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Comparison of the antimicrobial effects of 0.2% curcumin mouthwash and chlorhexidine mouthwash on Streptococcus mutans in orthodontic patients: a randomized clinical trial
DOI: PMID: 40258261
Authors: Tahura Etezadi
Abstract
The use of mouthwash is a practical approach to decreasing bacteria during orthodontic treatment. This study aimed to investigate the antibacterial effect of 0.2% curcumin mouthwash on Streptococcus mutans in individuals undergoing fixed orthodontic treatment. For this double-blinded clinical study, 22 orthodontic patients aged 15 years or older with no systemic or periodontal diseases were selected and randomly divided into 2 groups of 11 individuals. One group received 0.2% curcumin mouthwash (intervention), while the other group received 0.2% chlorhexidine mouthwash (control) to use twice daily. Orthodontic elastics were collected from the patients’ mouth immediately before the first use of the mouthwash, immediately after the first use, and after 20 days of mouthwash use. The elastics were stored in normal saline, and the samples were transferred to a microbiology laboratory for serial dilution, plating, and incubation. After 48 hours, the number of colony-forming units (CFUs) of S mutans were counted and compared. The Friedman and Wilcoxon tests were used for statistical analysis of intragroup data, while the Mann-Whitney U test was used for intergroup comparisons. A difference of P < 0.05 was considered statistically significant. Both the curcumin and chlorhexidine groups demonstrated a statistically significant decrease in CFUs of S mutans immediately after the initial use as well as after 20 days’ use (P < 0.05). After the first use, there was no statistically significant difference between the groups in the reduction of CFUs (P = 0.071). However, after 20 consecutive days of mouthwash use, the curcumin group had a significantly greater decrease in CFUs of S mutans than the chlorhexidine group (P < 0.001). Both chlorhexidine and curcumin mouthwashes significantly reduced the number of S mutans colonies when used regularly. The results of the present study suggest that curcumin herbal mouthwash is a superior choice to chlorhexidine for orthodontic patients due to its long-term antibacterial properties.
Keywords: Streptococcus mutans; clorhexidine; curcumin; mouthwashes; orthodontics.
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Conflict of interest statement
No conflicts of interest reported.
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A balancing act: Navigating the advantages and challenges of pioneering mycetoma treatment in Sudan-A landmark trial by the Mycetoma Research Center
Authors: Ahmed Hassan Fahal
Abstract
The global burden of mycetoma, a debilitating, neglected tropical disease, is unknown, and patients struggle to complete treatment due to limited accessibility and affordability of medications. This communication highlights a landmark clinical trial conducted by the Mycetoma Research Center (MRC) at the University of Khartoum, Sudan, in partnership with the Drugs for Neglected Diseases initiative (DNDi) and Eisai Co., Ltd. (Eisai). Published in The Lancet Infectious Diseases, this clinical trial marks a significant advancement in mycetoma research and treatment. As the first randomised clinical trial assessing a new mycetoma treatment, it compared fosravuconazole with the current standard of care, itraconazole. While the trial found no dose of fosravuconazole to be superior to itraconazole, it did reveal that fosravuconazole presented no new safety concerns. Moreover, its lower pill burden, reduced risk of drug-drug interactions, and the fact that it can be taken without food make it a more feasible alternative to the relatively expensive and less accessible itraconazole for treating eumycetoma. This clinical trial, conducted in a difficult socio-political situation in Sudan, was only made possible by the exceptional efforts of the MRC. This groundbreaking study not only advances treatment options for mycetoma but also enhances research capacity in an endemic region, paving the way for future investigations into neglected tropical diseases.
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Quantifying Potential Immortal Time Bias in Observational Studies in Acute Severe Infection
DOI: 10.1093/ofid/ofaf173
Authors: Tom A Yates
Abstract
Background: Immortal time bias is a spurious or exaggerated protective association that commonly arises in naive analyses of observational data. It occurs when people receive the intervention because they survive, rather than survive because they received the intervention. Studies in conditions with substantial early mortality, such as acute severe infections, are particularly vulnerable.
