Procalcitonin and procalcitonin kinetics for diagnosis and prognosis of intravascular catheter-related bloodstream infections in selected critically ill patients: a prospective observational studyBMC Infectious Diseases - Tập 12 - Trang 1-10 - 2012
Vasiliki P Theodorou, Vasilios E Papaioannou, Gregory A Tripsianis, Maria K Panopoulou, Elias K Christophoridis, Georgios A Kouliatsis, Theodora M Gioka, Efstratios S Maltezos, Sophia I Ktenidou-Kartali, Ioannis A Pneumatikos
Procalcitonin (PCT) has emerged as a valuable marker of sepsis. The potential role of PCT in diagnosis and therapy monitoring of intravascular catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) is still unclear and was evaluated. Forty-six patients were included in the study, provided they were free of infection upon admission and presented the first episode of suspected CRBSI during their ICU stay. Patients who had developed any other infection were excluded. PCT was measured daily during the ICU hospitalization. Primary endpoint was proven CRBSI. Therapy monitoring as according to infection control was also evaluated. Among the 46 patients, 26 were diagnosed with CRBSI. Median PCT on the day of infection suspicion (D0) was 7.70 and 0.10 ng/ml for patients with and without proven CRBSI, respectively (p < 0.001). The area under the curve (AUC) for PCT was 0.990 (95% CI; 0.972 – 1.000), whereas a cut-off value of 0.70 ng/ml provided sensitivity and specificity of 92.3 and 100% respectively. In contrast, the AUC for white blood cells (WBC) was 0.539 (95% CI; 0.369 – 0.709), and for C-reactive protein (CRP), 0.603 (95% CI; 0.438 – 0.768). PCT was the best predictor of proven infection. Moreover, an increase >0.20 ng/ml of PCT between the D0 and any of the 4 preceding days was associated with a positive predictive value exceeding 96%. PCT concentrations from the D2 to D6 after suspected infection tended to decrease in controlled patients, whereas remained stable in non-controlled subjects. A PCT concentration exceeding 1.5 ng/ml during D3 was associated with lack of responsiveness to therapy (p = 0.028). We suggest that PCT could be a helpful diagnostic and prognostic marker of CRBSI in critically ill patients. Both absolute values and variations should be considered.
Công thức dự đoán lâm sàng cho chẩn đoán viêm dây thần kinh ở bệnh nhân phong Dịch bởi AI BMC Infectious Diseases - Tập 21 - Trang 1-9 - 2021
Louise Mara Giesel, Yara Hahr Marques Hökerberg, Izabela Jardim Rodrigues Pitta, Lígia Rocha Andrade, Debora Bartzen Moraes, José Augusto da Costa Nery, Euzenir Nunes Sarno, Marcia Rodrigues Jardim
Chẩn đoán viêm dây thần kinh ở bệnh nhân phong có cơn đau thần kinh hoặc bệnh lý thần kinh mãn tính vẫn là một thách thức vì không có dấu hiệu cụ thể nào từ phòng thí nghiệm hoặc sinh lý thần kinh.
Trong một nghiên cứu chéo được thực hiện tại một phòng khám ngoại trú phong ở Rio de Janeiro, RJ, Brazil, 54 cá nhân phàn nàn về cơn đau thần kinh (tại một hoặc nhiều vị trí) đã được phân loại thành hai nhóm (“đau thần kinh” hoặc “viêm dây thần kinh”) bởi một chuyên gia thần kinh về phong dựa trên tiền sử bệnh cùng với các cuộc kiểm tra lâm sàng và điện sinh lý. Một bác sĩ thần kinh, không biết về các chẩn đoán đau, đã phỏng vấn và kiểm tra các người tham gia bằng cách sử dụng một biểu mẫu chuẩn hóa bao gồm các yếu tố dự đoán lâm sàng, đặc điểm cơn đau và triệu chứng thần kinh. Mối liên hệ giữa các yếu tố dự đoán lâm sàng và phân loại cơn đau đã được đánh giá thông qua kiểm định Chi-Bình phương của Pearson hoặc kiểm định chính xác của Fisher (p < 0,05). Sáu thuật toán lâm sàng đã được phát triển để đánh giá độ nhạy và độ đặc hiệu, với khoảng tin cậy 95%, cho các yếu tố dự đoán lâm sàng có liên quan thống kê với viêm dây thần kinh. Thuật toán lâm sàng có tính kết luận nhất là: đau khởi phát bất kỳ lúc nào trong 90 ngày qua, hoặc liên quan đến sự khởi đầu của các triệu chứng thần kinh trong 30 ngày trước, nhất thiết phải liên quan đến sự gia tăng cơn đau khi cử động và khi nắn dây thần kinh, với độ đặc hiệu 94% và độ nhạy 35%. Thuật toán này có thể giúp các bác sĩ xác nhận viêm dây thần kinh ở bệnh nhân phong có cơn đau thần kinh, đặc biệt là trong các đơn vị chăm sóc sức khỏe ban đầu không có sự tiếp cận với chuyên gia thần kinh hoặc các xét nghiệm điện sinh lý.
