Focus on infection

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Risk factors for nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae: data from a nation-wide surveillance study in Greece

<p>Abstract</p> <p>Background</p> <p>A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers.</p> <p>Methods</p> <p>A study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped.</p> <p>Results</p> <p>Between February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%). Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped.</p> <p>Conclusion</p> <p>Recent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of <it>S pneumoniae</it>. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.</p

Preventing the next 'SARS' - European healthcare workers' attitudes towards monitoring their health for the surveillance of newly emerging infections: qualitative study

<p>Abstract</p> <p>Background</p> <p>Hospitals are often the epicentres of newly circulating infections. Healthcare workers (HCWs) are at high risk of acquiring infectious diseases and may be among the first to contract emerging infections. This study aims to explore European HCWs' perceptions and attitudes towards monitoring their absence and symptom reports for surveillance of newly circulating infections.</p> <p>Methods</p> <p>A qualitative study with thematic analysis was conducted using focus group methodology. Forty-nine hospital-based HCWs from 12 hospitals were recruited to six focus groups; two each in England and Hungary and one each in Germany and Greece.</p> <p>Results</p> <p>HCWs perceived risk factors for occupationally acquired infectious diseases to be 1.) exposure to patients with undiagnosed infections 2.) break-down in infection control procedures 3.) immuno-naïvety and 4.) symptomatic colleagues. They were concerned that a lack of monitoring and guidelines for infectious HCWs posed a risk to staff and patients and felt employers failed to take a positive interest in their health. Staffing demands and loss of income were noted as pressures to attend work when unwell. In the UK, Hungary and Greece participants felt monitoring staff absence and the routine disclosure of symptoms could be appropriate provided the effectiveness and efficiency of such a system were demonstrable. In Germany, legislation, privacy and confidentiality were identified as barriers.</p> <p>All HCWs highlighted the need for knowledge and structural improvements for timelier recognition of emerging infections. These included increased suspicion and awareness among staff and standardised, homogenous absence reporting systems.</p> <p>Conclusions</p> <p>Monitoring absence and infectious disease symptom reports among HCWs may be a feasible means of surveillance for emerging infections in some settings. A pre-requisite will be tackling the drivers for symptomatic HCWs to attend work.</p

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Pharmacokinetic and pharmacodynamic evaluation of tigecycline

Introduction: As the spread of multidrug-resistant (MDR) and extensive drug-resistant (XDR) organisms constitutes a real threat for patients, new antimicrobials are needed. Tigecycline, the first-in-class glycylcycline, possesses an extended spectrum of antimicrobial activity including MDR and XDR organisms, which holds promise as a treatment option beyond currently approved indications and deserves expanded evaluation of its pharmacokinetics/pharmacodynamics (PK/PD). Areas covered: This review highlights the areas where our knowledge on PK/PD of tigecycline has been both strengthened and questioned during the recent years. New information has become available on the PK of tigecycline in patients with complicated skin and skin structure infections, complicated intra-abdominal infection, community-and nosocomial-acquired pneumonia. Human PD data from clinical trials linking tigecycline drug exposure to clinical, microbiological and toxicological outcomes are also of great interest. Expert opinion: Tigecycline remains one of our last resorts against MDR pathogens; its clear role has to be re-defined through intense PK/PD applications; dose escalation and exploration of combinations with other antibiotics seem to be the first step towards an expansion of its currently approved indications. The lung remains the most controversial and challenging site regarding the PK/PD standpoint due to the predominance of Acinetobacter baumannii and carbapenemase-producing Klebsiella pneumoniae among ventilator-associated pneumonia infections, for which tigecycline is mostly used off-label

Procalcitonin blood levels as an indicative parameter of bacterial infection in patients with febrile neutropenia

