Infectious diseases (London, England)最新文献

The COVID pandemic significantly impacted intensive care unit (ICU) antibiotic con sumption (AMC) and resistance (AMR). This study examines these effects over a 6-year period in 6 French ICUs.

Objectives: To evaluate the impact of the COVID pandemic on AMC and AMR in ICUs, focusing on changes in consumption patterns and bacterial resistance profiles.

Methods: Data were prospectively collected from 3 university hospitals, covering 6ICUs. The study compared two periods: before (2017-2019: befPAND period) and during (2020-2022: perPAND period) the pandemic. Antibiotic consumption was measured using Defined Daily Doses (DDD) globally per unit and per 1,000 patient-days in each unit. Antibiotic resistance was assessed from bacterial cultures from selected clinical cultures taken from ICU patients. Statistical analysis compared trends between the two periods.

Results: Total antibiotic consumption of all units increased by 28% during the pandemic period, but DDD/1000 patient-days of all units remained stable. There was an increase in the use of broad-spectrum antibiotics, particularly those classified as 'Reserve' by the WHO (5.6% to 9.6%, p < 0.0001).The number of positive cultures increased in the perPAND period for Staphylococcus epidermidis, Enterobacter sp., and Pseudomonas aeruginosa. Resistance levels showed an increase in Enterococcus species, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia, while methicillin-resistant Staphylococcus aureus and 3rd generation cephalosporins enterobacterales resistance remained stable.

Conclusions: The COVID pandemic increased the overall antibiotic consumption, but not the 1000-patients-day consumption in ICUs. However, one of the main effects was to shift usage towards more broad-spectrum antibiotics, which may contribute to growing resistance.

Background: Many countries reported declines in acute respiratory infections (ARIs) following public health and social measures to mitigate COVID-19.

Objectives: We describe the potential association with pandemic restrictions on the occurrence of non-COVID ARIs in Greenland, which experienced a late but sudden introduction of COVID-19.

Methods: We included national electronic medical records on ARIs in Greenland across three periods: pre-pandemic (January 2018-February 2020), pandemic (March 2020-June 2022), and endemic (July 2022-December 2023). Severe ARIs were defined using a case definition based on ICD-10/ICPC-2-R codes. Oral penicillin prescriptions served as a proxy for mild ARIs due to limited primary care data. We calculated ARI incidence and used Poisson regression to compare periods. Data on Influenza A/B and RSV PCR testing activity and results were included.

Results: During the pandemic, all ARIs decreased by 14% (IRR 0.86 [95% CI 0.84-0.88]) compared to pre-pandemic levels. In the endemic period, mild ARIs increased by 3% (IRR 1.03 [95% CI 1.02-1.06]), while severe ARIs increased by 40% (IRR 1.40 [95% CI 1.22-1.60]). The Influenza A/B positive rate declined during the pandemic (20.7% to 8.3%) but increased in the endemic period (14.2%), whereas RSV positive rate increased during the pandemic (19.8% to 57.2%).

Conclusions: We observed declines in mild and severe ARIs during the pandemic in Greenland. Unlike many other countries, mild ARIs did not rise during the endemic period, likely due to preventive travel measures limiting the spread of SARS-CoV-2 while allowing ongoing exposure to other respiratory viruses in society, preventing an infection rebound.

Background: Many Greenlanders move from Greenland, a tuberculosis (TB) high-incidence country, to Denmark, a TB low-incidence country. Surprisingly, according to official statistics, the TB incidence among Greenlanders in Denmark is much higher than in Greenland.

Objectives: This study investigates factors contributing to the extraordinarily high TB incidence among Greenlanders residing in Denmark.

Methods: Retrospective, register-based cohort study including all Greenlanders ≥18 years notified with TB in Denmark and Greenland, and Danes ≥18 years with TB in Denmark, 2006-2022. Demographic and microbiological characteristics were compared across groups using parametric and non-parametric statistical tests.

