Epidemiological and clinical features of patients hospitalized due to Clostridium difficile - associated diarrhea

UVOD: Dijareja uzrokovana bakterijom Clostridium difficile je jedna od češćih neželjenih posljedica primjene antibiotske terapije, no malo se zna o odnosu epidemioloških okolnosti razbolijevanja i kliničke težine bolesti te ishoda liječenja. ----- CILJ: Opisati epidemiološka i klinička obilježja bolesti te utvrditi odnos epidemioloških okolnosti razbolijevanja i kliničke težine bolesti i ishoda liječenja u bolesnika s Clostridium difficile infekcijom (CDI). ----- BOLESNICI I METODE: Radi se o retrospektivnom deskriptivnom istraživanju provedenom na bolesnicima oba spola i svih dobi hospitalno liječenim zbog dijareje uzrokovane laboratorijski potvrđenom CDI u razdoblju od 2013. – 2016. godine u Klinici za infektivne bolesti „Dr. Fran Mihaljević“, Zagreb. U statističkoj obradi podataka korištena je metoda linearne regresije, hi-kvadrat test, studentov t-test i njegove neparametarske inačice u slučaju odstupanja podataka od normalne distribucije. ----- REZULTATI: Od 776 bolesnika s CDI njih je 76% imalo CDI povezanu sa zdravstvenom skrbi, 16% je imalo izvanbolnički stečenu infekciju, a u 8% bolesnika se epidemiološke okolnosti razbolijevanja nisu mogle utvrditi. Udio bolesnika s CDI povezanom sa zdravstvenom skrbi je u promatranom razdoblju značajno rastao u odnosu na bolesnike s izvanbolnički stečenom CDI (p=0.0395). Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali statistički značajno veće vrijednosti maksimalne tjelesne temperature (prosjek 37,99 vs. 37,21), veći broj stolica u 24 sata (prosjek 9,14 vs. 5,83), češću pojavu renalne insuficijencije (19,2 vs. 5,7%) i češće prisutne ostale komplikacije (8,2 vs. 2,5%). Ti su bolesnici imali statistički značajno veće vrijednosti leukocita u perifernoj krvi (prosjek 15,51 vs. 13,64), niže vrijednosti albumina (prosjek 28,29 vs. 32,82) te su u njih vrijednosti kreatinina češće bile veće od 1,5x u odnosu na bazalne vrijednosti (33,2 vs. 15,1%). U njih je bio značajno veći McCabe skor (1.57 vs. 1.13) i ATLAS skor (4.05 vs. 1.85). Također, navedeni bolesnici su bili statistički značajno duže hospitalizirani (prosjek 14,83 vs. 10,13 dana) te je kod njih smrtni ishod bio značajno češći (11,7 vs. 3,3%) u odnosu na bolesnike s izvanbolnički stečenom CDI. ----- ZAKLJUČAK: U promatranom razdoblju je među hospitalno liječenim bolesnicima zabilježen značajan trend rasta udjela pacijenata koji su imali C. difficile infekciju povezanu sa zdravstvenom skrbi u periodu od 2013. – 2016. Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali klinički težu bolest i lošiji ishod od bolesnika s izvanbolničkom CDI.BACKGROUND: Clostridium difficile-associated diarrhea is one of the most common unintended consequences of the administration of antibiotics and the correlation between epidemiological circumstances of acquisition and severity of illness and its outcome is not well known. ----- OBJECTIVE: To determine epidemiological and clinical features of C. difficile infection (CDI) and to assess the relationship between the epidemiological circumstances of acquisition and severity of illness and its outcome. ----- PATIENTS AND METHODS: This is a retrospective descriptive study that includes patients of both genders and all age groups hospitalized and treated for CDI with laboratory detected infection from 2013 to 2016 at University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb. Linear regression analysis, Chi-square test, Student t-test are used to compare mean values and non-parametric tests are used if distribution is not normal. ----- RESULTS: Of 776 patients 76% had healthcare-associated C. difficile infection, 16% had community-associated C. difficile infection and 8% had undetermined association. Proportion of the patients with healthcare-associated C. difficile infection significantly increased compared to proportion of patients with community-associated infection over the study period (p=0.0395). Patients with healthcare-associated C. difficile infection had significantly higher maximum body temperature (mean 37,99 vs. 37,21), more stools in 24 hours (mean 9,14 vs. 5,83), had more often renal impairment (19,2% vs. 5,7%) and had more often other complications (8,2 vs. 2,5%). Patients with healthcare-associated C. difficile infection had significantly more elevated leukocyte count (mean 15,51 vs. 13,64), lower serum albumin (mean 28,29 vs. 32,82) and had more often ˃50% increase in baseline serum creatinine level (33,2 vs. 15,1%). Patients with healthcare-associated CDI had significantly higher McCabe score (1.57 vs. 1.13) and ATLAS score (4.05 vs. 1.85). Also, they had longer length of stay in hospital (mean 14,83 vs. 10,13 days) and higher mortality rates (11,7 vs. 3,3%) when compared to patients with community-associated C. difficile infection. ----- CONCLUSIONS: There is a significant increase in proportion of healthcare-associated C. difficile cases from 2013 – 2016. Patients with healthcare-associated CDI had more severe illness and worse outcome than patients with community-associated CDI

