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Wang, Q., Peng, K., Liu, Y., Xiao, X., Wang, Z., Li, R.
Antimicrobial Agents And Chemotherapy, 19.04.2021
Tilføjet 20.04.2021
The emergence and transmission of novel antimicrobial resistance genes pose a great threat to public health globally. Recently, the plasmid-encoding RND efflux pump TMexCD1-TOprJ1 in Klebsiella pneumoniae was reported to reduce the sensitivity of multiple antimicrobials. Herein, we identified a pandrug-resistant Proteus mirabilis isolate, which harbored the novel tmexCD3-toprJ3 gene cluster located on SXT/R391 ICE. This study expands current knowledge in transfer mechanism of tmexCD1-toprJ1-like gene clusters among P. mirabilis and warrant further genomic epidemiology investigations.
Læs mere Tjek på PubMedRehman, A., Jeukens, J., Levesque, R. C., Lamont, I. L.
Antimicrobial Agents And Chemotherapy, 19.04.2021
Tilføjet 20.04.2021
Ciprofloxacin is one of the most widely used antibiotics for treating Pseudomonas aeruginosa infections. However P. aeruginosa acquires mutations that confer ciprofloxacin resistance, making treatment more difficult. Resistance is multifactorial, with mutations in multiple genes influencing the resistance phenotype. However the contributions of individual mutations and mutation combinations to the amounts of ciprofloxacin that P. aeruginosa can tolerate are not well understood. Engineering P. aeruginosa strain PAO1 to contain mutations in any one of the resistance-associated genes gyrA, nfxB, rnfC, parC and parE showed that only gyrA mutations increased the Minimum Inhibitory Concentration (MIC) for ciprofloxacin. Mutations in parC and parE increased the MIC of a gyrA mutant, making the bacteria ciprofloxacin resistant. Mutations in nfxB and rnfC increased the MIC, conferring resistance, only if both were mutated in a gyrA background. Mutations in all of gyrA, nfxB, rnfC and parC/E further increased the MIC. These findings reveal an epistatic network of gene-gene interactions in ciprofloxacin resistance. We used this information to predict ciprofloxacin resistance/susceptibility for 274 isolates of P. aeruginosa from their genome sequences. Antibiotic susceptibility profiles were predicted correctly for 84% of the isolates. The majority of isolates for which prediction was unsuccessful were ciprofloxacin resistant, demonstrating the involvement of additional as yet unidentified genes and mutations in resistance. Our data show that gene-gene interactions can play an important role in antibiotic resistance and can be successfully incorporated into models predicting resistance phenotype.
Læs mere Tjek på PubMedSarah C Gilbert, Teresa Lambe
Lancet Infectious Diseases, 20.04.2021
Tilføjet 20.04.2021
The development of vaccines against SARS-CoV-2 has proceeded at an unprecedented pace, resulting in emergency use approvals and accelerated deployment of multiple vaccines. This development and deployment has occurred within a year of the Public Health Emergency of International Concern declaration by WHO. However, some attempts to develop vaccines have run into difficulties in early clinical development.
Læs mere Tjek på PubMedStephen Obaro
Lancet Infectious Diseases, 20.04.2021
Tilføjet 20.04.2021
The scourge of COVID-19 has been global, but the most affected subgroups in the population have largely been older people and individuals with comorbid conditions that predispose them to increasingly severe disease and poor outcomes. Overall, the disease burden in children has been reasonably mild, even in those with comorbidities, such as oncological conditions. Protection from severe disease in children might be related to a lower expression of host factors required for viral replication, and to differences in the magnitude and timing of innate or adaptive immune responses.
