Infectious diseases (London, England)最新文献

Background: In paediatric emergency departments the use of empirical antimicrobials is very common, even though most infections are caused by viruses, resulting in misuse of antimicrobials. We aimed to assess the impact of a comprehensive antimicrobial stewardship program (ASP) on the optimisation of antimicrobial prescribing and clinical outcomes in a paediatric Emergency Department Observation Unit (EDOU).

Methods: A quasi-experimental before-and-after longitudinal study was conducted at the EDOU of a paediatric hospital, over 24 quarters from January 2017 to December 2023, excluding 2020 due to the pandemic and the phase-in period. The ASP intervention included the development and implementation of clinical guidelines, rapid diagnostic tests (RDTs), and staff stabilisation. Data on antimicrobial use and clinical outcomes, such as revisits within 72 h and hospital admissions, were collected and analysed using Bayesian structural time series models.

Results: The study included 33,799 patients transferred to the EDOU. Mean antimicrobial consumption significantly decreased from 46.5 ± 12.9 pre-intervention defined daily doses (DDDs) per 100 patients transferred to the Observation Unit (TOs) to 20.1 ± 3.0 DDDs per 100 TOs in the intervention period (p < 0.0001). Significant reductions were observed for amoxicillin-clavulanic acid, amoxicillin, and azithromycin. The percentage of revisits and hospital admissions remained stable for the whole period.

Conclusion: The implementation of ASP measures improved antimicrobial prescribing in the paediatric EDOU. These findings support the need for continued efforts in ASP, emphasising the development and implementation of guidelines, RDTs, and staff stabilisation.

Background: Wild poliovirus type 1 (WPV1) transmission persists in Pakistan, with cases increasing from 6 in 2023 to 56 by November 2024, highlighting critical challenges in polio eradication efforts. The aim of this study is to assess the relationship between bivalent oral polio vaccine (bOPV) doses and the severity of paralysis in the confirmed WPV1 cases in Pakistan.

Methods: We analysed all confirmed WPV1 cases reported in Pakistan from January 1, 2024, to November 15, 2024. Bivariate analyses were first conducted to explore initial associations. Firth, logistic regression models were then employed to evaluate the strength of these associations while adjusting for potential confounders.

Results: Higher bOPV doses were significantly associated with a lower risk of severe paralysis in both univariate analysis (OR = 0.75, 95% CI: 0.60-0.93, p = 0.009) and after adjustment for age and sex (OR = 0.76, 95% CI: 0.59-0.97, p = 0.026). For residual paralysis after 60 days of onset, univariate analysis showed a significant association (OR = 0.77, 95% CI: 0.61-0.97, p = 0.026); however, this association was no longer statistically significant after adjustment (OR = 0.82, 95% CI: 0.64-1.05, p = 0.115).

Conclusion: The study found a significant association between higher bOPV dose count and reduced paralysis severity in confirmed WPV1 cases. These findings suggest that bOPV may help to moderate the severity of paralysis, in addition to preventing WPV1 infection.

Introduction: For public health purposes, it is essential to understand which population groups and their areas of residence are affected by a disease as COVID-19 and to what extent these groups are reached by preventive measures.

Aim: We investigated how individual-level and area-level characteristics are associated with COVID-19 morbidity and vaccine uptake.

Methods: A population-based observational study including the total adult population age 18 and older in Sweden from 1 January 2020 to 1 April 2022, except individuals living in nursing homes. Associations between both individual and area-level characteristics and COVID-19 morbidity (hospitalisation, admission to intensive care unit and death) and vaccine uptake were analysed using Cox proportional hazards regression and adjusted for age, sex, comorbidity and socioeconomic and demographic factors.

Results: In the fully adjusted model, the hazard ratio (HR) for COVID-19 hospitalisation was 34% lower for individuals living in the most affluent neighbourhoods (HR 0.66, 95%CI 0.63-0.68) compared to individuals in the most deprived neighbourhoods. For intensive care unit (ICU)-admission and COVID-19 death, the risks were 53% (HR 0.47, 95%CI 0.42-0.53) and 47% (HR 0.53, 95%CI 0.48-0.59) lower, respectively. When stratified by cross-classified sociodemographics, this pattern was consistent within all strata. A composite area-level measurement had a better predictive value compared to single measures.

Conclusions: Living in deprived neighbourhoods is associated with substantially higher risk of COVID-19 hospitalisation, ICU-admission, mortality and lower vaccine uptake. This risk factor remained strong even when taking individual level characteristics into account and within strata of individual-level factors.

Background: Infections of the aorta and its branches can occur either in native tissue, known as infective native aortic aneurysms (INAAs), or following vascular surgery involving native or prosthetic grafts, referred to as vascular graft or endograft infections (VGEIs).

Objectives: First, this study aimed to assess the all-cause on-year mortality of patients with INAAs and VGEIs. Second, this study described patients' characteristics and prognostic factors.

Methods: This observational study included patients hospitalised for INAA or VGEI, between 2014 and 2022, at Nancy University Hospital (France). Data were retrospectively collected from patients' medical record (ClinicalTrials.gov ID NCT05660733).

Results: Forty-seven patients were included in the INAAs group versus 40 in the VGEIs group. A history of immunosuppression or autoimmune disease were more frequent in INAAs patients. VGEIs patients had more chronic organ failure or cardiovascular pathology. The most commonly affected site was the infrarenal aorta, with thoracic involvement being more frequent in the INAAs group. Staphylococcus aureus was the most frequent identified pathogen (38.3% vs. 27.5%). There was no significant difference between groups in terms of all-cause 1-year mortality (40.4% in the INAAs group vs. 32.5% in the VGEIs group, log-rank test, p = .4803). The absence of surgery worsened the prognosis in the overall population (HR 2.8, 95% CI [1.2-6.3], p = .0125); this was also observed in the INAA group.

Conclusions: Despite different comorbidities and clinical presentations between groups, there was no significant difference in 1-year mortality. Surgical management appeared to be associated with improved outcomes.

Background: Infectious respiratory diseases significantly cause morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited diagnostic resources. This study explored the utility of lung ultrasound (LUS) paired with extra-pulmonary point-of-care ultrasound (POCUS) for differentiating infectious aetiologies in lower respiratory tract infections (LRTI).

Methods: This prospective cohort study was conducted at a tertiary care centre in India. We recruited consenting adults with suspected LRTI who underwent extended point-of-care lung ultrasound (EPLUS). The protocol included thoracic and abdominal views assessing for lung consolidations and B-lines, pleural effusion, pericardial effusion, focal splenic lesions, and abdominal lymphadenopathy and correlated these with patients' final diagnoses.

Results: We included 322 participants in our analysis cohort, which had a notable prevalence of previously existing chronic lung conditions (21%) and an HIV-prevalence of 5%. Infectious lung disease was identified in 48% of patients, comprising 35% with non-TB LRTI and 13% with TB. Non-infectious lung disease was present in 21% of patients. LUS detected consolidations in 75% and >3 B-lines in 72% of participants. LUS findings were mostly non-specific and prevalent across both infectious and non-infectious conditions. Extra-pulmonary ultrasound findings, such as pericardial effusion and splenic lesions, findings common in disseminated tuberculosis, were rare.

Conclusion: The study highlights the high sensitivity of LUS for detecting pulmonary changes but revealed low specificity to differentiate pulmonary conditions, especially in the presence of pre-existing comorbidities. Future research should explore the accuracy of combinations of clinical characteristics and ultrasound findings in algorithmic approaches, which may improve diagnostics in resource-limited settings.