Étude clinique sur l’impact du Staphylococcus aureus résistant à la méthicilline sur l’évolution des patients atteints de fibrose kystique

La prévalence du Staphylococcus aureus résistant à la méthicilline (SARM) a augmenté de façon dramatique dans les dernières années chez les patients atteints de fibrose kystique. Quoique le rôle du SARM dans la pathogénèse de l’atteinte respiratoire de la fibrose kystique ne soit pas clairement déterminé, certaines études récentes ont suggéré une association entre la persistance du SARM et le déclin accéléré de la fonction respiratoire. Cependant, l’importance clinique des diverses souches qui colonisent les patients atteints de fibrose kystique n’a pas encore été élucidée. Les objectifs de ce mémoire étaient de déterminer les effets d’une colonisation persistante par un SARM sur le statut clinique et respiratoire des enfants atteints de fibrose kystique. Également, nous tenions à étudier les caractéristiques des différentes souches de SARM dans cette population. Nous avons réalisé une étude rétrospective en analysant les données cliniques ainsi que les mesures de la fonction respiratoire chez les enfants atteints de fibrose kystique suivis à la Clinique de fibrose kystique du CHU Sainte-Justine entre 1996 et 2008 et ayant une colonisation persistante par un SARM. Afin de déterminer les souches qui colonisent cette population, nous avons effectué une caractérisation moléculaire des isolats du SARM. Nous avons identifié 22 patients avec une colonisation persistante par un SARM. Les résultats n’ont démontré aucun changement significatif en ce qui concernait le taux de déclin de la fonction respiratoire avant ou après l’acquisition du SARM. Cependant, la colonisation persistante par un SARM était associée à une augmentation du nombre d’hospitalisations pour une exacerbation pulmonaire. La plupart de nos patients étaient colonisés par le CMRSA-2, une souche épidémique au Canada. La présente étude suggère que la souche épidémique CMRSA-2 pouvait affecter l’évolution clinique des enfants atteints de fibrose kystique.Over the last several years, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has increased dramatically among cystic fibrosis (CF) patients. Although the exact role of MRSA in the pathogenesis of lung disease has not been clearly established, some studies suggest an association between persistent infection with MRSA and a more rapid rate of decline in lung function. It is uncertain whether all MRSA strains that infect CF patients are clinically important. The objectives of this thesis is to determine the effects of persistent MRSA on the clinical status and the lung function in children followed at the CF clinic at CHU Sainte-Justine and to characterize the MRSA strains in this population. We reviewed lung function measurements from subjects with persistent MRSA followed at our clinic between years 1996 and 2008. The first isolate from each patient was further characterized by molecular analysis. The results of the present study showed no significant difference for the rate of decline in lung function prior to and after MRSA colonization. However MRSA colonization was associated with an increased number of severe respiratory exacerbations requiring hospitalization. CMRSA-2, an epidemic clone in Canada, was found in the majority of our patients. This study suggests that persistent colonization with CMRSA-2 may affect the clinical outcome of children with cystic fibrosis

Excess body weight and age associated with the carriage of fluoroquinolone and third-generation cephalosporin resistance genes in commensal Escherichia coli from a cohort of urban Vietnamese children.

PURPOSE: Antimicrobial-resistant bacterial infections in low- and middle-income countries (LMICs) are a well-established global health issue. We aimed to assess the prevalence of and epidemiological factors associated with the carriage of ciprofloxacin- and ceftriaxone-resistant Escherichia coli and associated resistance genes in a cohort of 498 healthy children residing in urban Vietnam. METHODOLOGY: We cultured rectal swabs onto MacConkey agar supplemented with resistant concentrations of ciprofloxacin and ceftriaxone. Additionally, we screened meta-E. coli populations by conventional PCR to detect plasmid-mediated quinolone resistance (PMQR)- and extended-spectrum β-lactamase (ESBL)-encoding genes. We measured the associations between phenotypic/genotypic resistance and demographic characteristics using logistic regression.Results/Key findings. Ciprofloxacin- and ceftriaxone-resistant E. coli were cultured from the faecal samples of 67.7 % (337/498) and 80.3 % (400/498) of children, respectively. The prevalence of any associated resistance marker in the individual samples was 86.7 % (432/498) for PMQR genes and 90.6 % (451/498) for β-lactamase genes. Overweight children were significantly more likely to carry qnr genes than children with lower weight-for-height z-scores [odds ratios (OR): 1.24; 95 % confidence interval (CI): 10.5-1.48 for each unit increase in weight for height; P=0.01]. Additionally, younger children were significantly more likely to carry ESBL CTX-M genes than older children (OR: 0.97, 95 % CI: 0.94-0.99 for each additional year, P=0.01). CONCLUSION: The carriage of genotypic and phenotypic antimicrobial resistance is highly prevalent among E. coli in healthy children in the community in Vietnam. Future investigations on the carriage of antimicrobial resistant organisms in LMICs should focus on the progression of carriage from birth and structure of the microbiome in obesity

Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries.

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type

Pre and post-COVID 19 infection pulmonary functions in children with chronic respiratory disease : A case series

As functional respiratory impairment following COVID-19 infection (COVID-19) is increasingly reported in adult, data regarding children especially with pre-existing chronic respiratory disease (PCRD) remain scarce. We retrospectively assessed clinical presentation, duration of symptoms related to COVID-19 from paediatric patients with PCRD and compared their pre/post COVID-19-I spirometry values. Data from 12 patients were analysed. Timing between COVID-19 diagnosis and subsequent functional evaluation ranged from 26 to 209 days (mean 77). The PCRD in these patients included asthma, cystic fibrosis, bronchiolitis obliterans and bronchomalacia. During COVID-19, all clinical presentations were mild. One patient displayed persistent post-COVID-19 symptoms for 8 weeks after infection. Two patients presented significant deterioration of post-COVID-19 spirometric values with a return to pre-COVID-19 values in subsequent measures. We concluded that children with PCRD are not at increased risk for severe COVID disease and that most of them have no or only transient pulmonary functional impairment 1 to 7 months after COVID-19

Technical manual: Rice straw management towards circular economy and low emission in the Mekong Delta

The document “Technical manual: Rice straw management towards circular economy and low emission in the Mekong Delta” introduces readers to the characteristics of rice straw, the current status of its treatment, and the management process for using rice straw in a circular way to reduce GHG emissions in rice production. This manual will be a handbook for farmers, extension officers, cooperatives, and others who are interested in rice production that is associated with circular greenhouse gas emission reduction

Routine lung volume recruitment in boys with Duchenne muscular dystrophy:a randomised clinical trial

BACKGROUND: Impaired cough results in airway secretion retention, atelectasis and pneumonia in individuals with Duchenne muscular dystrophy (DMD). Lung volume recruitment (LVR) stacks breaths to inflate the lungs to greater volumes than spontaneous effort. LVR is recommended in DMD clinical care guidelines but is not well studied. We aimed to determine whether twice-daily LVR, compared with standard of care alone, attenuates the decline in FVC at 2 years in boys with DMD. METHODS: In this multicentre, assessor-blinded, randomised controlled trial, boys with DMD, aged 6–16 years with FVC >30% predicted, were randomised to receive conventional treatment or conventional treatment plus manual LVR twice daily for 2 years. The primary outcome was FVC % predicted at 2 years, adjusted for baseline FVC % predicted, age and ambulatory status. Secondary outcomes included change in chest wall distensibility (maximal insufflation capacity minus FVC) and peak cough flow. RESULTS: Sixty-six boys (36 in LVR group, 30 in control) were evaluated (median age (IQR): 11.5 years (9.5–13.5), median baseline FVC (IQR): 85% predicted (73–96)). Adjusted mean difference in FVC between groups at 2 years was 1.9% predicted (95% CI −6.9% to 10.7%; p=0.68) in the direction of treatment benefit. We found no differences in secondary outcomes. CONCLUSION: There was no difference in decline in FVC % predicted with use of twice-daily LVR for boys with DMD and relatively normal lung function. The burden associated with routine LVR may outweigh the benefit. Benefits of LVR to maintain lung health in boys with worse baseline lung function still need to be clarified. TRIAL REGISTRATION NUMBER: NCT01999075

Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type