Results: The TB incidence was extraordinarily high among Greenlanders in Denmark (341/100,000; n = 813), compared to Danes in Denmark (2/100,000; n = 1799) and Greenlanders in Greenland (149/100,000; n = 1088). Additionally, they were more often part of a TB cluster (75.6%) compared to Danes in Denmark (53.3%) and Greenlanders in Greenland (64.0%) and demonstrated very high rates of recurrent TB (23.9%), with 75.6% of cases being reinfections involving new Mycobacterium tuberculosis strains.

Conclusion: TB poses a significant public health challenge for Greenlanders in Denmark. Their high incidence combined with elevated clustering and reinfection rates suggest substantial active TB transmission, and their cluster distribution indicates that many infections are locally acquired rather than reactivations of infection acquired in Greenland. Greenlanders with TB in Denmark are likely part of a socially marginalised minority with TB high-risk behaviours similar to Danes developing TB. These findings highlight the need for targeted TB prevention and control strategies for Greenlanders residing in Denmark.

Background: Influenza ranges from a mild and self-limiting infection to a life-threatening disease with high mortality despite intensive care. Conclusive data on the association between influenza type/subtype and mortality among adults treated at intensive care units (ICU) is lacking.

Objectives: To investigate the mortality in adults admitted to ICU with laboratory-confirmed influenza during three consecutive influenza seasons.

Methods: This observational multicenter study included adults with PCR-confirmed influenza requiring intensive care at four hospitals in southern Sweden between 2015-2018. The primary outcome was all-cause one-year mortality. Patient characteristics and the impact of influenza type/subtype were studied using Kaplan-Meier and logistic regression analyses.

Results: A total of 146 individuals were included: median age 67 years (interquartile range 56-74), 54% were male. Influenza type/subtype was available for 144/146 (99%); A(H1N1)pdm09 in 50 (35%), A(H3N2) in 37 (26%), and B in 57 (40%) patients. Mortality was 19% in the ICU and 32% before hospital discharge. At one year, 43% were deceased, ranging from 36% to 49%, depending on type/subtype (log-rank test p = 0.32). Mortality rates remained similar for all three influenza types/subtypes after adjusting for age, sex, and a modified comorbidity index. Antibiotics were prescribed for 125/145 (86%) within 48 h of ICU admission, with microbiological confirmation of coinfection in 53/125 (42%).

Conclusions: Among adults admitted to intensive care with PCR-confirmed influenza, mortality rates were similar independently of influenza type/subtype. Mortality increased from 19% in the ICU to 43% one year after admission, highlighting the importance of monitoring ICU-survivors and reporting long-term outcomes in critically ill influenza patients.

Background: The impact of COVID-19-related nonpharmaceutical interventions (NPI) on the bacterial composition of upper airway infections remains largely unexplored.

Objectives: We aimed to investigate the incidence and microbiology of peritonsillar abscess (PTA) following the cessation of NPI and to compare these findings with the periods before and during NPI implementation.

Methods: We performed a cross-sectional analysis of all PTA cases and their microbiological findings from 12 March, 2018 to 11 March, 2024, among patients admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Patients were categorised into three two-year periods in relation to NPI. Age-stratified population data for the catchment area were sourced from Statistics Denmark.

Results: A total of 1,030 patients were included. The annual incidence rate of PTA was significantly higher post-NPI (26.9 cases/100,000) compared to both the NPI period (14.9 cases/100,000, p < 0.001) and the pre-NPI period (21.8 cases/100,000, p = 0.003). Increased post-NPI rates were observed across all age groups. The number of cases positive for Streptococcuspyogenes and Fusobacterium necrophorum increased post-NPI (n = 102 and n = 89, respectively) compared to during the NPI period (n = 28 and n = 64, p < 0.001 and p = 0.052, respectively) and pre-NPI (n = 67 and n = 60, p = 0.009 and p = 0.021, respectively). Statistically non-significant increasing trends were found for less prevalent bacteria.

Conclusion: Following NPI cessation, PTA incidence rates surpassed both the NPI and pre-NPI levels. The rising PTA incidence rates post-NPI were primarily driven by an increasing number of cases positive for S. pyogenes and F. necrophorum, suggesting an immunity debt to these prevalent pathogens.

