Infection prevention and control of Clostridium difficile – a global review of guidelines, strategies, and recommendations

BACKGROUND: Clostridium difficile is the leading cause of health care–associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. METHODS: We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI–targeted IPC recommendations and describe the assessment of evidence in available guidelines. RESULTS: We identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long–term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported “strong” recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality. CONCLUSION: Our review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations

Aetiology of bacterial meningitis in infants aged <90 days : Prospective surveillance in Luanda, Angola

Background: Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. Objective: To describe the aetiology of BM in Angolan infants Methods: A prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged Results: Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. Conclusions: BM was common among infantsPeer reviewe

Impact of vaccination and non-pharmacological interventions on COVID-19: a review of simulation modeling studies in Asia

IntroductionEpidemiological modeling is widely used to offer insights into the COVID-19 pandemic situation in Asia. We reviewed published computational (mathematical/simulation) models conducted in Asia that assessed impacts of pharmacological and non-pharmacological interventions against COVID-19 and their implications for vaccination strategy.MethodsA search of the PubMed database for peer-reviewed, published, and accessible articles in English was performed up to November 2022 to capture studies in Asian populations based on computational modeling of outcomes in the COVID-19 pandemic. Extracted data included model type (mechanistic compartmental/agent-based, statistical, both), intervention type (pharmacological, non-pharmacological), and procedures for parameterizing age. Findings are summarized with descriptive statistics and discussed in terms of the evolving COVID-19 situation.ResultsThe literature search identified 378 results, of which 59 met criteria for data extraction. China, Japan, and South Korea accounted for approximately half of studies, with fewer from South and South-East Asia. Mechanistic models were most common, either compartmental (61.0%), agent-based (1.7%), or combination (18.6%) models. Statistical modeling was applied less frequently (11.9%). Pharmacological interventions were examined in 59.3% of studies, and most considered vaccination, except one study of an antiviral treatment. Non-pharmacological interventions were also considered in 84.7% of studies. Infection, hospitalization, and mortality were outcomes in 91.5%, 30.5%, and 30.5% of studies, respectively. Approximately a third of studies accounted for age, including 10 that also examined mortality. Four of these studies emphasized benefits in terms of mortality from prioritizing older adults for vaccination under conditions of a limited supply; however, one study noted potential benefits to infection rates from early vaccination of younger adults. Few studies (5.1%) considered the impact of vaccination among children.ConclusionEarly in the COVID-19 pandemic, non-pharmacological interventions helped to mitigate the health burden of COVID-19; however, modeling indicates that high population coverage of effective vaccines will complement and reduce reliance on such interventions. Thus, increasing and maintaining immunity levels in populations through regular booster shots, particularly among at-risk and vulnerable groups, including older adults, might help to protect public health. Future modeling efforts should consider new vaccines and alternative therapies alongside an evolving virus in populations with varied vaccination histories

Ship-board determination of whole-rock (ultra-)trace element concentrations by laser ablation-inductively coupled plasma mass spectrometry analysis of pressed powder pellets aboard the D/V Chikyu

The Oman Drilling Project (OmanDP), performed under the International Continental Scientific Drilling Program (ICDP), is an international scientific research project that undertook drilling at a range of sites in the Semail ophiolite (Oman) to collect core samples spanning the stratigraphy of the ophiolite, from the upper oceanic crust down to the basal thrust. The cores were logged to International Ocean Discovery Program (IODP) standards aboard the D/V Chikyu. During ChikyuOman2018 Leg 3 (July-August 2018), participants described cores from the crust-mantle transition (CM) sites. The main rock types recovered at these sites were gabbros, dunites and harzburgites, rocks typically forming the base of the oceanic crust and the shallow mantle beneath present-day spreading centres. In addition to the core description, selected samples were analysed by X-ray fluorescence spectrometry (XRF) for their chemical compositions, including major, minor and some trace elements. To complement these standard procedures, we developed new approaches to measure ultra-trace element concentrations using a procedure adapted from previous works to prepare fine-grained pressed powder pellets coupled with laser ablation-inductively coupled plasma mass spectrometry (LA-ICP-MS) analysis using instrumentation aboard the D/V Chikyu. First, three (ultra)mafic reference materials were investigated to test and validate our procedure (BHVO-2, BIR-1a and JP-1), and then the procedure was applied to a selection of gabbro and dunite samples from the CM cores to explore the limitations of the method in its current stage of development. The obtained results are in good agreement with preferred values for the reference materials and with subsequent solution replicate analyses of the same samples performed in shore-based laboratories following Leg 3 for the CM samples. We describe this procedure for the determination of 37 minor and (ultra-)trace elements (transition elements and Ga, Li and Large-Ion Lithophile Elements (LILE), Rare Earth Elements (REE), High-Field-Strength Elements (HFSE), U, Th, and Pb) in mafic and ultramafic rocks. The presented method has the major advantage that it allows the determination at sea of the (ultra-)trace element concentrations in a "dry", safe way, without using acid reagents. Our new approach could be extended for other elements of interest and/or be improved to be adapted to other rock materials during future ocean drilling operations aboard the D/V Chikyu and other platforms.This research used samples and/or data provided by the Oman Drilling Project. The Oman Drilling Project (OmanDP) has been possible through co-mingled funds from the International Continental Scientific Drilling Project (ICDP; Peter B. Kelemen, Juerg Matter, Damon A. H. Teagle Lead PIs), the Sloan Foundation – Deep Carbon Observatory (grant no. 2014-3-01, Kele- men PI), the National Science Foundation (grant no. NSF-EAR- 1516300, Kelemen lead PI), NASA – Astrobiology Institute (grant no. NNA15BB02A, Templeton PI), the German Research Founda-tion (DFG: grant no. KO 1723/21-1, Koepke PI), the Japanese Society for the Promotion of Science (JSPS (grant no. 16H06347), Michibayashi PI; and KAKENHI (grant no. 16H02742), Takazawa PI), the European Research Council (Adv: grant no. 669972; Jamveit PI), the Swiss National Science Foundation (SNF: grant no. 20FI21_163073, Früh-Green PI), JAMSTEC, the TAMU-JR Science Operator, and contributions from the Sultanate of Oman Ministry of Regional Municipalities and Water Resources, the Oman Public Authority of Mining, Sultan Qaboos University, CNRS- Univ. Montpellier, Columbia University of New York, and the University of Southampton. Mathieu Rospabé’s participation in onsite and shipboard operations was made possible through a financial support provided by the Centre National de la Recherche Scientifique-Institut National des Sciences de l’Univers (CNRSINSU), IODP-France (regular fund

