confidence interval (CI) 1.07-11.39, P = 0.04. Washing hands with soap was associated with a reduced risk of H. pylori infection by three times (OR 0.35, 95% CI 0.17-0.69, P = 0.002). Children living in a family where members had a history of H. pylori infection were nine times more likely to be infected with H. pylori (OR 8.87, 95% CI 1.15-68.45, P = 0.04).

Conclusions

The prevalence of H. pylori infection in Vietnamese children with gastroenteritis is high. Our results identified several risk factors and emphasize the role of handwashing with soap before eating and after using the toilet in reducing the risk of H. pylori infection in children.

Malaria is a major public health problem in India, with ∼0.18 million cases reported in 2022 and 1,309 million population living at risk of infection. The Indian government has introduced various intervention strategies to reduce and manage the number of outbreaks with proper mechanisms. In this policy paper, we have extensively reviewed these intervention strategies using a quantitative approach. The success of the Urban Malaria Scheme, focusing on the 131 urban regions distributed across the country, along with the Intensified Malaria Control Project implemented in the seven hotspots, has been highlighted. The recently formulated National Framework for Malaria Elimination in India has resulted in declining malaria cases in hotspots like Odisha. However, states like West Bengal, Maharashtra, and Tripura have emerged as new hotspots in recent years. A systematic platform for data dissemination and active public-private partnership will expedite malaria elimination in India.

Objectives

Our aim was to describe the epidemiology and outcomes of multisystem inflammatory syndrome in children (MIS-C) in Latin America.

Methods

We conducted an observational, retrospective, and prospective multicenter study that gathered information from 84 participating centers across 16 Latin American countries between August 1, 2020 and June 30, 2022.

Results

Of the 1239 reported children with MIS-C, 84.18% were previously healthy. The most frequent clinical manifestation in our studied population was abdominal pain (N = 804, 64.9%), followed by conjunctival injection (N = 784, 63.3%). The median duration of fever at the time of hospital admission was 5 days and a significant number of subjects required admission to an intensive care unit (N = 589, 47.5%). Most of the subjects (N = 1096, 88.7%) were treated with intravenous immunoglobulin, whereas 76.7% (N = 947) were treated with steroids, of whom 10.6% (N = 100) did not receive intravenous immunoglobulin. The death rate attributed to MIS-C was 4.88%, with a rate of 3.39% for those initially diagnosed with MIS-C and 8.85% for those whose admission diagnosis was not MIS-C (P <0.001, odds ratio 2.76, 95% confidence interval 1.6-4.6).

Conclusions

One of the most significant findings from our study was the death rate, especially in those not initially diagnosed with MIS-C, in whom the rate was higher. This highlights the importance of increasing awareness and making an earlier diagnosis of MIS-C in Latin America.

Guillain–Barré syndrome is an immune-mediated acute demyelinating polyradiculoneuropathy, characterized by progressive flaccid weakness, triggered mainly by respiratory and gastrointestinal infections. We present the case of a 63-year-old male patient with a history of Ehrlichia infection, who consulted the internal medicine emergency department for lower back pain and progressive lower limb paresthesia, accompanied by decreased lower limb strength and nerve conduction velocity test, with results compatible with acute demyelinating sensorimotor polyradiculoneuropathy. To the best of our knowledge, this is the first documented case in Honduran medical literature; in our research, no other cases were found in Latin America or Europe. The importance of the topic and its dissemination in countries where Ehrlichia infection exists is that when cases of Guillain–Barré syndrome that cannot be associated with previous gastrointestinal or respiratory infection, they could be attributed to Ehrlichia infection as a possible cause; therefore, exhaustive preventive measures can be established regarding the transmitting vector of ehrlichiosis.

Objectives

In northeastern Syria (NES), the adherence of health care facilities to infection prevention and control (IPC) standards remains underexplored. This study evaluates the IPC performance of various health facilities against World Health Organization (WHO) benchmarks using the IPC Assessment Framework (IPCAF) and the Hand Hygiene Self-Assessment Framework (HHSAF).

Methods

We conducted a cross-sectional survey of 33 health care facilities, including primary (PHC), secondary (SHC), and tertiary health care centres (THC). Data were collected via on-site evaluations using the IPCAF and HHSAF tools.

Results

A significant 91% of facilities did not meet half of the WHO IPC minimum requirements. Specifically, 57% of PHCs met 26-50% of the standards, while none exceeded 75%. Among SHCs, 71% met 26-50% of the standards, while 44% of THCs fell within this range. Notably, 81.8% of facilities were classified as ‘inadequate’ per the IPCAF, with none achieving ‘intermediate’ or ‘advanced’ levels. The HHSAF results were similarly concerning, with 34.4% deemed ‘inadequate’ and 65.6% at the ‘basic’ level. A weak positive correlation (0.137) was found between IPCAF and HHSAF scores.

Conclusions

NES health care facilities demonstrate substantial deficiencies in IPC compliance, with critical gaps in IPC programmes, health care–associated infection surveillance, and training. Urgent interventions are required to enhance IPC practices, leveraging local strengths and fostering international collaborations to improve patient safety and health care quality in the region.