Læs mere Tjek på PubMedKeith J Chappell, Francesca L Mordant, Zheyi Li, Danushka K Wijesundara, Paula Ellenberg, Julia A Lackenby, Stacey T M Cheung, Naphak Modhiran, Michael S Avumegah, Christina L Henderson, Kym Hoger, Paul Griffin, Jillian Bennet, Luca Hensen, Wuji Zhang, Thi H O Nguyen, Sara Marrero-Hernandez, Kevin J Selva, Amy W Chung, Mai H Tran, Peter Tapley, James Barnes, Patrick C Reading, Suellen Nicholson, Stavroula Corby, Thomas Holgate, Bruce D Wines, P Mark Hogarth, Katherine Kedzierska, Damian F J Purcell, Charani Ranasinghe, Kanta Subbarao, Daniel Watterson, Paul R Young, Trent P Munro
Lancet Infectious Diseases, 20.04.2021
Tilføjet 20.04.2021
This first-in-human trial shows that a subunit vaccine comprising mammalian cell culture-derived, MF59-adjuvanted, molecular clamp-stabilised recombinant spike protein elicits strong immune responses with a promising safety profile. However, the glycoprotein 41 peptide present in the clamp created HIV diagnostic assay interference, a possible barrier to widespread use highlighting the criticality of potential non-spike directed immunogenicity during vaccine development. Studies are ongoing with alternative molecular clamp trimerisation domains to ameliorate this response.
Læs mere Tjek på PubMedPaul A Goepfert, Bo Fu, Anne-Laure Chabanon, Matthew I Bonaparte, Matthew G Davis, Brandon J Essink, Ian Frank, Owen Haney, Helene Janosczyk, Michael C Keefer, Marguerite Koutsoukos, Murray A Kimmel, Roger Masotti, Stephen J Savarino, Lode Schuerman, Howard Schwartz, Lawrence D Sher, Jon Smith, Fernanda Tavares-Da-Silva, Sanjay Gurunathan, Carlos A DiazGranados, Guy de Bruyn
Lancet Infectious Diseases, 20.04.2021
Tilføjet 20.04.2021
The lower than expected immune responses, especially in the older age groups, and the high reactogenicity after dose two were probably due to higher than anticipated host-cell protein content and lower than planned antigen doses in the formulations tested, which was discovered during characterisation studies on the final bulk drug substance. Further development of the AS03-adjuvanted candidate vaccine will focus on identifying the optimal antigen formulation and dose.
Læs mere Tjek på PubMedDavid L. Hahn
PLoS One Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
by David L. Hahn
Background Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported.
Methods The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented.
Findings No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (p<0.00001) associated with asthma severity.
Interpretation C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.
Læs mere Tjek på PubMedUgochinyere Ijeoma Nwagbara, Emmanuella Chinonso Osual, Rumbidzai Chireshe, Obasanjo Afolabi Bolarinwa, Balsam Qubais Saeed, Nelisiwe Khuzwayo, Khumbulani W. Hlongwana
PLoS One Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
by Ugochinyere Ijeoma Nwagbara, Emmanuella Chinonso Osual, Rumbidzai Chireshe, Obasanjo Afolabi Bolarinwa, Balsam Qubais Saeed, Nelisiwe Khuzwayo, Khumbulani W. Hlongwana
Background Knowledge, attitudes, perception, and preventative practices regarding coronavirus- 2019 (COVID-19) are crucial in its prevention and control. Several studies have noted that the majority of people in sub-Saharan African are noncompliant with proposed health and safety measures recommended by the World Health Organization (WHO) and respective country health departments. In most sub-Saharan African countries, noncompliance is attributable to ignorance and misinformation, thereby raising questions about people™s knowledge, attitudes, perception, and practices towards COVID-19 in these settings. This situation is particularly of concern for governments and public health experts. Thus, this scoping review is aimed at mapping evidence on the knowledge, attitudes, perceptions, and preventive practices (KAP) towards COVID-19 in sub-Saharan Africa (SSA).
Methods Systematic searches of relevant articles were performed using databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, the WHO library and grey literature. Arksey and O™Malley™s framework guided the study. The risk of bias for included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVIVO version 10 was used to analyse the data and a thematic content analysis was used to present the review™s narrative account.
Results A total of 3037 eligible studies were identified after the database search. Only 28 studies met the inclusion criteria after full article screening and were included for data extraction. Studies included populations from the following SSA countries: Ethiopia, Nigeria, Cameroon, Uganda, Rwanda, Ghana, Democratic Republic of Congo, Sudan, and Sierra Leone. All the included studies showed evidence of knowledge related to COVID-19. Eleven studies showed that participants had a positive attitude towards COVID-19, and fifteen studies showed that participants had good practices towards COVID-19.
Conclusions Most of the participants had adequate knowledge related to COVID-19. Despite adequate knowledge, the attitude was not always positive, thereby necessitating further education to convey the importance of forming a positive attitude and continuous preventive practice towards reducing contraction and transmission of COVID19.
Læs mere Tjek på PubMedAdam Palayew, Alexandra M. Schmidt, Sahar Saeed, Curtis L. Cooper, Alexander Wong, Valérie Martel-Laferrière, Sharon Walmsley, Joseph Cox, Marina B. Klein, for the Canadian Coinfection Cohort Study Investigators
PLoS One Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
by Adam Palayew, Alexandra M. Schmidt, Sahar Saeed, Curtis L. Cooper, Alexander Wong, Valérie Martel-Laferrière, Sharon Walmsley, Joseph Cox, Marina B. Klein, for the Canadian Coinfection Cohort Study Investigators
Background HIV-HCV coinfected individuals are often more deprived than the general population. However, deprivation is difficult to measure, often relying on aggregate data which does not capture individual heterogeneity. We developed an individual-level deprivation index for HIV-HCV co-infected persons that encapsulated social, material, and lifestyle factors.
Methods We estimated an individual-level deprivation index with data from the Canadian Coinfection Cohort, a national prospective cohort study. We used a predetermined process to select 9 out of 19 dichotomous variables at baseline visit to include in the deprivation model: income >$1500/month; education >high school; employment; identifying as gay or bisexual; Indigenous status; injection drug use in last 6 months; injection drug use ever; past incarceration, and past psychiatric hospitalization. We fitted an item response theory model with: severity parameters (how likely an item was reported), discriminatory parameters, (how well a variable distinguished index levels), and an individual parameter (the index). We considered two models: a simple one with no provincial variation and a hierarchical model by province. The Widely Applicable Information Criterion (WAIC) was used to compare the fitted models. To showcase a potential utility of the proposed index, we evaluated with logistic regression the association of the index with non-attendance to a second clinic visit (as a proxy for disengagement) and using WAIC compared it to a model containing all the individual parameters that compose the index as covariates.
Results We analyzed 1547 complete cases of 1842 enrolled participants. According to the WAIC the hierarchical model provided a better fit when compared to the model that does not consider the individual™s province. Values of the index were similarly distributed across the provinces. Overall, past incarceration, education, and unemployment had the highest discriminatory parameters. However, in each province different components of the index were associated with being deprived reflecting local epidemiology. For example, Saskatchewan had the highest severity parameter for Indigenous status while Quebec the lowest. For the secondary analysis, 457 (30%) failed to attend a second visit. A one-unit increase in the index was associated with 17% increased odds (95% credible interval, 2% to 34%) of not attending a second visit. The model with just the index performed better than the model with all the components as covariates in terms of WAIC.
Conclusion We estimated an individual-level deprivation index in the Canadian Coinfection cohort. The index identified deprivation profiles across different provinces. This index and the methodology used may be useful in studying health and treatment outcomes that are influenced by social disparities in co-infected Canadians. The methodological approach described can be used in other studies with similar characteristics.
Læs mere Tjek på PubMedGeorge Edwards, Louise Newbould, Charlotte Nesbitt, Miranda Rogers, Rebecca L. Morris, Alastair D. Hay, Stephen M. Campbell, Gail Hayward
PLoS One Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
by George Edwards, Louise Newbould, Charlotte Nesbitt, Miranda Rogers, Rebecca L. Morris, Alastair D. Hay, Stephen M. Campbell, Gail Hayward
Background Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness.
Aim To identify symptoms, signs, and investigation results associated with good and poor prognosis, and clinical decision making in children aged 1-12 years with RTI symptoms, at home and presenting to ambulatory care.
Design and setting Systematic literature review.
Methods We searched MEDLINE, EMBASE, Cinahl, Web of Science and the Cochrane database of systematic reviews for studies of children aged 1 to 12 years with a RTI or related condition reporting symptoms, signs and investigation results associated with prognostic outcomes. Quality was assessed using the QUIPS tool.
Results We included 27 studies which included 34802 children and measured 192 factors. Nine studies explored future outcomes and the remainder explored clinical management from the initial consultation with the health services. None were conducted in a home setting. Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. Little evidence was available for other outcomes.
Conclusion Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
Læs mere Tjek på PubMedCalderaro, A., Buttrini, M., Martinelli, M., Montecchini, S., Covan, S., Ruggeri, A., Rodighiero, I., Di Maio, A., Galullo, M., Larini, S., Arcangeletti, M. C., Chezzi, C., De Conto, F.
BMJ Open, 19.04.2021
Tilføjet 19.04.2021
Objectives
The distribution of carbapenemase-producing Klebsiella pneumoniae (CPKP) phenotypes and genotypes in samples collected during 2011–2018 was evaluated. The association between patients with CPKP-positive rectal swab and those with CPKP infection, as well as the overall analysis of CPKP-infected patients, was performed.
Setting
The study was performed in a tertiary-care hospital located in Northern Italy.
Participants
Two groups were considered: 22 939 ‘at-risk’ patients submitted to active surveillance for CPKP detection in rectal swabs/stools and 1094 CPKP-infected patients in which CPKP was detected in samples other than rectal swabs.
Results
CPKP-positive rectal swabs were detected in 5% (1150/22 939). A CPKP infection was revealed in 3.1% (719/22 939) of patients: 582 with CPKP-positive rectal swab (50.6% of the 1150 CPKP-positive rectal swabs) and 137 with CPKP-negative rectal swab. The 49.4% (568/1150) of the patients with CPKP-positive rectal swab were carriers. The overall frequency of CPKP-positive patients (carriers and infected) was almost constant from 2012 to 2016 (excluding the 2015 peak) and then increased in 2017–2018. blaKPC was predominant followed by blaVIM. No difference was observed in the frequency of CPKP-positive rectal swab patients among the different material groups. Among the targeted carbapenemase genes, blaVIM was more significantly detected from urine than from other samples.
Conclusions
The high prevalence of carriers without evidence of infection, representing a potential reservoir of CPKP, suggests to maintain the guard about this problem, emphasising the importance of active surveillance for timely detection and separation of carriers, activation of contact precautions and antibiotic treatment guidance on suspicion of infection.
Læs mere Tjek på PubMedOliveira, C. R., Ortiz, A. M., Sheth, S. S., Shapiro, E. D., Niccolai, L. M.
BMJ Open, 19.04.2021
Tilføjet 19.04.2021
Introduction
In 2006, the first human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration in the USA based on pre-licensure clinical trials that found it to be highly efficacious at preventing persistent infection and precancerous, high-grade cervical lesions (HGCLs) caused by viral types the vaccine protects against. However, the real-world effectiveness of HPV vaccines as used in clinical practice may be quite different from the efficacy found in pre-licensure clinical trials. More than 10 years have passed since the introduction of the vaccine programme. It is critical to determine if the full benefits of HPV are being realised in real-world settings.
Methods and analysis
The objectives of this study were to estimate the effectiveness of HPV vaccines as used in real-world clinical settings and to determine the degree to which the vaccine’s effectiveness varies based on age at the time of immunisation and the number of doses received. The study will be a population-based, matched case–control study. Cases will be women with newly diagnosed HGCL associated with HPV types 16 and 18. Matched controls will be women with a normal Pap test result, matched individually to cases in a 2:1 ratio by age, a practice and date of testing. Medical records will be reviewed to determine dates of receipt of the HPV vaccine for all participants. We will use multivariate conditional logistic regression to control for potential confounders.