Nasopharyngeal pneumococcal carriage in South Asian infants:Results of observational cohort studies in vaccinated and unvaccinated populations

BACKGROUND: Nasopharyngeal pneumococcal carriage (NPC) is a prerequisite for invasive pneumococcal disease and reduced carriage of vaccine serotypes is a marker for the protection offered by the pneumococcal conjugate vaccine (PCV). The present study reports NPC during the first year of life in a vaccinated (with PCV10) cohort in Bangladesh and an unvaccinated cohort in India. METHODS: A total of 450 and 459 infants were recruited from India and Bangladesh respectively within 0-7 days after birth. Nasopharyngeal swabs were collected at baseline, 18 and 36 weeks after birth. The swabs were processed for pneumococcal culture and identification of serotypes by the Quellung test and polymerase chain reaction (PCR). An identical protocol was applied at both sites. RESULTS: Prevalence of NPC was 48% in the Indian and 54.8% in the Bangladeshi cohort at 18 weeks. It increased to 53% and 64.8% respectively at 36 weeks. The average prevalence of vaccine serotypes was higher in the Indian cohort (17.8% vs 9.8% for PCV-10 and 26.1% vs17.6% for PCV-13) with 6A, 6B, 19F, 23F, and 19A as the common serotypes. On the other hand, the prevalence of non-vaccine serotypes was higher (43.6% vs 27.1% for non-PCV13) in the Bangladeshi cohort with 34, 15B, 17F, and 35B as the common serotypes. Overcrowding was associated with increased risk of pneumococcal carriage. The present PCV-13 vaccine would cover 28%-30% and 47%-48% serotypes in the Bangladeshi and Indian cohorts respectively. CONCLUSIONS: South Asian infants get colonised with pneumococci early in infancy; predominantly vaccine serotypes in PCV naïve population (India) and non-vaccine serotypes in the vaccinated population (Bangladesh). These local findings are important to inform the public health policy and the development of higher valent pneumococcal vaccines

Pediatric COVID-19 in Argentina: a comprehensive analysis of disease and economic burden through official data and a systematic literature review

BackgroundLimited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents.MethodsWe analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0–18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023.ResultsA total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%–28% of cases were asymptomatic, 68%–88% were mild or moderate, and 3%–10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC.ConclusionSignificant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively

Empagliflozin cardiovascular and renal effectiveness and safety compared to dipeptidyl peptidase-4 inhibitors across 11 countries in Europe and Asia : Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study

Background: Continued expansion of indications for sodium-glucose cotransporter-2 inhibitors increases importance of evaluating cardiovascular and kidney efficacy and safety of empagliflozin in patients with type 2 diabetes compared to similar therapies. Methods: The EMPRISE Europe and Asia study is a non-interventional cohort study using data from 2014 -2019 in seven European (Denmark, Finland, Germany, Norway, Spain, Sweden, United Kingdom) and four Asian (Israel, Japan, South Korea, Taiwan) countries. Patients with type 2 diabetes initiating empagliflozin were 1:1 propensity score matched to patients initiating dipeptidyl peptidase-4 inhibitors. Primary end-points included hospitalization for heart failure, all-cause mortality, myocardial infarction and stroke. Other cardiovascular, renal, and safety outcomes were examined.Findings: Among 83,946 matched patient pairs, (0.7 years overall mean follow-up time), initiation of empagli-flozin was associated with lower risk of hospitalization for heart failure compared to dipeptidyl peptidase-4 inhibitors (Hazard Ratio 0.70; 95% CI 0.60 to 0.83). Risks of all-cause mortality (0.55; 0.48 to 0.63), stroke (0. 82; 0.71 to 0.96), and end-stage renal disease (0.43; 0.30 to 0.63) were lower and risk for myocardial infarc-tion, bone fracture, severe hypoglycemia, and lower-limb amputation were similar between initiators of empagliflozin and dipeptidyl peptidase-4 inhibitors. Initiation of empagliflozin was associated with higher risk for diabetic ketoacidosis (1.97; 1.28 to 3.03) compared to dipeptidyl peptidase-4 inhibitors. Results were consistent across continents and regions.Interpretation: Results from this EMPRISE Europe and Asia study complements previous clinical trials and real-world studies by providing further evidence of the beneficial cardiorenal effects and overall safety of empagliflozin compared to dipeptidyl peptidase-4 inhibitors.(c) 2023 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Peer reviewe