Methods: We developed IMMORTOOL, an R package accessible via a user-friendly web interface (https://petedodd.github.io/IMMORTOOL-live/). This tool will estimate the potential for immortal time bias using empiric or assumed data on the distributions of time to intervention and time to event. Assumptions are that no other biases are present and that the intervention does not affect the outcome. The tool was benchmarked using studies presenting both naive analyses and analyses with the intervention fit as a time-varying exposure. We applied IMMORTOOL to a set of influential observational studies that used naive analyses when estimating the impact of polyclonal intravenous immunoglobulin (IVIG) on survival in streptococcal toxic shock syndrome (STSS).
Results: IMMORTOOL demonstrated that published estimates suggesting a survival advantage from giving IVIG in STSS are explained, at least in part, by immortal time bias.
Conclusions: IMMORTOOL can quantify the potential for immortal time bias in observational analyses. Importantly, it simulates only bias resulting from misallocation of person-time, not other related selection biases. The tool may help readers interrogate published studies. We do not advocate IMMORTOOL being used to justify naive analyses where robust analyses are possible. To what extent giving IVIG in STSS improves survival remains uncertain.
Keywords: antimicrobials; clinical epidemiology; clinical microbiology; immortal time bias; infectious diseases; streptococcal toxic shock syndrome.
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Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicobacter pylori eradication
Authors: Yi-Zhou Jiang
Abstract
Background: Helicobacter pylori (H. pylori) infection is a common chronic infection, and there are over half of the global population infected with H. pylori. It is still controversial whether the supplementation of Saccharomyces boulardii (S. boulardii) to bismuth quadruple therapy is beneficial for H. pylori eradication.
Aim: To determine the effects of S. boulardii supplementation to bismuth quadruple therapy on H. pylori eradication.
Methods: We performed a systematic literature search across PubMed, Embase, Web of Science, and China National Knowledge Infrastructure for articles published up to October 2023. We calculated the pooled relative risk (RR) with the 95% confidence interval (CI). Statistical analyses were conducted using Stata/SE 15.1 software.
Results: Ten randomized controlled trials were included. Notably, S. boulardii supplementation to bismuth quadruple therapy significantly improved H. pylori eradication rates (RR = 1.08, 95% CI: 1.04-1.12) and reduced the incidence of total adverse effects (RR = 0.53, 95% CI: 0.45-0.62). Specifically, it reduced the incidence of some gastrointestinal adverse effects and nonspecific adverse effects, including diarrhea (RR = 0.28, 95% CI: 0.22-0.36), constipation (RR = 0.32, 95% CI: 0.18-0.55), abdominal distention (RR = 0.39, 95% CI: 0.26-0.59), nausea (RR = 0.59, 95% CI: 0.36-0.97), and rash (RR = 0.49, 95% CI: 0.28-0.86). In the subgroup analysis, long-term eradication duration (> 10 days; RR = 1.08, 95% CI: 1.04-1.13) and S. boulardii supplementation to be started and stopped at the same time as eradication treatment (RR = 1.09, 95% CI: 1.04-1.14) were found to significantly improve the eradication rate regardless of the S. boulardii dose (500 mg/day, RR = 1.10, 95% CI: 1.03-1.17; 1000 mg/day, RR = 1.08, 95% CI: 1.03-1.12).
Conclusions: The addition of S. boulardii to bismuth quadruple therapy significantly increased H. pylori eradication rates and decreased the adverse effects. We recommend adding 500 mg/day S. boulardii concurrently with bismuth quadruple therapy and continuing this therapy for > 10 days for optimal H. pylori eradication efficacy.
Keywords: Saccharomyces boulardii; Bismuth quadruple therapy; Helicobacter pylori; Meta-analysis.
© 2025. The Author(s).