Aim of this study was to evaluate procalcitonin (PCT) as an index for the diagnosis of an infection in the field of febrile neutropenia, in comparison to Creative protein (CRP). In this open prospective study 115 patients with febrile neutropenia were enrolled, all developing neutropenia post chemotherapy. Blood samples were collected before chemotherapy, every 48 hours on neutropenia and at 24 hour intervals of fever until its resolution. PCT was determined by an immunochemiluminometric assay and CRP by nephelometry. Median PCT on the first day of fever was 8 23 ng/ml in the field of bacteremia compared to 0.86 ng/ml in localized bacterial infections (P=0.017). Median PCT in severe sepsis was 2.62 ng/ml compared to 0.57 ng/ml in clinically documented infections (P<0.001); no similar differences were found with CRP. PCT decreased dramatically following resolution of the infection, while PCT levels were found elevated when the infection worsened. Concentrations achieving best sensitivity and specificity for the diagnosis of bacteremia was 1.0 ng/ml and for severe sepsis 2.0 ng/ml. These findings reveal PCT as a useful parameter in the accurate diagnosis of bacteremia and the early detection of severe sepsis in the field of febrile neutropenia. Furthermore, the results provide new insight into the application of PCT as an indicator of the need to change an antimicrobial regimen.Ο στόχος της παρούσας διατριβής ήταν ο προσδιορισμός της προκαλσιτονίνης (PCT) ως δείκτη βακτηριακής λοίμωξης σε ασθενείς με εμπύρετη ουδετεροπενία συγκριτικά με τη C-αντιδρώσα πρωτεΐνη (CRP). Συμπεριλήφθηκαν 115 ασθενείς και δείγματα αίματος συνελέγησαν προ της χημειοθεραπείας, ανά 48ωρο από της εμφάνισης ουδετεροπενίας και ανά 24ωρο πυρετού μέχρι και την πρώτη ημέρα απυρεξίας. Η PCT προσδιορίσθηκε με μέθοδο ανοσοχημειοφωταύγειας και η CRP με νεφελομετρική μέθοδο. Με βακτηριαιμία η διάμεση τιμή της PCT την πρώτη ημέρα του πυρετού ήταν 8.23 ng/ml και 0.86 ng/ml σε εντοπισμένη βακτηριακή λοίμωξη (Ρ=0.017); δεν παρατηρήθηκε διαφορά μεταξύ των αντιστοίχων τιμών της CRP. Η διάμεση τιμή της PCT με σοβαρή σήψη ήταν 2.62 και 0.57 σε κλινικώς εντοπισμένη λοίμωξη (Ρ<0.001). Καμιά διαφορά δεν καταγράφηκε μεταξύ των αντιστοίχων τιμών της CRP. Τα επίπεδα της ΡCΤ κατακρημνίζονταν μετά τον έλεγχο της λοίμωξης και αυξάνονταν επί επιδείνωσης. Η υψηλότερη ευαισθησία και ειδικότητα για τη διάγνωση της βακτηριαιμίας διαπιστώθηκε σε τιμές μεγαλύτερες του 1.0 ng/ml ενώ για την πρώιμη διάγνωση της σοβαρής σήψης του 2.0 ng/ml. Συμπερασματικά η PCT δύναται να συνεισφέρει στην έγκαιρη διάγνωση της βακτηριαιμίας και της σοβαρής σήψης σε εμπύρετο ουδετεροπενία ενώ παρέχει πληροφορίες για την ανταπόκριση στην αντιμικροβιακή αγωγή

Emerging and Re-Emerging Infectious Diseases: Humankind’s Companions and Competitors

Infectious disease outbreaks had a significant impact on shaping the societies and cultures throughout human history [...

Severe acute respiratory infections in the postpandemic era of H1N1

Purpose of review Shortly after the advent of severe acute respiratory syndrome and the avian influenza, the emergence of the influenza A(H1N1) 2009 pandemic caused significant vibrations to the public health authorities and stressed the health systems worldwide. We sought to investigate whether this experience has altered our knowledge and our current and future practice on the management of severe acute respiratory infections (SARI) and community-acquired pneumonia. Recent findings A changing epidemiology was demonstrated, with obesity and pregnancy beyond established risk groups for influenza A, other clinical syndromes beyond primary viral pneumonia, possible coinfections by other viral beyond bacterial pathogens and a disappointing performance of all available severity assessment tools. On the treatment topic, accumulating evidence suggesting worse outcomes argues against the use of corticosteroids, but some noninvasive ventilating modalities require further assessment. Summary The recent influenza A(H1N1) 2009 pandemic has highlighted our weaknesses relating to the diagnosis and assessment of severity of SARI, compromising early treatment and ultimate outcomes; further research based on this experience will help to improve prognosis and boost our future preparedness. An important message is the necessity of international collaboration for the rapid dissemination of locally acquired knowledge