Nasopharyngeal colonisation dynamics of bacterial pathogens in patients with fever in rural Burkina Faso: an observational studyBMC Infectious Diseases - Tập 22 - Trang 1-10 - 2022
Liesbeth Martens, Bérenger Kaboré, Annelies Post, Christa E. van der Gaast-de Jongh, Jeroen D. Langereis, Halidou Tinto, Jan Jacobs, André J. van der Ven, Quirijn de Mast, Marien I. de Jonge
Nasopharyngeal colonisation with clinically relevant bacterial pathogens is a risk factor for severe infections, such as pneumonia and bacteraemia. In this study, we investigated the determinants of nasopharyngeal carriage in febrile patients in rural Burkina Faso. From March 2016 to June 2017, we recruited 924 paediatric and adult patients presenting with fever, hypothermia or suspicion of severe infection to the Centre Medical avec Antenne Chirurgicale Saint Camille de Nanoro, Burkina Faso. We recorded a broad range of clinical data, collected nasopharyngeal swabs and tested them for the presence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Klebsiella pneumoniae by quantitative polymerase chain reaction. Using logistic regression, we investigated the determinants of carriage and aimed to find correlations with clinical outcome. Nasopharyngeal colonisation with S. pneumoniae, H. influenzae and M. catarrhalis was highly prevalent and strongly dependent on age and season. Females were less likely to be colonised with S. pneumoniae (OR 0.71, p = 0.022, 95% CI 0.53–0.95) and M. catarrhalis (OR 0.73, p = 0.044, 95% CI 0.54–0.99) than males. Colonisation rates were highest in the age groups < 1 year and 1–2 years of age and declined with increasing age. Colonisation also declined towards the end of the rainy season and rose again during the beginning of the dry season. K. pneumoniae prevalence was low and not significantly correlated with age or season. For S. pneumoniae and H. influenzae, we found a positive association between nasopharyngeal carriage and clinical pneumonia [OR 1.75, p = 0.008, 95% CI 1.16–2.63 (S. pneumoniae) and OR 1.90, p = 0.004, 95% CI 1.23–2.92 (H. influenzae)]. S. aureus carriage was correlated with mortality (OR 4.01, p < 0.001, 95% CI 2.06–7.83), independent of bacteraemia caused by this bacterium. Age, sex and season are important determinants of nasopharyngeal colonisation with S. pneumoniae, H. influenzae and M. catarrhalis in patients with fever in Burkina Faso. S. pneumoniae and H. influenzae carriage is associated with clinical pneumonia and S. aureus carriage is associated with mortality in patients with fever. These findings may help to understand the dynamics of colonisation and the associated transmission of these pathogens. Furthermore, understanding the determinants of nasopharyngeal colonisation and the association with disease could potentially improve the diagnosis of febrile patients.