Epidemiological and clinical features of patients hospitalized due to Clostridium difficile - associated diarrhea

UVOD: Dijareja uzrokovana bakterijom Clostridium difficile je jedna od češćih neželjenih posljedica primjene antibiotske terapije, no malo se zna o odnosu epidemioloških okolnosti razbolijevanja i kliničke težine bolesti te ishoda liječenja. ----- CILJ: Opisati epidemiološka i klinička obilježja bolesti te utvrditi odnos epidemioloških okolnosti razbolijevanja i kliničke težine bolesti i ishoda liječenja u bolesnika s Clostridium difficile infekcijom (CDI). ----- BOLESNICI I METODE: Radi se o retrospektivnom deskriptivnom istraživanju provedenom na bolesnicima oba spola i svih dobi hospitalno liječenim zbog dijareje uzrokovane laboratorijski potvrđenom CDI u razdoblju od 2013. – 2016. godine u Klinici za infektivne bolesti „Dr. Fran Mihaljević“, Zagreb. U statističkoj obradi podataka korištena je metoda linearne regresije, hi-kvadrat test, studentov t-test i njegove neparametarske inačice u slučaju odstupanja podataka od normalne distribucije. ----- REZULTATI: Od 776 bolesnika s CDI njih je 76% imalo CDI povezanu sa zdravstvenom skrbi, 16% je imalo izvanbolnički stečenu infekciju, a u 8% bolesnika se epidemiološke okolnosti razbolijevanja nisu mogle utvrditi. Udio bolesnika s CDI povezanom sa zdravstvenom skrbi je u promatranom razdoblju značajno rastao u odnosu na bolesnike s izvanbolnički stečenom CDI (p=0.0395). Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali statistički značajno veće vrijednosti maksimalne tjelesne temperature (prosjek 37,99 vs. 37,21), veći broj stolica u 24 sata (prosjek 9,14 vs. 5,83), češću pojavu renalne insuficijencije (19,2 vs. 5,7%) i češće prisutne ostale komplikacije (8,2 vs. 2,5%). Ti su bolesnici imali statistički značajno veće vrijednosti leukocita u perifernoj krvi (prosjek 15,51 vs. 13,64), niže vrijednosti albumina (prosjek 28,29 vs. 32,82) te su u njih vrijednosti kreatinina češće bile veće od 1,5x u odnosu na bazalne vrijednosti (33,2 vs. 15,1%). U njih je bio značajno veći McCabe skor (1.57 vs. 1.13) i ATLAS skor (4.05 vs. 1.85). Također, navedeni bolesnici su bili statistički značajno duže hospitalizirani (prosjek 14,83 vs. 10,13 dana) te je kod njih smrtni ishod bio značajno češći (11,7 vs. 3,3%) u odnosu na bolesnike s izvanbolnički stečenom CDI. ----- ZAKLJUČAK: U promatranom razdoblju je među hospitalno liječenim bolesnicima zabilježen značajan trend rasta udjela pacijenata koji su imali C. difficile infekciju povezanu sa zdravstvenom skrbi u periodu od 2013. – 2016. Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali klinički težu bolest i lošiji ishod od bolesnika s izvanbolničkom CDI.BACKGROUND: Clostridium difficile-associated diarrhea is one of the most common unintended consequences of the administration of antibiotics and the correlation between epidemiological circumstances of acquisition and severity of illness and its outcome is not well known. ----- OBJECTIVE: To determine epidemiological and clinical features of C. difficile infection (CDI) and to assess the relationship between the epidemiological circumstances of acquisition and severity of illness and its outcome. ----- PATIENTS AND METHODS: This is a retrospective descriptive study that includes patients of both genders and all age groups hospitalized and treated for CDI with laboratory detected infection from 2013 to 2016 at University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb. Linear regression analysis, Chi-square test, Student t-test are used to compare mean values and non-parametric tests are used if distribution is not normal. ----- RESULTS: Of 776 patients 76% had healthcare-associated C. difficile infection, 16% had community-associated C. difficile infection and 8% had undetermined association. Proportion of the patients with healthcare-associated C. difficile infection significantly increased compared to proportion of patients with community-associated infection over the study period (p=0.0395). Patients with healthcare-associated C. difficile infection had significantly higher maximum body temperature (mean 37,99 vs. 37,21), more stools in 24 hours (mean 9,14 vs. 5,83), had more often renal impairment (19,2% vs. 5,7%) and had more often other complications (8,2 vs. 2,5%). Patients with healthcare-associated C. difficile infection had significantly more elevated leukocyte count (mean 15,51 vs. 13,64), lower serum albumin (mean 28,29 vs. 32,82) and had more often ˃50% increase in baseline serum creatinine level (33,2 vs. 15,1%). Patients with healthcare-associated CDI had significantly higher McCabe score (1.57 vs. 1.13) and ATLAS score (4.05 vs. 1.85). Also, they had longer length of stay in hospital (mean 14,83 vs. 10,13 days) and higher mortality rates (11,7 vs. 3,3%) when compared to patients with community-associated C. difficile infection. ----- CONCLUSIONS: There is a significant increase in proportion of healthcare-associated C. difficile cases from 2013 – 2016. Patients with healthcare-associated CDI had more severe illness and worse outcome than patients with community-associated CDI