Background: Early diagnosis of chronic hepatitis B virus (CHB) prevents onward transmission and liver disease progression. In Norway, CHB infections are concentrated among migrants from countries with a high CHB prevalence.

Objectives: To calculate time from migration to diagnosis and proportion presenting late (a hospital consultation for end-stage liver disease within 24 months after CHB diagnosis) among diagnosed cases of CHB in Norway from 2008-2022.

Method: We analysed linked national registry data and described each outcome by year, age, sex, region of residence and country of birth. We explored factors associated with time from migration to diagnosis in accelerated failure time models and presented adjusted time ratios (aTR) with 95% confidence intervals (CI).

Results: Among 10,542 cases of CHB, 273 (2.6%) presented late, with a higher proportion in older age groups (≥60 years: 11%). The median time from migration to diagnosis among 3,665 cases who migrated from 2008 onwards was 1.1 years (interquartile range: 0.3-3.1). Compared to cases from high-prevalence countries with a high proportion of refugees or asylum seekers to Norway, cases born in other high-prevalence countries (aTR: 1.37, 95% CI: 1.26-1.50) or low-prevalence countries (aTR: 1.66, 95% CI: 1.49-1.89) had a longer time from migration to diagnosis.

Conclusion: Among persons diagnosed with CHB in Norway, 2-3% present with severe liver disease within 2 years of CHB diagnosis. Initiatives to improve testing strategies could focus on migrants from high-prevalence countries arriving for reasons other than refuge or who arrived several years ago but have not yet been tested.

Introduction: Strategies for tuberculosis (TB) elimination in low-incidence countries involve screening recent migrants from TB-endemic regions for TB infection (TBI) and providing TB preventive treatment (TPT) to individuals with an increased risk of reactivation. This study aimed to determine TB incidence and identify reactivation risk markers in a cohort of asylum seekers in Sweden after screening.

Method: We conducted a registry-based retrospective cohort study with a three-year follow-up of asylum seekers receiving post-arrival Interferon Gamma Release Assay (IGRA) screening in three Swedish regions 2015-2019. Medical records, health-examination records, and the national TB disease registry were linked using identification numbers or probabilistic methods. The primary outcome was TB disease more than 90 days post-screening. Explanatory variables included age, sex, IGRA-result (positive/negative), TPT-initiation, and TB incidence in the country of origin. Poisson and Cox regression addressed incidence rates (IR), incidence rate ratios (IRR), and hazard ratios over a three-year follow-up.

Results: The cohort included 21 739 individuals and 70 467 person-years. Incident TB disease was recorded in 41 cases (IR 58.2/100 000 person-years). The IR for those with a positive IGRA was 321.7/100 000 person-years (n = 34). The highest risk was in persons aged under 20 with no TPT (1 279.0/100 000 person-years). Positive IGRA result, age under 20 years, and origin from TB-endemic country predicted incident TB.

Discussion: Risk markers for incident TB were similar to findings previously reported. However, the observed 0.3% annual reactivation risk found among all IGRA-positive individuals in this study was considerably lower compared to earlier findings.

Background: Hepatitis is a variably reported manifestation of acute Q fever; however, its clinical implications remain unclear. This study investigates whether hepatitis is associated with distinct clinical features and outcomes compared to cases without hepatitis.

Methods: Data from a retrospective, single-centre study of adult patients diagnosed with acute Q fever between January 2018 and December 2023 were analysed. Patients with clinical and laboratory evidence of acute infection, defined by positive phase II IgG serology or Coxiella burnetii RT-PCR were included. Patients were categorised into two groups based on the presence or absence of hepatitis, defined as elevated liver transaminases above the upper normal limit. Descriptive comparisons were conducted between the two groups.