Lập kế hoạch cho mùa cúm H1N1 tiếp theo: một nghiên cứu mô hình Dịch bởi AI BMC Infectious Diseases - Tập 10 - Trang 1-9 - 2010
Fabrice Carrat, Camille Pelat, Daniel Levy-Bruhl, Isabelle Bonmarin, Nathanael Lapidus
Mức độ miễn dịch cộng đồng trước và sau mùa dịch cúm năm 2009 đầu tiên chưa được xác định chính xác, và việc dự đoán hình dạng của mùa dịch cúm H1N1 tiếp theo là một thử thách khó khăn. Đây là một nghiên cứu mô hình dựa trên dữ liệu về các chuyến thăm y tế vì bệnh giống cúm được thu thập bởi mạng lưới Bác sĩ Đa khoa Sentinel của Pháp, cũng như tỷ lệ bao phủ tiêm vaccine H1N1 dịch cúm, và một mô hình tập trung vào cá nhân dành cho bệnh cúm. Chúng tôi đã ước lượng tỷ lệ tấn công nhiễm trùng trong mùa dịch cúm H1N1 năm 2009 đầu tiên tại Pháp, cùng với tỷ lệ miễn dịch trước và sau khi tiếp xúc. Sau đó, chúng tôi đã mô phỏng các kịch bản khác nhau trong đó virus cúm H1N1 đại dịch sẽ được tái giới thiệu vào một quần thể với các mức độ miễn dịch chéo bảo vệ khác nhau, và xem xét tác động của việc mở rộng tiêm vaccine cúm. Trong mùa dịch đầu tiên tại Pháp, tỷ lệ người bị nhiễm là 18,1% tổng thể, 38,3% ở trẻ em, 14,8% ở người trưởng thành trẻ tuổi và 1,6% ở người cao tuổi. Tỷ lệ miễn dịch trước khi tiếp xúc cần thiết để phù hợp với dữ liệu thu thập được trong mùa dịch đầu tiên là 36% ở người trưởng thành trẻ và 85% ở người cao tuổi. Chúng tôi ước tính rằng tỷ lệ miễn dịch sau khi tiếp xúc là 57,3% (Khoảng tin cậy 95% (95%CI) 49,6%-65,0%) tổng thể, 44,6% (95%CI 35,5%-53,6%) ở trẻ em, 53,8% (95%CI 44,5%-63,1%) ở người trưởng thành trẻ và 87,4% (95%CI 82,0%-92,8%) ở người cao tuổi. Hình dạng của mùa bệnh thứ hai sẽ phụ thuộc vào mức độ miễn dịch chéo bảo vệ bền vững đối với các thế hệ tiếp theo của virus H1N1 năm 2009. Tỷ lệ bảo vệ chéo 70% có nghĩa là chỉ một tỷ lệ nhỏ của quần thể bị ảnh hưởng. Với tỷ lệ bảo vệ chéo 50%, mùa thứ hai sẽ có gánh nặng bệnh tật tương tự như mùa đầu tiên, trong khi việc tiêm vaccine cho 50% toàn bộ dân số, ngoài dân số đã được tiêm trong mùa dịch đầu tiên, sẽ giảm một nửa gánh nặng này. Với tỷ lệ bảo vệ chéo 30%, mùa thứ hai có thể nghiêm trọng hơn, và việc tiêm vaccine sẽ không mang lại lợi ích đáng kể. Những phát hiện dựa trên mô hình này nên giúp chuẩn bị cho một mùa dịch thứ hai, và nhấn mạnh sự cần thiết của các nghiên cứu về các thành phần khác nhau của sự bảo vệ miễn dịch.
Hepatitis C virus prevalence among men who have sex with men: a cross-sectional study in 12 Brazilian citiesBMC Infectious Diseases - Tập 23 - Trang 1-10 - 2023
Vanessa C. M. Silva, Lígia R. F. S. Kerr, Carl Kendall, Rosa S. Mota, Mark Drew C. Guimarães, Andréa F. Leal, Edgar Merchan-Hamann, Inês Dourado, Maria Amélia Veras, Ana Maria de Brito, Alexandre K. Pontes, Raimunda H. M. Macena, Daniela Knauth, Luana N. G. C. Lima, Socorro Cavalcante, Ana Cláudia Camillo, Ximena P. Díaz-Bermudez, Lisangela C. Oliveira, Laio Magno, Marcílio F. Lemos, Adriana P. Compri, Ana Rita C. Motta-Castro, Regina C. Moreira
Despite the preventive policies adopted, reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) has been limited. The risk of hepatitis C virus (HCV) infection has increased among the most vulnerable population groups, including MSM. The aim of this study was to estimate the prevalence of HCV infection and to assess risky practices among MSM from 12 Brazilian cities. This study was carried out from June to December 2016 using respondent driven sampling (RDS). Participants completed a self-administered questionnaire to collect behavioral, socioeconomic, and demographic variables. In addition, the rapid diagnostic test (RDT) for HCV was offered. Positive results were sent to Instituto Adolfo Lutz for confirmation. A total of 4,176 participants were recruited and 23 samples were sent for confirmation. Of these, 16 were confirmed, resulting in a prevalence of 0.7% (95% CI: 0.3%—1.7%). The Southeast region showed a prevalence of 0.9% (95% CI: 0.3—2.6), followed by the South region, with 0.6% (95% CI: 0.2—2.1). The Northeast region had a prevalence of 0.3% (95% CI: 0.1—1.0) and the Midwest 0.1% (95% CI: 0.0—0.7). No positive cases were found in the North. Single men aged 40 years or older were the majority of participants exposed to HCV. High levels of alcohol consumption, illicit drug use, irregular condom use, in addition to infection with other STIs, were associated with exposure to HCV. STIs continue to be important health problems in Brazil and globally. Many STIs are inapparent for many years until they bring more serious consequences. Extra investment in HCV is also warranted, given that it can be eliminated. Relying solely on clinical data to provide information about inapparent infection, especially in stigmatized populations, will make that goal more difficult to achieve. Surveillance studies, such as the one reported here need to be repeated over time to demonstrate trends and to provide information for evaluation, program and policies. Investments in the most vulnerable populations are critical to achieve the World Health Organization global health goals including the elimination of viral hepatitis by 2030.