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Comparison of Cefuroxime-Based Dual Therapy With Quadruple Therapy in Helicobacter pylori-Infected Treatment-Naive Patients: A Prospective, Multicenter, Randomized Controlled Trial
DOI: 10.1111/hel.70037
Authors: Ji-Yan Li
Abstract
Background: High-Dose Dual Therapy With Amoxicillin Has Shown Advantages to Eradicate Helicobacter pylori (H. pylori), but Not for Penicillin-Allergic Patients. It Is Recommended That Cefuroxime Could Be an Alternative, but Whether Cefuroxime Could Be Used in Dual Therapy Has Not Been Reported. This Study Aimed to Compare the Efficacy, Safety, and Compliance of Cefuroxime-Based Dual Therapy (CDT) With Cefuroxime-Based Bismuth Quadruple Therapy (CQT) to Treat H. pylori Infection.
Materials and methods: The Prospective, Multicenter, Open-Label, Randomized Controlled Trial Was Conducted to Enroll Patients With Treatment-Naive H. pylori Infection From 9 Institutions. Patients Were Randomly Assigned to CDT Group (Cefuroxime 500 Mg Three Times/Day and Vonoprazan 20 Mg Twice/Day) or CQT Group (Cefuroxime 500 Mg Twice/Day, Levofloxacin 500 Mg Once/Day, Vonoprazan 20 Mg Twice/Day, and Bismuth 220 Mg Twice/Day), both for 14 Days.
Results: 700 Patients (350 per Group) Were Enrolled. In the Intention-To-Treat Analysis, Eradication Rates Were 76.0% and 86.3% in CDT Group and CQT Group (P = 0.001). In the Modified Intention-To-Treat Analysis, Eradication Rates Were 78.9% and 89.1% (P < 0.001). In the Per-Protocol Analysis, Eradication Rates Were 80.2% and 91.2% (P < 0.001). The Incidence of Adverse Events Was Significantly Lower in CDT Group Than CQT Group (14.4% vs. 29.8%, P < 0.001). Non-inferiority Was Confirmed Between CDT and CQT Group (All P > 0.025). Compliance Was Good in Both Groups (96.0% vs. 92.8%, P = 0.073). Poor Adherence Was a Risk Factor for Reducing the Efficacy in Both Groups.
Conclusions: CQT Was More Effective Than CDT for H. pylori Eradication, Which Might Be Recommended for Penicillin-Allergic Patients. If There Were Contraindications or Intolerance of CQT, CDT Would Be an Alternative.
Trail registration: ChiCTR2300071210.
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Efficacy and safety of ziresovir in hospitalised infants aged 6 months or younger with respiratory syncytial virus infection in China: findings from a phase 3 randomised trial with 24-month follow-up
Authors: Han Zhang
Abstract
Background: Respiratory syncytial virus (RSV) is a particularly dangerous infection in some populations, including very young infants. This study examined the efficacy and safety of ziresovir in hospitalised infants aged 6 months or younger with RSV infection.
Methods: In this double-blind, randomised, placebo-controlled trial conducted across 28 hospitals in China, patients aged 1-24 months hospitalised for virologically confirmed RSV infection were randomly allocated (2:1) to receive ziresovir (10-40 mg by weight twice daily) or placebo orally for 5 days, with 2 years of follow-up. Patients were included if they had a Wang bronchiolitis clinical score (WBCS) of at least 5 at first dosing and were administered their first dose of study drug within 7 days of the onset of symptoms of RSV infection. In this prespecified subanalysis of patients aged 6 months and younger at randomisation, we analysed the primary endpoint (change from baseline in WBCS on day 3 [48 h post-baseline]) in the intention-to-treat infected (ITT-i) population (comprising patients who received at least one dose of study drug and who had PCR-confirmed RSV infection). Safety endpoints were assessed in all patients who received at least one dose. This study is registered with ClinicalTrials.gov (NCT04231968) and is completed.
