52 research outputs found
Estimating Potential Infection Transmission Routes in Hospital Wards Using Wearable Proximity Sensors
Contacts between patients, patients and health care workers (HCWs) and among
HCWs represent one of the important routes of transmission of hospital-acquired
infections (HAI). A detailed description and quantification of contacts in
hospitals provides key information for HAIs epidemiology and for the design and
validation of control measures. We used wearable sensors to detect close-range
interactions ("contacts") between individuals in the geriatric unit of a
university hospital. Contact events were measured with a spatial resolution of
about 1.5 meters and a temporal resolution of 20 seconds. The study included 46
HCWs and 29 patients and lasted for 4 days and 4 nights. 14037 contacts were
recorded. The number and duration of contacts varied between mornings,
afternoons and nights, and contact matrices describing the mixing patterns
between HCW and patients were built for each time period. Contact patterns were
qualitatively similar from one day to the next. 38% of the contacts occurred
between pairs of HCWs and 6 HCWs accounted for 42% of all the contacts
including at least one patient, suggesting a population of individuals who
could potentially act as super-spreaders. Wearable sensors represent a novel
tool for the measurement of contact patterns in hospitals. The collected data
provides information on important aspects that impact the spreading patterns of
infectious diseases, such as the strong heterogeneity of contact numbers and
durations across individuals, the variability in the number of contacts during
a day, and the fraction of repeated contacts across days. This variability is
associated with a marked statistical stability of contact and mixing patterns
across days. Our results highlight the need for such measurement efforts in
order to correctly inform mathematical models of HAIs and use them to inform
the design and evaluation of prevention strategies
Using a pharmacist-led educational tool to teach elementary and middle-school students in Lebanon about microbes, antibiotic use and antimicrobial resistance: A pilot study
Background: Teaching school students about antibiotic use and antimicrobial resistance (AMR) can shape their future behaviour to become antibiotic guardians. This study aims to assess the impact of a pharmacist-led educational tool in boosting knowledge of these topics at elementary and middle school educational stages. Methods: A prospective web-based cross-sectional pre-post study was conducted in Lebanese private schools from April 2020 to December 2021. Results: The results showed that the pharmacist-led intervention increased the general knowledge (p = 0.01) and understanding of microbes (junior versus senior, p = 0.003 versus p = 0.004). In middle school, the spread of infection (p < 0.001) and the AMR concept (p = 0.001) significantly changed post-test, while antibiotics use and AMR concept remained unchanged in elementary students. Conclusion: The successful learning impact of the educational tool designed and led by pharmacists shows their importance as antibiotic experts in influencing early pedagogic learning about antibiotics and AMR starting at the middle-school stage.Scopu
Simulation of an SEIR infectious disease model on the dynamic contact network of conference attendees
The spread of infectious diseases crucially depends on the pattern of
contacts among individuals. Knowledge of these patterns is thus essential to
inform models and computational efforts. Few empirical studies are however
available that provide estimates of the number and duration of contacts among
social groups. Moreover, their space and time resolution are limited, so that
data is not explicit at the person-to-person level, and the dynamical aspect of
the contacts is disregarded. Here, we want to assess the role of data-driven
dynamic contact patterns among individuals, and in particular of their temporal
aspects, in shaping the spread of a simulated epidemic in the population.
We consider high resolution data of face-to-face interactions between the
attendees of a conference, obtained from the deployment of an infrastructure
based on Radio Frequency Identification (RFID) devices that assess mutual
face-to-face proximity. The spread of epidemics along these interactions is
simulated through an SEIR model, using both the dynamical network of contacts
defined by the collected data, and two aggregated versions of such network, in
order to assess the role of the data temporal aspects.
We show that, on the timescales considered, an aggregated network taking into
account the daily duration of contacts is a good approximation to the full
resolution network, whereas a homogeneous representation which retains only the
topology of the contact network fails in reproducing the size of the epidemic.