Spatiotemporal prediction of vancomycin-resistant Enterococcus colonisationBMC Infectious Diseases - - 2022
Julius M. van Niekerk, Mariëtte Lokate, Louise Marie Antoinette Braakman-Jansen, Julia E.W.C. van Gemert-Pijnen, Amanda L. Stein
Abstract
Background
Vancomycin-resistant enterococci (VRE) is the cause of severe patient health and monetary burdens. Antibiotic use is a confounding effect to predict VRE in patients, but the antibiotic use of patients who may have frequented the same ward as the patient in question is often neglected. This study investigates how patient movements between hospital wards and their antibiotic use can explain the colonisation of patients with VRE.
Methods
Intrahospital patient movements, antibiotic use and PCR screening data were used from a hospital in the Netherlands. The PageRank algorithm was used to calculate two daily centrality measures based on the spatiotemporal graph to summarise the flow of patients and antibiotics at the ward level. A decision tree model was used to determine a simple set of rules to estimate the daily probability of patient VRE colonisation for each hospital ward. The model performance was improved using a random forest model and compared using 30% test sample.
Results
Centrality covariates summarising the flow of patients and their antibiotic use between hospital wards can be used to predict the daily colonisation of VRE at the hospital ward level. The decision tree model produced a simple set of rules that can be used to determine the daily probability of patient VRE colonisation for each hospital ward. An acceptable area under the ROC curve (AUC) of 0.755 was achieved using the decision tree model and an excellent AUC of 0.883 by the random forest model on the test set. These results confirms that the random forest model performs better than a single decision tree for all levels of model sensitivity and specificity on data not used to estimate the models.
Conclusion
This study showed how the movements of patients inside hospitals and their use of antibiotics could predict the colonisation of patients with VRE at the ward level. Two daily centrality measures were proposed to summarise the flow of patients and antibiotics at the ward level. An early warning system for VRE can be developed to test and further develop infection prevention plans and outbreak strategies using these results.
Heavily treatment-experienced people living with HIV in the OPERA® cohort: population characteristics and clinical outcomesBMC Infectious Diseases -
Ricky Hsu, Jennifer S Fusco, Cassidy Henegar, Vani Vannappagari, Andrew Clark, Laurence Brunet, Philip C. Lackey, Gerald Pierone, Gregory Fusco
Abstract
Background
Multi-class resistance, intolerance, and drug–drug interactions can result in unique antiretroviral (ART) combinations for heavily treatment-experienced (HTE) people living with HIV (PLWH). We aimed to compare clinical outcomes between HTE and non-HTE PLWH.
Methods
Eligible ART-experienced PLWH in care in the OPERA® Cohort were identified in a cross-sectional manner on December 31, 2016 and observed from the date of initiation of the ART regimen taken on December 31, 2016 until loss to follow up, death, study end (December 31, 2018), or becoming HTE (non-HTE group only). In the absence of resistance data, HTE was defined based on the ART regimens used (i.e., exposed to ≥ 3 core agent classes or regimen suggestive of HTE). Time to virologic undetectability, failure, and immunologic preservation were assessed using Kaplan–Meier methods; cumulative probabilities were compared between the two groups. Regimen changes, incident morbidities, and death were described.