Allergic rhinitis: a cross-sectional survey assessing the knowledge and therapeutic approach among final year medical students, pharmacy students, general practitioners and community pharmacists in Croatia

Objectives. To assess the current knowledge of allergic rhinitis (AR) among final year medical and pharmacy students, general practitioners (GPs) and community pharmacists in Croatia. Methods: Data were collected from September 2017 to November 2017 through an online questionnaire. Final year medical and pharmacy students (N=201), GPs and pharmacists from Croatia (N=127) were included. The two factor structured questionnaire was formed regarding general knowledge and treatment of AR. T-test and chi-square tests were used for statistical analysis. Results: Overall knowledge of AR was low among respondents (mean score among GPs: 11.4/20, pharmacists: 11.3/20, pharmacy students: 10.8/20, medical students: 10.3/20). With reference to treatment mean scores were also low; GPs 5.1/10, pharmacists: 4.9/10, pharmacy students: 4.3/10 and medical students: 4.1/10. GPs were significantly better than medical students in reference to treatment approach (p<.001) and overall knowledge (p=0.004). Pharmacists\u27 knowledge of treatment was better than pharmacy students\u27 (p=0.029), and the overall knowledge was insignificantly higher (p=0.210). The overall knowledge was insignificantly different among GPs and pharmacists (p=0.911), as was knowledge of treatment approach (p=0.335). The overall knowledge and knowledge of AR treatment was insignificantly better among pharmacy vs. medical students (p=0.252, p=0.583 respectively). Conclusion: This study indicates an inadequate level of knowledge of AR among participants. Even though GPs and pharmacists’ knowledge on therapy of AR was better than among students, it was still unsatisfying. It would be advisable to introduce the changes to curriculum regarding AR, with more emphasis on treatment approach and to organize additional education for GPs and pharmacists

Allergic rhinitis: a cross-sectional survey assessing the knowledge and therapeutic approach among final year medical students, pharmacy students, general practitioners and community pharmacists in Croatia

Objectives. To assess the current knowledge of allergic rhinitis (AR) among final year medical and pharmacy students, general practitioners (GPs) and community pharmacists in Croatia. Methods: Data were collected from September 2017 to November 2017 through an online questionnaire. Final year medical and pharmacy students (N=201), GPs and pharmacists from Croatia (N=127) were included. The two factor structured questionnaire was formed regarding general knowledge and treatment of AR. T-test and chi-square tests were used for statistical analysis. Results: Overall knowledge of AR was low among respondents (mean score among GPs: 11.4/20, pharmacists: 11.3/20, pharmacy students: 10.8/20, medical students: 10.3/20). With reference to treatment mean scores were also low; GPs 5.1/10, pharmacists: 4.9/10, pharmacy students: 4.3/10 and medical students: 4.1/10. GPs were significantly better than medical students in reference to treatment approach (p<.001) and overall knowledge (p=0.004). Pharmacists\u27 knowledge of treatment was better than pharmacy students\u27 (p=0.029), and the overall knowledge was insignificantly higher (p=0.210). The overall knowledge was insignificantly different among GPs and pharmacists (p=0.911), as was knowledge of treatment approach (p=0.335). The overall knowledge and knowledge of AR treatment was insignificantly better among pharmacy vs. medical students (p=0.252, p=0.583 respectively). Conclusion: This study indicates an inadequate level of knowledge of AR among participants. Even though GPs and pharmacists’ knowledge on therapy of AR was better than among students, it was still unsatisfying. It would be advisable to introduce the changes to curriculum regarding AR, with more emphasis on treatment approach and to organize additional education for GPs and pharmacists