These results have important implications in understanding the level of
detail needed to correctly inform computational models for the study and
management of real epidemics
Mortality Following Clostridioides difficile Infection in Europe : A Retrospective Multicenter Case-Control Study
We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome
Clostridium difficile infection in patients hospitalized in a large tertiary hospital
Clostridium difficile est responsable de 15 à 25% des cas de diarrhées post-antibiotiques (ATB) et de plus de 95% des cas de colite pseudomembraneuse. Depuis 2003 et suite à l'émergence du clone 027, les ICD sont devenues plus fréquentes et plus sévères. Compte tenu des conséquences, il a été décidé d'explorer en détail et prospectivement cette maladie au Groupement Hospitalier Edouard Herriot L'inclusion des patients a débuté fin février 2011 et devrait s'arrêter fin février 2014. Dans une méta-analyse, nous avons montré que l'ICD communautaire est associée à l'exposition aux mêmes ATB qu'une ICD nosocomiale. Une analyse de la littérature, en utilisant la grille ORION comme outil, nous a permis de synthétiser les connaissances sur la prévention et le contrôle d'ICD en milieu hospitalier. Par la suite sur la base d'une étude rétrospective, le sexe, la CRP et l'exposition aux fluoroquinolones ont été identifiés comme associés à une ICD sévère chez les patients hospitalisés en réanimation. Entre 2011 et 2013, 430 patients ont été inclus dans notre cohorte. L'analyse des données de la prise en charge thérapeutique de 118 cas d'ICD a montré un niveau insuffisant de la connaissance des recommandations actuelles concernant le traitement de cette infection. L'analyse pronostique a montré un taux de mortalité de 19,5% dans les 30 jours qui suivent le diagnostic. L'ICD était indiquée comme une cause principale ou contributive de décès dans quinze cas (65,7% des décédés). Les analyses multivariées ont montré que les facteurs associés au décès sont différents entre les patients avec une ICD et les patients présentant une diarrhée non liée au Clostridium difficileClostridium difficile is responsible for almost all cases of pseudomembranous colitis and for 15%-25% of cases of post-antibiotic (ATB) diarrhea. Since 2003 and the emergence of 027 strain, CDI epidemiology is changing, with evidence of rising incidence and severity. In response to the alarming situation we decided to conduct a prospective study at Eduard Herriot Hospital to explore in details this infection. Patient’s inclusion has started in February 2011 and will end in February 2014. In a meta-analysis we found that the risk profiles for antimicrobial classes as risk factors for community-acquired CDI are similar to those described for nosocomial CDI. We used the ORION statement (Outbreak Reports and Intervention Studies Of Nosocomial infection) to synthesize knowledge of interventions to reduce and to control CDI in hospitals. Then in a retrospective study, we found that male gender, rising serum C-reactive protein level, and previous exposure to fluoroquinolones were independently associated with severe CDI in ICU. Between 2011 and 2013, 430 patients were included in our prospective cohort study. Data analysis of 118 cases of CDI showed an inefficient knowledge of current recommendations of CDI treatment. The crude mortality rate within 30 days after CDI diagnosis was 19.5%, with 15 deaths (65.7% of deceased patients) related to CDI. In a multivariate cox regression model, gender, serum albumin, antidiarrheal medications, cephalosporins, peritonitis and septic shock were independently associated with mortality in CDI patients. When diarrhea was not related to C. difficile, mortality was rather associated with cancer and high WBC leve
Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital
Introduction: Clostridioides (Clostridium) difficile can be isolated from stool in 3% of healthy adults and in at least 10% of asymptomatic hospitalized patients. C. difficile, the most common cause of hospital-acquired infectious diarrhea in the developed world, has re-emerged in recent years with increasing incidence and severity. In an effort to reduce the spread of the pathogen, published recommendations suggest isolation and contact precautions for patients suffering from C. difficile infection (CDI). However, asymptomatic colonized patients are not targeted by infection control policies, and active surveillance for colonization is not routinely performed. Moreover, given the current changes in the epidemiology of CDI, particularly the emergence of new virulent strains either in the hospital or community settings, there is a need for identification of factors associated with colonization by C. difficile and CDI. Methods and analysis: We are carrying out a prospective, observational, cohort