Ethics and dissemination
This protocol presents minimal risk to the subjects. This protocol has received approval from the Institutional Review Board of Yale University (HIC: 1502015308), and a Health Insurance Portability and Accountability Act (HIPAA) Waiver of Authorisation has been granted to allow investigators to recruit subjects for the study. Findings will be disseminated through peer-reviewed, open-access scientific journals and conference presentations.
Læs mere Tjek på PubMedDayem Ullah, A. Z. M., Sivapalan, L., Kocher, H. M., Chelala, C.
BMJ Open, 19.04.2021
Tilføjet 19.04.2021
Objective
To explore risk factors associated with COVID-19 susceptibility and survival in patients with pre-existing hepato–pancreato–biliary (HPB) conditions.
Design
Cross-sectional study.
Setting
East London Pancreatic Cancer Epidemiology (EL-PaC-Epidem) Study at Barts Health National Health Service Trust, UK. Linked electronic health records were interrogated on a cohort of participants (age ≥18 years), reported with HPB conditions between 1 April 2008 and 6 March 2020.
Participants
EL-PaC-Epidem Study participants, alive on 12 February 2020, and living in East London within the previous 6 months (n=15 440). The cohort represents a multi-ethnic population with 51.7% belonging to the non-White background.
Main outcome measure
COVID-19 incidence and mortality.
Results
Some 226 (1.5%) participants had confirmed COVID-19 diagnosis between 12 February and 12 June 2020, with increased odds for men (OR 1.56; 95% CI 1.2 to 2.04) and Black ethnicity (2.04; 1.39 to 2.95) as well as patients with moderate to severe liver disease (2.2; 1.35 to 3.59). Each additional comorbidity increased the odds of infection by 62%. Substance misusers were at more risk of infection, so were patients on vitamin D treatment. The higher ORs in patients with chronic pancreatic or mild liver conditions, age >70, and a history of smoking or obesity were due to coexisting comorbidities. Increased odds of death were observed for men (3.54; 1.68 to 7.85) and Black ethnicity (3.77; 1.38 to 10.7). Patients having respiratory complications from COVID-19 without a history of chronic respiratory disease also had higher odds of death (5.77; 1.75 to 19).
Conclusions
In this large population-based study of patients with HPB conditions, men, Black ethnicity, pre-existing moderate to severe liver conditions, six common medical multimorbidities, substance misuse and a history of vitamin D treatment independently posed higher odds of acquiring COVID-19 compared with their respective counterparts. The odds of death were significantly high for men and Black people.
Læs mere Tjek på PubMedAlison Farrell
Nature, 19.04.2021
Tilføjet 19.04.2021
Nature Medicine, Published online: 19 April 2021; doi:10.1038/d41591-021-00020-w
Feeding the gut microbiota aids growth in undernourished children.
Læs mere Tjek på PubMedMonette Zard, Ling San Lau, Diana M. Bowser, Fouad M. Fouad, Diego I. LucumÃ, Goleen Samari, Arturo Harker, Donald S. Shepard, Wu Zeng, Rachel T. Moresky, Mhd Nour Audi, Claire M. Greene, S. Patrick Kachur
Nature, 19.04.2021
Tilføjet 19.04.2021
Nature Medicine, Published online: 19 April 2021; doi:10.1038/s41591-021-01328-3
Ensuring access to vaccines against COVID-19 for refugee and displaced populations and addressing health inequities are vital for an effective pandemic response.
Læs mere Tjek på PubMedEmerging Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
BMC Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
Abstract
Background
Since the outbreak of COVID-19 pandemic, clinical data from various parts of the world have been reported. Up till now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze factors that influence COVID-19 patient™s length of hospitalization (LOH).
Methods
This retrospective cohort study was conducted at Tuzla University Clinical Center (UKC), B&H. It involved 25 COVID-19 positive patients that needed hospitalisation between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of known comorbidities, serum creatinine and O2 saturation upon admission.