Findings: Participants were recruited from Sept 22, 2020, to Jan 19, 2022, and followed up to Feb 4, 2024. Among patients aged 6 months or younger, 188 participants (125 in the ziresovir group and 63 in the placebo group) received at least one dose of study drug and were included in the safety analysis, while the ITT-i population included 150 patients (100 in the ziresovir group and 50 in the placebo group). In the ziresovir group, 33 (26%) of 125 patients were female, 92 (74%) were male, mean age was 3·4 months (SD 1·4), and mean baseline WBCS was 6·8 (SD 1·7). In the placebo group, 15 (24%) of 63 patients were female, 48 (76%) were male, mean age was 3·3 months (1·5), and mean baseline WBCS was 6·9 (1·8). The least-squares mean change in WBCS from baseline to day 3 was -3·5 points (95% CI -3·9 to -3·1) with ziresovir versus -2·2 points (-2·8 to -1·7) with placebo (difference -1·2 [95% CI -1·9 to -0·6], p=0·0004). Drug-related treatment-emergent adverse events occurred in 22 (18%) of 125 patients who received ziresovir and seven (11%) of 63 patients who received placebo. No drug-related serious adverse events were observed and no deaths occurred.
Interpretation: Ziresovir had a favourable safety profile and was associated with a significant clinical benefit during the treatment period compared with placebo in patients aged 6 months or younger.
Funding: Shanghai Ark Biopharmaceutical, National Clinical Research Center for Respiratory Diseases, and National Major Science and Technology Projects of China.
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Transmissibility of a new Plasmodium falciparum 3D7 bank for use in malaria volunteer infection studies evaluating transmission blocking interventions
Authors: Sean A Lynch
Abstract
Transmission blocking activity is an important characteristic of antimalarial drugs, and can be evaluated in malaria volunteer infection studies (VIS). We undertook a pilot VIS to evaluate the suitability of a recently manufactured Plasmodium falciparum 3D7 bank (3D7-MBE-008) for evaluating transmission blocking interventions. Four adults were inoculated with P. falciparum 3D7-MBE-008 infected erythrocytes and administered piperaquine on days 8 and 10 to clear asexual parasitemia while permitting gametocyte development. On day 25, participants were randomised (1:1) to receive either 0.25 mg/kg primaquine (primaquine group) or no intervention (control group). Transmissibility was assessed by enriched membrane feeding assays on days 25, 29, 32, and 39, with transmission intensity (proportion of mosquitoes infected) determined by 18S qPCR. All participants were infective on day 25, with a median 94% (range, 12-100%) of mosquitoes positive for oocysts, and 76% (range, 8-94%) positive for sporozoites. In the primaquine group, mosquito infectivity decreased substantially between days 25 and 29. In the control group, mosquito infectivity remained high up to day 32, and persisted to day 39 in one participant. The P. falciparum 3D7-MBE-008 parasite bank induced blood-stage infections that were highly transmissible to mosquitoes and is therefore suitable for evaluating transmission blocking interventions.Trial registration anzctr.org.au (registration number: ACTRN12622001097730), registered 08/08/2022.
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Integrated assessment of antimicrobial stewardship in carbapenem resistant Klebsiella pneumoniae prevalent hospitals in China: a multidisciplinary surveillance network-based survey.
Authors: Wushouer H et al
Abstract
Background: China has established an extensive multidisciplinary surveillance network encompassing antimicrobial utilisation, antimicrobial resistance, and nosocomial infections. We aimed to identify challenges and barriers in antimicrobial stewardship (AMS) development based on this national multidisciplinary surveillance network.
Methods: This cross-sectional study was conducted in 15 hospitals across China from July 2021 to April 2023. Purposeful sampling was employed to select the hospitals based on the rising prevalence of carbapenem-resistant Klebsiella pneumoniae. The survey consisted of three parts: a testing questionnaire was used to assess the awareness of clinical physicians regarding AMS; a scoring table was developed through the Delphi method to assess the hospitals’ multidisciplinary management covering antibacterial usage surveillance, resistance surveillance, fungal surveillance, infectious disease management, and infection prevention and control; an on-site investigation based on case review and field inspection. Pearson correlation tests were used to examine the relationship between resistance levels and scores for various items. Theme analysis was applied to highlight key areas of focus in hospital multidisciplinary AMS from the on-site investigation.