study in Edouard Herriot Hospital, Hospices Civils de Lyon, a 900-bed university hospital in Lyon, France. All consecutive adult patients admitted on selected units are eligible to participate in the study. Stool samples or rectal swabs for C. difficile testing are obtained on admission, every 3–5 days during hospitalization, at the onset of diarrhea (if applicable), and at discharge. Descriptive and logistic regression analyses will be completed to mainly estimate the proportion of asymptomatic colonization at admission, and to evaluate differences between factors associated with colonization and those related to CDI. Ethics: The study is conducted in accordance with the ethical principles of the Declaration of Helsinki, French law, and the Good Clinical Practice guidelines. The study protocol design was approved by the participating units, the ethics committee and the hospital institutional review board (Comité de protection des personnes et Comission Nationale de l’Informatique et des Libertés; N°: 00009118). Dissemination: The results of this study will be disseminated by presenting the findings locally at each participating ward, as well as national and international scientific meetings. Findings will be shared with interested national societies crafting guidelines in CDI
Épidémiologie des infections à Clostridium difficile chez les patients hospitalisés dans un centre hospitalo-universitaire
Clostridium difficile is responsible for almost all cases of pseudomembranous colitis and for 15%-25% of cases of post-antibiotic (ATB) diarrhea. Since 2003 and the emergence of 027 strain, CDI epidemiology is changing, with evidence of rising incidence and severity. In response to the alarming situation we decided to conduct a prospective study at Eduard Herriot Hospital to explore in details this infection. Patient’s inclusion has started in February 2011 and will end in February 2014. In a meta-analysis we found that the risk profiles for antimicrobial classes as risk factors for community-acquired CDI are similar to those described for nosocomial CDI. We used the ORION statement (Outbreak Reports and Intervention Studies Of Nosocomial infection) to synthesize knowledge of interventions to reduce and to control CDI in hospitals. Then in a retrospective study, we found that male gender, rising serum C-reactive protein level, and previous exposure to fluoroquinolones were independently associated with severe CDI in ICU. Between 2011 and 2013, 430 patients were included in our prospective cohort study. Data analysis of 118 cases of CDI showed an inefficient knowledge of current recommendations of CDI treatment. The crude mortality rate within 30 days after CDI diagnosis was 19.5%, with 15 deaths (65.7% of deceased patients) related to CDI. In a multivariate cox regression model, gender, serum albumin, antidiarrheal medications, cephalosporins, peritonitis and septic shock were independently associated with mortality in CDI patients. When diarrhea was not related to C. difficile, mortality was rather associated with cancer and high WBC levelClostridium difficile est responsable de 15 à 25% des cas de diarrhées post-antibiotiques (ATB) et de plus de 95% des cas de colite pseudomembraneuse. Depuis 2003 et suite à l'émergence du clone 027, les ICD sont devenues plus fréquentes et plus sévères. Compte tenu des conséquences, il a été décidé d'explorer en détail et prospectivement cette maladie au Groupement Hospitalier Edouard Herriot L'inclusion des patients a débuté fin février 2011 et devrait s'arrêter fin février 2014. Dans une méta-analyse, nous avons montré que l'ICD communautaire est associée à l'exposition aux mêmes ATB qu'une ICD nosocomiale. Une analyse de la littérature, en utilisant la grille ORION comme outil, nous a permis de synthétiser les connaissances sur la prévention et le contrôle d'ICD en milieu hospitalier. Par la suite sur la base d'une étude rétrospective, le sexe, la CRP et l'exposition aux fluoroquinolones ont été identifiés comme associés à une ICD sévère chez les patients hospitalisés en réanimation. Entre 2011 et 2013, 430 patients ont été inclus dans notre cohorte. L'analyse des données de la prise en charge thérapeutique de 118 cas d'ICD a montré un niveau insuffisant de la connaissance des recommandations actuelles concernant le traitement de cette infection. L'analyse pronostique a montré un taux de mortalité de 19,5% dans les 30 jours qui suivent le diagnostic. L'ICD était indiquée comme une cause principale ou contributive de décès dans quinze cas (65,7% des décédés). Les analyses multivariées ont montré que les facteurs associés au décès sont différents entre les patients avec une ICD et les patients présentant une diarrhée non liée au Clostridium difficil
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