EMERGING AND RE-EMERGING DISEASES – THE THREAT CONTINUES

Infectious diseases have accompanied human development from the earliest times and have often influenced it greatly. Although they were considered “an endangered species” in the second half of the 20th century, they continue to pose a serious threat to individual or public health. Diagnosis technique improvement, climate changes, increased population mobility and vaccine cover decrease are only some of the factors that have contributed lately to the occurrence and fast spreading of new pathogens or to the re-emerging of diseases already considered historical. Most of these infectious agents (Zika, Ebola, Chikungunya, MERS, SARS, new influenza viruses), for which there are few therapeutic resources, were the cause for regional or global epidemic outbreaks, which generated concern among healthcare professionals and often panic in the population, as well as significant economic losses. The international and medical communities joined their forces and got financially and logistically involved, sometimes paying with their own lives, in fighting these new threats. The fast understanding of the epidemiological process, pathogenesis and development of diagnosis and prevention methods has often helped limit the spread of emerging diseases and has laid the grounds for their future control

Outcomes of Chronic Hepatitis C Treatment in The Infectious Diseases Hospital Iasi

Chronic hepatitis C is an important cause of morbidity and mortality due o hepatic disease. Material and method The retrospectively studied the evolution of 30 patients with chronic hepatitis C, treated in the Infectious Diseases Hospital of Iasi, with Peginterferon and Ribavirin for 48 weeks. Results 18 patients were treated with Peginterferon α2a and Ribavirin, and 12 with Peginterferon α2b and Ribavirin. Most of them (73.3%) were adults, aged between 30 and 50 years, with a sex ratio M/F – 13/17. Most of them had risk factors for the transmission of HCV: 28 of them suffered surgery and 2 of them had infected sexual partners. 3 patients didn’t achieve a rapid virusologic response and 6 patients were relapsers. All the other 70% of patients had a sustained virologic response. The side effects were present in all patients, with a moderate intensity. Conclusion The success (SVR) rate of antiviral therapy was higher than expected (especially for genotype 1 HCV). The patients with a viral relapse could be soon treated with the new protease inhibitors and hope for a cure

Oral Systemic Infection – Endocardial Involvement

The aim of the present study is to investigate oral systemic infections and their complications, with a closer look to the endocardial involvement. Material and methods The present study was performed on 31 patients diagnosed with oral sepsis between 2004-2010, in “Sf. Cuv. Parascheva” Infectious Diseases Hospital from Iasi. The link between dental intervention and bacterial endocarditis was anamnestic documented. The organic damages or dysfunctions occurred in sepsis were followed, and the aetiology and clinical response to the applied antibiotherapy were analysed. Results Patients included in this study, most men coming from rural areas, and having most affected group aged between 40 and 60 years, had presented in association predisposing conditions for the basic damage (oral sepsis). Other patients were accused of an oral hygiene lack and incomplete dental treatment for initial conditions. After interdisciplinary clinical examination and intraoperative assessment in Surgery Clinics (Oro-maxillo-facial Surgery, Ophthalmology) the diagnose of patients oriented to specific damages and then they were transferred to the Infectious Diseases Hospital and diagnosed with oral sepsis, on prone land to this pathology (valvular, implanted cardiac devices, diabetes, liver diseases, cancer, tuberculosis, pancytopenia). At 4 patients, the transthoracic echocardiography detected vegetation on mitral valve (specific for endocarditis) and prosthetic valve dehiscence in mitral position to a patient from rural areas, with periapical abscess and multiple root debris. Echocardiographic diagnosis of infectious endocarditis subsequently confirmed by positive blood cultures (Enterococcus faecalis, anaerobic gram-negative bacilli) was found at patients with valvular heart diseases and a history of tooth extraction without prophylaxis. Regarding the therapy of these infections were used antibiotics as beta-lactams in association with quinolones and/or chloramphenicol in order to cover the specific polimicrobian spectrum, applying the de-escalation techniques, with an evolution and favourable prognosis in more than half cases. Conclusions Literature and guidelines for prevention and management of odontogenic bacteraemia were in constant review, regarding prophylactic antibiotics and invasive procedures with dental visa, expressing different opinions. Diagnosis of infective endocarditis (5 cases) on patients with valvular heart disease and a history of tooth extraction without prophylaxis, unfortunately indicate a low level of compliance of some practitioners to the specific recommendations, and non-recognition of the situations when the prophylaxis is absolutely necessary

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

BACKGROUND: The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. METHODS: We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. RESULTS: At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P &lt; .001). CONCLUSIONS: Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia

Objective: Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study. Design: The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP. Results: 3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95% CI: 3.34-15.35, p < 0.001) when compared to centres representing other continents. Conclusions: This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies. Published by Elsevier Ltd on behalf of The British Infection Association

Aspiration risk factors, microbiology, and empiric antibiotics for patients hospitalized with community-acquired pneumonia

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study design and methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P 50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage