Mechanisms of action and immune response for COVID-19 vaccines: A narrative review

Background:Corona virus disease – 2019 (COVID-19) is the most important topic in this century with consideration of vaccines as the most important protective tools. In this review we aimed to discuss the different types of COVID-19 vaccines as regarding structures, immunological basics, and currently available forms. We reviewed the available literature about recombinant viral vector, mRNA, inactivated, and protein subunit vaccines. And in the review, we covered mechanisms of action, available forms and whether they lead to lifelong immunity or not. We concluded that it is not yet possible to confirm a lifelong immunity by the available COVID-19 vaccines. With the emergence of SARS-CoV2 new mutant strains, no single vaccine can prove to have a lifelong immunity. Further experiments and research work are needed. We need to conduct research to estimate the prevalence and incidence of COVID-19 patients in already vaccinated people, trials to reach the best ways of giving the vaccines to have the longer protection and the effect of these vaccines on the SARS-CoV-2 new variants

Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey

Infection control; Multidrug resistance; StewardshipControl de infección; Resistencia a múltiples fármacos; AdministraciónControl d'infecció; Resistència a múltiples fàrmacs; AdministracióWe explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases–International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (~5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%−90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs’ implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted

Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey

We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases-International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (similar to 5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%-90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs' implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted. (C) 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences

Role of fiberoptic bronchoscopy and BAL in assessment of the patients with non-responding pneumonia

Background: Non-responding pneumonia is usually a topic of interest for pulmonologists. Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) may be an important tool in assessment of non-responding pneumonia. There is paucity of recent studies in this area. Aim: This study aimed to assess the impact of early bronchoscopy and BAL in etiological diagnosis of the patients with non-responding pneumonia with special emphasis on efficacy of FOB and BAL in diagnosis. Settings and design: A prospective, observational study was conducted in chest and medical microbiology and immunology departments, Zagazig University Hospitals. Patients and methods: There were total 135 patients included in our study after fulfilling the criteria of non-responding pneumonia by clinical and laboratory parameters, patients were subjected to FOB and BALF microbiological, cytological, histopathological investigations. Results: The patients were 90 males and 45 females with a mean age of 47.6 ± 12.2 years. Unilateral lung involvement was seen in 108 (80%) patients, whereas bilateral involvement in 27 (20%) patients. Right upper lobe was the most commonly involved site (25.9%). In this study, bacterial pneumonia 83.71% was found to be the commonest etiology of non-resolving pneumonia, followed by bronchogenic carcinoma 13.3% and tuberculosis 2.96%. FOB was done for all patients. BAL fluid results were 88 positive, gram stain samples (65.1%), 4 BAL ZN stain and mycobacterial culture positive cases (2.96%), pyogenic organisms were isolated in 113 patients 83.71% by BAL fluid culture. Bronchoscopic biopsies were also performed in 18 cases. BAL fluid cytology was positive in 6 cases (33.3%), transbronchial forceps biopsy positive results were found in 10 cases (55.55%) and bronchial brushing showed positive results in 3 cases (16.66%). Conclusions: NRP is common and represents a difficult clinical problem as the cause may vary from a benign delay in recovery to life-threatening progressive pneumonia. A systematic approach to investigation and management is recommended with consideration of both infectious and non-infectious causes

Willingness to Receive COVID-19 Vaccination among Older Adults in Saudi Arabia: A Community-Based Survey

Identifying the factors driving vaccine hesitancy can improve vaccine attitudes and motivate individuals to have the recommended vaccinations. However, failure to address the issue directly, or worse, ignoring it, could deepen such concerns, resulting in lower vaccination rates, leading to elevated rates of illness and vaccine-preventable deaths among older adults. The aim of this study was to explore the rate of acceptance of the COVID-19 vaccine among older adults in Saudi Arabia, along with the associated predicting factors and reasons for hesitancy. This study extracted data from a cross-sectional online survey on the acceptability of COVID-19 vaccination in Saudi Arabia, which was conducted from 8 to 14 December 2020. The sample of the study included 488 older adults aged 50 and older. The major data analytic tools employed in the study were bivariate and multivariable regression analyses. Among the 488 participants, 214 (43.85%) reported willingness to accept the COVID-19 vaccine when available. Older men were more likely to be willing to be vaccinated (adjusted odds ratio (aOR): 2.277; 95% confidence interval (CI): 1.092–4.745) than older women. High levels of education were significantly associated with willingness to be vaccinated. Older adults who had previously refused any vaccine were less likely to take the COVID-19 vaccine (aOR: 0.358; 95% CI: 0.154–0.830). Those who expressed a high or very high level of concern related to becoming infected were more likely to accept the vaccine against COVID-19 (aOR: 4.437; 95% CI: 2.148–9.168). Adverse side effects (27.01%), and safety and efficacy concerns (22.63%) were the most commonly cited reasons for vaccine hesitancy. The vaccination acceptance rate among older adults in Saudi Arabia is low. Interventions designed specifically for older adults addressing worries and concerns related to the vaccine are of paramount importance. In particular, these interventions should be tailored to address gender-based and health literacy level differences

Prospective analysis of febrile neutropenia patients with bacteraemia: The results of an international ID-IRI study

OBJECTIVES: Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS: The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS: A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS: Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance

Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted

Worldwide practices on flexible endoscope reprocessing

Abstract Background Endoscopy related infections represent an important threat for healthcare systems worldwide. Recent outbreaks of infections with multidrug resistant micro-organisms have highlighted the problems of contaminated endoscopes. Endoscopes at highest risk for contamination have intricate mechanisms, multiple internal channels and narrow lumens that are especially problematic to clean. In light of raised awareness about the necessity for meticulous reprocessing of all types of endoscopes, a call for international collaboration is needed. An overview is presented on current practices for endoscope reprocessing in facilities worldwide. Method An electronic survey was developed and disseminated by the International Society for Antimicrobials and Chemotherapy. The survey consisted of 50 questions aimed at assessing the reprocessing of flexible endoscopes internationally. It covered three core elements: stakeholder involvement, assessment of perceived risks, and reprocessing process. Results The survey received a total of 165 completed responses from 39 countries. It is evident that most facilities, 82% (n = 136), have a standard operating procedure. There is, however a lot of variation within the flexible endoscope reprocessing practices observed. The need for regular training and education of reprocessing practitioners were identified by 50% (n = 83) of the respondents as main concerns that need to be addressed in order to increase patient safety in endoscope reprocessing procedures. Conclusion This international survey on current flexible endoscope reprocessing identified a large variation for reprocessing practices among different health care facilities/countries. A standardised education and training programme with a competency assessment is essential to prevent reprocessing lapses and improve patient safety