Farmakološko liječenje koronavirusne bolesti 19 (COVID-19): gdje smo sada?

Since the first cases of COVID-19 were reported from China the disease became pandemic within a few months. The viral genome was sequenced soon after the outbreak of COVID-19 which enabled development of diagnostic tests and therapeutic options. As the knowledge of SARS-CoV-2 virology increased, many potential drugs appeared. At this moment (January 12th 2021), 4426 studies of COVID-19 are registered, and more than 2680 studies are investigating therapeutic options. This is a short narrative review of currently available evidence on pharmacological treatment of COVID-19.U roku nekoliko mjeseci od pojave prvih slučajeva COVID-19 u Kini, bolest je poprimila pandemijske razmjere. Virusni genom je sekvencioniran ubrzo nakon pojave COVID-19 što je omogućilo razvoj dijagnostičkih testova i terapije. Kako su pristizala saznanja o samom virusu SARS-CoV-2, pojavljivali su se razni potencijalni lijekovi. U ovom trenutku (12. siječnja 2021.) registrirano je 4426 studija o COVID-19, a više od 2680 studija se bavi istraživanjem terapijskih opcija. U ovom preglednom radu prikazana su sadašnja saznanja o farmakološkom liječenju COVID-19

Successful treatment of genotype 3 hepatitis C infection in a noncirrhotic HIV infected patient on chronic dialysis with the combination of sofosbuvir and velpatasvir

RATIONALE: Data on anti-HCV therapy in patients on dialysis is still evolving. Sofosbuvir is mainly eliminated through the renal route and there is controversy about its use in these patients. ----- PATIENT CONCERNS: We describe a 53-year-old male patient with HCV genotype 3 and human immunodeficiency type 1 (HIV) infection on chronic dialysis. HIV infection was diagnosed in 1987 and since July 2007 the patient was compliant with his antiretroviral therapy (ART) and had an undetectable plasma HIV viral load on all follow-up measurements. The patient was known to have HCV infection since 1997 but has never been treated for chronic hepatitis C. Because of progressive renal impairment dialysis started in 2005. ----- DIAGNOSIS: Before anti-HCV treatment commenced the patient liver transient elastography (FibroScan) indicated F3 fibrosis (stiffness, 11.6 kPa) and his HCV RNA viral load was 320,798 IU/mL (Abbott RealTime HCV assay). ----- INTERVENTION: Fixed dose combination of sofosbuvir/velpatasvir (400 mg/100 mg) for 11 weeks. ----- OUTCOMES: Twelve weeks after treatment cessation HCV RNA was undetectable, hence the patient achieved a sustained virologic response. The drugs were well tolerated and the patient did not report any side effects. ----- LESSONS: Sofosbuvir/velpatasvir may be an option for HCV genotype 3 infection in patients coinfected with HIV on long-term dialysis

Epidemiological and clinical features of patients hospitalized due to Clostridium difficile - associated diarrhea