Results
A total of 24,183 PLWH (2277 HTE PLWH, 21,906 non-HTE) were followed for a median of 28 months (IQR 21, 38). Viremic HTE PLWH (viral load [VL] ≥ 50 copies/mL) were less likely to achieve undetectability (VL < 50 copies/mL; 24-month cumulative probability: 80% [95% Confidence Interval 77–82]) than their non-HTE counterparts (85% [84–86]). No difference was observed in the probability of maintaining VLs < 200 copies/mL over the first 48 months after achieving suppression (< 50 copies/mL). HTE PLWH were less likely than non-HTE PLWH to maintain CD4 cell counts ≥ 200 cells/µL (24-month cumulative probability: 95% HTE [91–93]; 97% non-HTE [97–97]), and more likely to change regimens (45% HTE; 41% non-HTE). Incident non-AIDS defining event (ADE) morbidities were common in both populations, though more likely among HTE PLWH (45%) than non-HTE PLWH (35%). Incident ADE morbidities and deaths were uncommon among HTE (ADEs 5%; deaths 2%) and non-HTE (ADEs 2%; deaths 1%) PLWH.
Conclusions
HTE PLWH were at greater risk of unfavorable treatment outcomes than non-HTE PLWH, suggesting additional therapeutic options are needed for this vulnerable population.
Prolonged oral vancomycin for secondary prophylaxis of relapsing Clostridium difficile infectionBMC Infectious Diseases - Tập 19 - Trang 1-4 - 2019
Kevin Zhang, Patricia Beckett, Salaheddin Abouanaser, Vida Stankus, Christine Lee, Marek Smieja
Clostridium difficile infection (CDI) is an important cause of diarrhea and continues to be a major burden within healthcare institutions and in the community. For a small subset of patients with frequently relapsing CDI who do not have access to fecal microbiota transplantation (FMT), or fail FMT, there are no clear treatment recommendations. We review our experience with prolonged oral vancomycin for secondary prophylaxis of relapsing CDI. We performed a retrospective chart review of cases from the C. difficile consultation service at our institution since 2013. The service had three primary physicians providing consultations and performing over 1000 FMTs over the five-year period. Patients with relapsing CDI who were not candidates for FMT, refused, or relapsed after FMT were treated with vancomycin, followed by long-term oral vancomycin at a dose of 125 mg once daily. Twenty patients received at least 8 weeks of once-daily oral vancomycin for prophylaxis of relapsing CDI. Patients had a median age of 80 years, and experienced a median of four episodes of CDI prior to long-term vancomycin. Most were female and 75% had received FMT. Only a single case of C. difficile relapse occurred while on long-term vancomycin during 200 patient-months of follow-up. Amongst those who stopped long-term vancomycin, 31% relapsed within 6 weeks. No adverse events were observed. For elderly patients with frequently relapsing C. difficile, prolonged vancomycin once daily at a dose of 125 mg orally was effective in preventing further relapse. Vancomycin secondary prophylaxis may be considered in patients who have failed FMT, or in cases where FMT is not available.
Clinical and microbiological characteristics and challenges in diagnosing infected aneurysm: a retrospective observational study from a single center in JapanBMC Infectious Diseases - Tập 22 - Trang 1-9 - 2022
Kohsuke Matsui, Kensuke Takahashi, Masato Tashiro, Takeshi Tanaka, Koichi Izumikawa, Takashi Miura, Kiyoyuki Eishi, Akitsugu Furumoto, Koya Ariyoshi
It is challenging to diagnose infected aneurysm in the early phase. This study aimed to describe the clinical and microbiological characteristics of infected aneurysm, and to elucidate the difficulties in diagnosing the disease. Forty-one cases of infected aneurysm were diagnosed in Nagasaki University Hospital from 2005 to 2019. Information on clinical and microbiological characteristics, radiological findings, duration of onset, and type of initial computed tomography (CT) imaging conditions were collected. Factors related to diagnostic delay were analyzed by Fisher’s exact test for categorical variables or by the Wilcoxon rank-sum test for continuous variables. Pathogens were identified in 34 of 41 cases; the pathogens were Gram-positive cocci in 16 cases, Gram-negative rods in 13 cases, and others in five cases. Clinical characteristics did not differ in accordance with the identified bacteria. At the time of admission, 16 patients were given different initial diagnoses, of which acute pyelonephritis (n = 5) was the most frequent. Compared with the 22 patients with an accurate initial diagnosis, the 19 initially misdiagnosed patients were more likely to have been examined by plain CT. The sensitivities of plain CT and contrast-enhanced CT were 38.1% and 80.0%, respectively. In cases of infected aneurysm, diagnostic delay is attributed to non-specific symptoms and the low sensitivity of plain CT. Clinical characteristics of infected aneurysm mimic various diseases. Contrast-enhanced CT should be considered if infected aneurysm is suspected.