Results
The mean age was 52.92‰±‰19.15‰years and BMI 28.80‰±‰4.22. LOH for patients with BMI <‰25 was 9‰±‰SE2.646‰days (CI 95% 3.814-14.816) vs 14.182‰±‰SE .937 (CI 95% 12.346-16.018 p <‰0.05; HR 5.148 CI95% 1.217 to 21.772 p =‰0.026) for ≥25 BMI. The mean LOH of patients with normal levels of O2 ≥‰95% was 11.667‰±‰SE1.202 (CI95% 8.261 to 13.739; p =‰0.046), while LOH for patients with <‰95% was 14.625‰±‰SE 1.231 CI95% 12.184 to 16.757 p =‰0.042; HR 3.732 CI95%1.137-12.251 p =‰0.03). Patients without known comorbidities had a mean LOH of 11.700‰±‰SE1.075 (CI 95% 9.592-13.808), while those with comorbidities had a mean of 14.8‰±‰1.303 (CI 95% 12.247-17.353; p =‰0.029) with HR2.552.
Conclusion
LOH varied among COVID-19 patients and was prolonged when analyzed for BMI ≥25, comorbidities, elevated creatinine, and O2 saturation‰<‰95%. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from those reported in other countries.
Læs mere Tjek på PubMedVictoria Birlutiu, Alin Iulian Feiereisz, George Oprinca, Simona Dobritoiu, Maria Rotaru, Rares Mircea Birlutiu, Gabriela Mariana Iancu
International Journal of Infectious Diseases, 19.04.2021
Tilføjet 19.04.2021
The expression levels of the ACE2 receptors in various human tissues may be responsible for the pathogenesis of SARS-CoV-2 infection. The presence of ACE2 receptors in the respiratory system, cardiovascular system, digestive tract (esophageal mucosa, ileum), kidneys and uroepithelium explains their involvement in the context of SARS-CoV-2 infection. Skin involvement in the severe acute respiratory syndrome coronavirus 2 infection has been clinically and histopathological incompletely studied. The Academic Emergency Hospital Sibiu, Romania, was involved from the beginning in the treatment of SARS-CoV-2 infected patients.
Læs mere Tjek på PubMedM. Isabel GarcÃaLaorden, Arie J. Hoogendijk, Maryse A. Wiewel, Lonneke A. van Vught, Marcus J. Schultz, Niels Bovenschen, Alex F. de Vos, Tom van der Poll
Clinical & Experimental Immunology, 18.04.2021
Tilføjet 19.04.2021
Manuel Othoniel LópezTorres, Brenda MarquinaCastillo, Octavio RamosEspinosa, Dulce MataEspinosa, Jorge A. BarriosPayan, Guillermina BaayGuzman, Sara Huerta Yepez, Estela Bini, Ivan TorreVillalvazo, Nimbe Torres, Armando Tovar, William Chamberlin, Yu Ge, Andrea Carranza, Rogelio HernándezPando
Clinical & Experimental Immunology, 18.04.2021
Tilføjet 19.04.2021
Emily Treleaven, Caroline Whidden, Faith Cole, Kassoum Kayentao, Mohamed Bana Traoré, Djoumé Diakité, Seydou Sidibé, Tracy Kuo Lin, David Boettiger, Souleymane Cissouma, Vincent Sanogo, Nancy Padian, Ari Johnson, Jenny Liu
Tropical Medicine & International Health, 18.04.2021
Tilføjet 19.04.2021
Hagai Rossman, Smadar Shilo, Tomer Meir, Malka Gorfine, Uri Shalit, Eran Segal
Nature, 19.04.2021
Tilføjet 19.04.2021
Nature Medicine, Published online: 19 April 2021; doi:10.1038/s41591-021-01337-2
A retrospective analysis of data from the Israeli Ministry of Health collected between 28 August 2020 and 24 February 2021 documents the real-life effect of a national vaccination campaign on the pandemic dynamics.
Læs mere Tjek på PubMedPere Domingo, Virgina Pomar, Isabel Mur, Ivan CastellvÃ, Héctor Corominas, Natividad de Benito
Clinical Microbiology and Infection, 18.04.2021
Tilføjet 19.04.2021
We aimed to assess differences in patients™ profiles in the first two surges of the SARS-CoV-2 pandemic in Barcelona, Spain.