UVOD: Dijareja uzrokovana bakterijom Clostridium difficile je jedna od češćih neželjenih posljedica primjene antibiotske terapije, no malo se zna o odnosu epidemioloških okolnosti razbolijevanja i kliničke težine bolesti te ishoda liječenja. ----- CILJ: Opisati epidemiološka i klinička obilježja bolesti te utvrditi odnos epidemioloških okolnosti razbolijevanja i kliničke težine bolesti i ishoda liječenja u bolesnika s Clostridium difficile infekcijom (CDI). ----- BOLESNICI I METODE: Radi se o retrospektivnom deskriptivnom istraživanju provedenom na bolesnicima oba spola i svih dobi hospitalno liječenim zbog dijareje uzrokovane laboratorijski potvrđenom CDI u razdoblju od 2013. – 2016. godine u Klinici za infektivne bolesti „Dr. Fran Mihaljević“, Zagreb. U statističkoj obradi podataka korištena je metoda linearne regresije, hi-kvadrat test, studentov t-test i njegove neparametarske inačice u slučaju odstupanja podataka od normalne distribucije. ----- REZULTATI: Od 776 bolesnika s CDI njih je 76% imalo CDI povezanu sa zdravstvenom skrbi, 16% je imalo izvanbolnički stečenu infekciju, a u 8% bolesnika se epidemiološke okolnosti razbolijevanja nisu mogle utvrditi. Udio bolesnika s CDI povezanom sa zdravstvenom skrbi je u promatranom razdoblju značajno rastao u odnosu na bolesnike s izvanbolnički stečenom CDI (p=0.0395). Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali statistički značajno veće vrijednosti maksimalne tjelesne temperature (prosjek 37,99 vs. 37,21), veći broj stolica u 24 sata (prosjek 9,14 vs. 5,83), češću pojavu renalne insuficijencije (19,2 vs. 5,7%) i češće prisutne ostale komplikacije (8,2 vs. 2,5%). Ti su bolesnici imali statistički značajno veće vrijednosti leukocita u perifernoj krvi (prosjek 15,51 vs. 13,64), niže vrijednosti albumina (prosjek 28,29 vs. 32,82) te su u njih vrijednosti kreatinina češće bile veće od 1,5x u odnosu na bazalne vrijednosti (33,2 vs. 15,1%). U njih je bio značajno veći McCabe skor (1.57 vs. 1.13) i ATLAS skor (4.05 vs. 1.85). Također, navedeni bolesnici su bili statistički značajno duže hospitalizirani (prosjek 14,83 vs. 10,13 dana) te je kod njih smrtni ishod bio značajno češći (11,7 vs. 3,3%) u odnosu na bolesnike s izvanbolnički stečenom CDI. ----- ZAKLJUČAK: U promatranom razdoblju je među hospitalno liječenim bolesnicima zabilježen značajan trend rasta udjela pacijenata koji su imali C. difficile infekciju povezanu sa zdravstvenom skrbi u periodu od 2013. – 2016. Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali klinički težu bolest i lošiji ishod od bolesnika s izvanbolničkom CDI.BACKGROUND: Clostridium difficile-associated diarrhea is one of the most common unintended consequences of the administration of antibiotics and the correlation between epidemiological circumstances of acquisition and severity of illness and its outcome is not well known. ----- OBJECTIVE: To determine epidemiological and clinical features of C. difficile infection (CDI) and to assess the relationship between the epidemiological circumstances of acquisition and severity of illness and its outcome. ----- PATIENTS AND METHODS: This is a retrospective descriptive study that includes patients of both genders and all age groups hospitalized and treated for CDI with laboratory detected infection from 2013 to 2016 at University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb. Linear regression analysis, Chi-square test, Student t-test are used to compare mean values and non-parametric tests are used if distribution is not normal. ----- RESULTS: Of 776 patients 76% had healthcare-associated C. difficile infection, 16% had community-associated C. difficile infection and 8% had undetermined association. Proportion of the patients with healthcare-associated C. difficile infection significantly increased compared to proportion of patients with community-associated infection over the study period (p=0.0395). Patients with healthcare-associated C. difficile infection had significantly higher maximum body temperature (mean 37,99 vs. 37,21), more stools in 24 hours (mean 9,14 vs. 5,83), had more often renal impairment (19,2% vs. 5,7%) and had more often other complications (8,2 vs. 2,5%). Patients with healthcare-associated C. difficile infection had significantly more elevated leukocyte count (mean 15,51 vs. 13,64), lower serum albumin (mean 28,29 vs. 32,82) and had more often ˃50% increase in baseline serum creatinine level (33,2 vs. 15,1%). Patients with healthcare-associated CDI had significantly higher McCabe score (1.57 vs. 1.13) and ATLAS score (4.05 vs. 1.85). Also, they had longer length of stay in hospital (mean 14,83 vs. 10,13 days) and higher mortality rates (11,7 vs. 3,3%) when compared to patients with community-associated C. difficile infection. ----- CONCLUSIONS: There is a significant increase in proportion of healthcare-associated C. difficile cases from 2013 – 2016. Patients with healthcare-associated CDI had more severe illness and worse outcome than patients with community-associated CDI

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal–oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic