Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

Prevalenca in dejavniki, povezani z bolnišničnimi okužbami v slovenskih bolnišnicah za akutno oskrbo : rezultati tretje nacionalne presečne raziskave

Introduction. In the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them. Methods. Patients were enrolled into a one-day cross-sectional study in November 2017. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors. Results. Among 5,743 patients, 4.4% had at least one HAI and an additional 2.2% were still treated for HAIs on the day of the survey, with a prevalence of HAIs of 6.6%. The prevalence of pneumoniae was the highest (1.8%), followed by surgical site infections (1.5%) and urinary tract infections (1.2%). Prevalence of blood stream infections was 0.3%. In intensive care units (ICUs), the prevalence of patients with at least one HAI was 30.6%. Factors associated with HAIs included central vascular catheter (adjusted odds ratio [aOR] 4.195% confidence intervals [CI]: 3.1–5.4), peripheral vascular catheter (aOR 3.095% CI: 2.3–3.9), urinary catheter (aOR 1.895% CI: 1.4–2.3). Conclusions. The prevalence of HAIs in Slovenian acute care hospitals in 2017 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.Izhodišča. Tretja slovenska nacionalna presečna raziskava bolnišničnih okužb (BO) je potekala v okviru evropske presečne raziskave okužb, povezanih z zdravstvom in uporabe protimikrobnih zdravil v bolnišnicah za akutno oskrbo. Naši cilji so bili oceniti prevalenco vseh vrst BO in opredeliti dejavnike, ki so povezani z BO. Metode. V enodnevno presečno raziskavo smo vključili vse bolnike, ki so bili na izbrani dan v novembru 2017 zdravljeni v slovenskih bolnišnicah za akutno oskrbo. Z deskriptivnimi analizami smo opisali značilnosti bolnikov, izpostavljenost invazivnim posegom in ocenili prevalenco različnih vrst BO. Z univariatnimi in multivariatnimi analizami povezanosti BO z možnimi dejavniki tveganja smo opredelili dejavnike tveganja. Rezultati. Na dan raziskave je imelo BO 4,4 % (95 % interval zaupanja (IZ): 3,9 %–4,9 %) bolnikov in dodatnih 2,2 % (95% IZ: 1,8 %–2,6 %) bolnikov je bilo še vedno zdravljenih zaradi BO, torej je imelo BO 6,6 % (95% IZ: 6,0 %–7,3 %) bolnikov oziroma je bila prevalenca BO 6,6 %. Na 100 bolnikov je bilo 7,1 epizod BO, ker so nekateri bolniki imeli več kot eno epizodo. Najvišja je bila prevalenca pljučnic (1,8 %), sledile so okužbe kirurške rane (1,5 %) in okužbe sečil (1,2 %). Prevalenca okužb krvi je bila 0,3 %. Delež bolnikov z vsaj eno BO je bil najvišji v enotah za intenzivno zdravljenje (30,6 %). Na 100 bolnikov v enotah za intenzivno zdravljenje je bilo 38,3 epizod BO. V primerjavi z bolniki brez različnih invazivnih posegov so imeli bolniki s centralnim žilnim katetrom 4,1-krat višji obet BO (prilagojeno razmerje obetov (pRO) 4,195 % interval zaupanja (IZ): 3,1–5,4), bolniki s perifernim žilnim katetrom 3,0-krat višji obet BO (pRO 3,095 % IZ: 2,3–3,9), bolniki z urinskim katetrom 1,8-krat višji obet BO (pRO 1,895 % IZ: 1,4–2,3) in bolniki z operacijo v času hospitalizacije 1,6-krat višji obet BO (pRO 1,695% IZ: 1,2–2,0). Zaključki. Prevalenca BO v slovenskih bolnišnicah za akutno oskrbo je bila v letu 2017 precejšnja. Predvsem je bila visoka v enotah za intenzivno zdravljenje. Preprečevanje in obvladovanje BO je pomembna javnozdravstvena prednostna naloga. Za preprečevanje in obvladovanje BO, ki temelji na dokazih, je treba vzpostaviti nacionalno epidemiološko spremljanje BO tudi v enotah za intenzivno zdravljenje

Prevalence of and factors associated with healthcare-associated infections in Slovenian acute care hospitals: Results of the third national survey

In the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them

HIV-1 transmitted drug resistance in Slovenia and its impact on predicted treatment effectiveness: 2011–2016 update

<div><p>Abstract</p><p>HIV-positive individuals that have a detected transmitted drug resistance (TDR) at baseline have a higher risk of virological failure with antiretroviral therapy (ART). This study offers an update on the prevalence of TDR in Slovenia, looks for onward transmission of TDR, and reassesses the need for baseline drug resistance testing. Blinded questionnaires and partial <i>pol</i> sequences were obtained from 54.5% (168/308) of all of the patients diagnosed with HIV-1 from 2011 to 2016. Subtype B was detected in 82.7% (139/168) of patients, followed by subtype A (8.3%), subtype C (2.4%), and CRF01_AE (1.8%). Surveillance drug resistance mutations (SDRMs) were found in four individuals (2.4%), all of them men who have sex with men (MSM) and infected with subtype B. K103N was detected in two patients and T68D and T215D in one person each, corresponding to a prevalence of 0%, 1.2%, and 1.2% of TDR to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), and non-NRTIs (NNRTIs), respectively. The impact of mutations on drug susceptibility was found to be most pronounced for NNRTIs. No forward spread of TDR within the country was observed; however, phylogenetic analysis revealed several new introductions of HIV into Slovenia in recent years, possibly due to increased risky behavior by MSM. This was indirectly confirmed by a substantial increase in syphilis cases and HIV-1 non-B subtypes during the study period. A drug-resistant HIV variant with good transmission fitness is thus more likely to be imported into Slovenia in the near future, and so TDR should be closely monitored.</p></div

Large phylogenetic clusters (<i>n</i> > 10) of Slovenian sequences subtyped B or B-like.

<p>Large phylogenetic clusters (<i>n</i> > 10) of Slovenian sequences subtyped B or B-like.</p

Distribution of genotypic sensitivity scores of recommended first-line regimen as predicted from baseline HIV protease and reverse-transcriptase sequences obtained from individuals diagnosed with HIV-1 in Slovenia, 2000 to 2016.

<p>Distribution of genotypic sensitivity scores of recommended first-line regimen as predicted from baseline HIV protease and reverse-transcriptase sequences obtained from individuals diagnosed with HIV-1 in Slovenia, 2000 to 2016.</p

Characteristics of individuals diagnosed with HIV-1 in Slovenia, 2011–2016.

<p>Characteristics of individuals diagnosed with HIV-1 in Slovenia, 2011–2016.</p

Genotypic sensitivity scores (GSSs) of individual antiretroviral drugs as estimated from sequences obtained from individuals diagnosed with HIV-1 in Slovenia, 2000–2010 and 2011–2016.

<p>ATV = atazanavir; r = ritonavir (protease inhibitor booster); DRV = darunavir; LPV = lopinavir; ABC = abacavir; AZT = zidovudine; FTC = emtricitabine; 3TC = lamivudine; TDF = tenofovir; EFV = efavirenz; ETR = etravirine; NVP = nevirapine; RPV = rilpivirine.</p