Læs mere Tjek på PubMedGabriela Abelenda-Alonso, Alexander Rombauts, Núria Burguillos, Jordi CarratalÃ
Clinical Microbiology and Infection, 18.04.2021
Tilføjet 19.04.2021
Air pollution and antimicrobial resistance are two of the most important public health problems facing the world today. Although the harmful effects of air pollution have been known at least since the beginning of the twentieth century, governments and economic leaders around the world remain reluctant to comply with international agreements drawn up to reduce the emission of air pollutants and greenhouse gases. A statistic that arouses particular concern is the fact that, in 2019 according to the 2020 State of Global Air report, air pollution moved up from the fifth to the fourth leading risk factor for mortality worldwide, with 6.67 million attributable deaths.
Læs mere Tjek på PubMedMatheus Ribeiro Ãvila, Pedro Henrique Scheidt Figueiredo, Vanessa Pereira Lima, Whesley Tanor Silva, Marcus VinÃcius Accetta Vianna, LaÃs Helena Carvalho Fernandes, Alda Cristina Alves de Azevedo, Márcia Maria Oliveira Lima, Alessandra de Carvalho Bastone, Maria do Carmo Pereira Nunes, Mauro Felippe Felix Mediano, Manoel Otávio da Costa Rocha, Henrique Silveira Costa
Tropical Medicine & International Health, 17.04.2021
Tilføjet 18.04.2021
BMC Infectious Diseases, 17.04.2021
Tilføjet 17.04.2021
Abstract
Background
Over the past decades, Klebsiella pneumoniae (K. pneumoniae) infections have been increasing and affected immunocompromised patients nosocomially and communally, with extended-spectrum β-lactamase (ESBL) production becoming a major concern. Patients with rheumatic autoimmune diseases, mostly receiving immunosuppressive therapy, are vulnerable to various infections, including K. pneumoniae. However, few have investigated K. pneumoniae infections in this specific population. This study aimed to identify factors associated with ESBL production and mortality of K. pneumoniae pneumonia among patients with rheumatic autoimmune diseases in the Emergency Department.
Methods
We retrospectively investigated patients with rheumatic diseases who were diagnosed with K. pneumoniae pneumonia. The diagnosis of K. pneumoniae pneumonia was based on clinical manifestations, radiological findings and microbiological testing results. Prognostic factors and risk factors for ESBL production were determined with univariate and multivariate logistic regression analysis. Empirical therapy and antimicrobial susceptibility data were also collected.
Results
Of 477‰K. pneumoniae pneumonia patients, 60 were enrolled into this study. The in-hospital mortality was 28.3%. Septic shock, ICU admission, the need for mechanical ventilation and change of antibiotics due to clinical deterioration, all related to mortality, were included as unfavorable clinical outcomes. Multivariate analysis suggested that ESBL production (OR, 6.793; p‰=‰0.012), initial PCT‰â‰¥‰0.5‰ng/ml (OR, 5.024; p‰=‰0.033) and respiratory failure at admission (OR, 4.401; p‰=‰0.046) predicted increased mortality. ESBL production was significantly associated with dose of corticosteroids (OR, 1.033; p‰=‰0.008) and CMV viremia (OR, 4.836; p‰=‰0.032) in patients with rheumatic autoimmune diseases. Abnormal leukocyte count (OR, 0.192; p‰=‰0.036) was identified as a protective factor of ESBL-producing K. pneumoniae pneumonia. The most commonly used empirical antibiotic was ceftazidime, while most isolates showed less resistance to carbapenems and amikacin in susceptibility testing.
Conclusions
K. pneumoniae pneumonia could be life-threatening in patients with rheumatic autoimmune diseases. Our findings suggested that ESBL production, initial PCT‰â‰¥‰0.5‰ng/ml and respiratory failure at admission were independent factors associated with poor prognosis. Dose of corticosteroids and CMV viremia, predicting ESBL production in K. pneumoniae pneumonia, may help make individualized antibiotic decisions in clinical practice.
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