Results: 116 patients were included, 87 in the hepatitis group and 29 in the non-hepatitis group. The hepatitis group showed a male predominance (66.7%), while the non-hepatitis group had a higher proportion of females (55.2%) (p = 0.03). Fever was more common in the hepatitis group (85.1%) compared to the non-hepatitis group (65.5%) (p = 0.02). A confirmed diagnosis was more frequent in the hepatitis group (62.1% vs. 27.6%) (p < 0.001). A greater proportion of patients in the hepatitis group received appropriate antibiotic treatment (79.3% vs. 44.8%), with earlier initiation. Despite these differences, complication rates were comparable between groups, and no in-hospital mortality was observed.

Conclusion: Hepatitis is a common manifestation of acute Q fever and is associated with a higher likelihood of confirmed diagnosis and earlier initiation of appropriate antibiotic treatment. Clinical outcomes remain favourable, even in patients with hepatitis.

Background: Dalbavancin is a long-acting lipoglycopeptide approved for acute bacterial skin and soft-tissue infections. Its prolonged half-life enables outpatient treatment, reducing the burden of hospitalisation. Despite increasing off-label use for complex Gram-positive infections, real-world effectiveness data remain limited.

Objective: This study aimed to evaluate the clinical effectiveness and safety of dalbavancin in a real-world tertiary care setting in Sweden.

Methods: We retrospectively analysed the medical records of all patients (n = 66) who received dalbavancin in Region Västmanland, Sweden, from 2019 to 2023. Patient characteristics, source of infection, identified pathogens, treatment regimens, and outcomes were extracted from medical records. The primary outcome was clinical cure at 6 months; secondary outcomes included mortality, need for suppressive therapy, and adverse events.

Results: Sixty-six patients (median age 73 years; 47% female) received dalbavancin for orthopaedic/bone infections (56%), endocarditis (23%), vascular graft infections (6%), bacteraemia (6%), sacral ulcer infections (6%), and other infections (3%). The patients had significant comorbidities: diabetes (38%), malignancy (33%), chronic kidney disease (44%), and substance use disorders (17%)."Methicillin-susceptible" Staphylococcus aureus was the predominant pathogen (31% of isolates). Dalbavancin was prescribed to facilitate outpatient therapy (53%), address poor compliance (17%), or manage antibiotic intolerances (17%). Patients received a median of 2 doses (range 1-17). At 6-month follow-up, 62% achieved clinical cure, 18% remained on suppressive therapy, and 20% died, primarily from underlying conditions. Adverse events were infrequent (6%) and generally mild.

Conclusions: Dalbavancin achieved a 62% cure rate despite significant comorbidities, offering a safe alternative to inpatient care for elderly, comorbid patients.

Nocardiosis is caused by the Gram-positive bacterium Nocardia spp. The most common inborn error in immunity (IEI) associated with nocardiosis is chronic granulomatous disease (CGD). This case series highlights five cases of nocardiosis with a diagnosis of IEI other than CGD. P1, nine-year-old male child, diagnosed case of IL12RB1 deficiency, presented with seizures. MRI brain showed multiple ring-enhancing lesions. He was empirically treated with AKT and steroids for tuberculomas. Newer lesions on MRI brain prompted biopsy that showed acid-fast filaments on modified-ZN stain. Culture grew Nocardia spp. P2, 10-year-old male presented with cachexia, deep jaundice, abdominal distension with right pyopneumothorax and large splenic abscess. Splenic aspirate and pleural tap revealed the presence of Nocardia spp on culture and Nocardia cyriacigeorgica on MALDI-TOF. In view of disseminated nocardiosis, NBT/DHR test was advised which was normal, WES revealed homozygous IL12RB1 pathogenic variant. P3, nine-year male with refractory atopic dermatitis since three months of age. He had eosinophilia (10,000 cells/cumm) and hyper IgE (2360 IU/ml). He was diagnosed with DOCK8 deficiency on NGS. While being evaluated for BMT he had focal seizure with ataxia, MRI brain revealed the presence of cerebellar abscess. Biopsy revealed Nocardia spp. P4 and P5 were patients with Goods syndrome and nocardia pneumonia. Thus, isolation of nocardia at any age must prompt one to look for underlying IEI other than CGD as well. Extensive and invasive tests along with radiological tests need to be undertaken in patients with IEI to isolate and appropriately treat.