8 research outputs found
Utilization of non-invasive hemodynamic monitoring in resource-limiting settings — Preliminary experience
The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study.
INTRODUCTION:Typhoid fever (TF) continues to cause considerable morbidity and mortality in Nepal, but only limited epidemiologic data is available about TF outside Kathmandu. METHODS:As part of an interventional trial, we performed a prospective cohort study of bacteremic TF patients in Dhulikhel Hospital between October 2012 and October 2014. Demographic, epidemiological, clinical, and microbiologic data were recorded. RESULTS:116 bacteremic typhoid patients were included in the study. Most were young, healthy, adults (mean age 27.9±12 years), 41.4% of whom were female. More than 70% of patients were employed in non-manual services or were university students. Salmonella Typhi accounted for 64/115 (55.7%) of all isolates, while Salmonella Paratyphi accounted for 51/115 (44.3%), of which 42 were Paratyphi A and 9 Paratyphi B. A significant proportion of TF cases occurred also during the dry season (48/116, 41.6%). The clinical presentation of Salmonella Typhi and Paratyphi infections was similar, except for a greater proportion of arthralgia in patients with Salmonella Typhi. Most Salmonella Typhi and Paratyphi isolates were resistant to nalidixic acid and susceptible to older antibiotics. One Salmonella Paratyphi isolate was resistant to ceftriaxone. CONCLUSIONS:TF remains common in the Dhulikhel area, even among those with a high level of education. Public health measures aimed at reducing the incidence of TF in the Dhulikhel area are warranted. The relative burden of TF caused by Salmonella Paratyphi is rising; a vaccine with activity against Salmonella Paratyphi is needed. Since Salmonella Paratyphi B was more prevalent in this cohort than in large cohorts of patients from Kathmandu, it is likely that there are significant regional variations in the epidemiology of TF outside Kathmandu
In vivo fitness of carbapenem-resistant Acinetobacter baumannii strains in murine infection is associated with treatment failure in human infections
Mortality among patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infections varies between studies. We examined whether in vivo fitness of CRAB strains is associated with clinical outcomes in patients with CRAB infections
In vivo fitness of carbapenem-resistant Acinetobacter baumannii strains in murine infection is associated with treatment failure in human infections
Objectives: Mortality among patients with carbapenem-resistant
Acinetobacter baumannii (CRAB) infections varies between studies. We
examined whether in vivo fitness of CRAB strains is associated with
clinical outcomes in patients with CRAB infections. Methods: Isolates
were collected from patients enrolled in the AIDA trial with
hospital-acquired pneumonia, bloodstream infections and/or urinary tract
infections caused by CRAB. The primary outcome was 14-day clinical
failure, defined as failure to meet all criteria: alive;
haemodynamically stable; improved or stable Sequential Organ Failure
Assessment (SOFA) score; improved or stable oxygenation; and
microbiological cure of bacteraemia. The secondary outcome was 14-day
mortality. We tested in vivo growth using a neutropenic murine thigh
infection model. Fitness was defined based on the CFU count 24 hours
after injection of an inoculum of 105 CFU. We used mixed-effects
logistic regression to test the association between fitness and the two
outcomes. Results: The sample included 266 patients; 215 (80.8%)
experienced clinical failure. CRAB fitness ranged from 5.23 to 10.08 log
CFU/g. The odds of clinical failure increased by 62% for every 1-log
CFU/g increase in fitness (OR 1.62, 95% CI 1.04-2.52). After adjusting
for age, Charlson score, SOFA score and acquisition in the intensive
care unit, fitness remained significant (adjusted OR 1.63, 95% CI
1.03-2.59). CRAB fitness had a similar effect on 14-day mortailty,
although the association was not statistically significant (OR 1.56,
95% CI 0.95-2.57). It became significant after adjusting for age,
Charlson score, SOFA score and recent surgery (adjusted OR 1.88, 95% CI
1.09-3.25). Conclusions: In vivo CRAB fitness was associated with
clinical failure in patients with CRAB infection. Amir Nutman, Clin
Microbiol Infect 2022;28:73 (c) 2021 European Society of Clinical
Microbiology and Infectious Diseases. Published by Elsevier Ltd. All
rights reserved
The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study
The Staphylococcus aureus Network Adaptive Platform Trial Protocol: New Tools for an Old Foe (vol 75, pg 2027, 2022)
10.1093/cid/ciac730CLINICAL INFECTIOUS DISEASES75111532-153