Results: Findings revealed that physicians of respiratory, infectious disease, and critical care were the top 3 specialists in AMS awareness scores, with an average of 70 points, 65 points and 62.5 points, respectively (a full mark of 100 points). Performance in infectious disease management, antibacterial surveillance, and infection prevention and control showed a scoring rate over 70%, with relatively low scores in resistance surveillance (49.1%) and fungal surveillance (36.0%). No significant correlation was found between any single scoring item and the resistance levels of focused drug-resistance pathogens. Five key areas were identified for improving multidisciplinary AMS: organizational structure, staffing and training, drug formulary and prescription management, laboratory testing and quality control, and clinical sampling and data reporting.
Conclusions: The prevalence of focused drug-resistance pathogens could not attribute to any single factor. The following AMS activities should emphasise the establishment of sophisticated communication and collaboration mechanisms within multidisciplinary teams. Trial registration: Approval for this study was granted by the Ethics Committee of Peking University (reference number IRB00001052-22100).
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Acinetobacter baumannii: A Comprehensive Review of Global Epidemiology, Clinical Implications, Host Interactions, Mechanisms of Antimicrobial Resistance and Mitigation Strategies.
Authors: Sharma R et al
Abstract
Since the discovery of Acinetobacter baumannii, it has emerged as a significant global health threat due to its increasing prevalence in healthcare settings and remarkable ability to develop resistance to various antibiotics. This detailed review addresses global epidemiology, emphasizing the worldwide distribution of carbapenem-resistant A. baumannii (CRAb), which is particularly prevalent in high-density healthcare settings and regions with intensive antibiotic usage, such as India. Clinically, A. baumannii infection poses serious health challenges, with mortality rates ranging from 30% to 75% for multidrug-resistant (MDR) strains. The review highlights the clinical impact and disease spectrum of A. baumannii, associated with pneumonia, wound infections, bloodstream infections, and, urinary tract infections with a strong association to invasive medical procedures and devices. Additionally, it discusses human-pathogen interactions by exploring various mechanisms, persistence in hospital environments, and survival under harsh conditions. The review further elaborates on different resistance mechanisms, focusing broadly on antibiotic degradation, altered drug targets, reduced drug permeability, and efflux systems, which facilitate the survival and persistence of A. baumannii. Finally, it evaluates strategies to combat AMR, emphasizing infection control measures, antimicrobial stewardship, and the urgent need for innovative therapeutic approaches such as phage therapy and new antibiotic development. The review calls for concerted, collaborative efforts among researchers, healthcare professionals, and public health authorities to mitigate the global threat posed by MDR A. baumannii strains.
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Epidemiology and Microbiology of Healthcare-Associated Infections in Neurosurgery Department: A Cross-Sectional Study.
Authors: Jablonska R et al
Abstract
Objective: Hospital-acquired infections (HAIs) present a significant challenge in neurosurgical settings. This study aimed to assess the prevalence, risk factors, and clinical impact of HAIs in a neurosurgery department.
Methods: A retrospective cross-sectional study was conducted on 5474 patients hospitalized in a neurosurgery department (2019-2023). HAIs were diagnosed in 93 patients (2.7%), accounting for 147 infections. The final cohort included 273 patients: 93 with HAIs and 181 matched controls (age, sex, mortality). Demographic, clinical, and microbiological data were analyzed. Nutritional status was assessed using the Nutritional Risk Screening (NRS, 2002) and consciousness was assessed using the Glasgow Coma Scale (GCS). Infections were classified according to Centers for Disease Control and Prevention (CDC) criteria.
Results: The most frequent HAIs were pneumonia (PN, 18.3%), bloodstream infections (BSI, 16.2%), and surgical site infections (SSI, 16.3%). Malnutrition (NRS ≥3) was significantly more common in infected patients (65.6% vs. 11%, p < .001). Patients with GCS ≤8 had higher rates of PN (44.7%) and urinary tract infections (UTI, 32.5%) (p = .004), while GCS 13-15 was linked to SSI (91.7%). HAIs occurred more frequently after emergency procedures (57.8% vs. 30%, p < .0001). Hospital stay was significantly longer in infected patients (40 vs. 5.4 days, p = .001). Klebsiella pneumoniae (15.1%) and Staphylococcus aureus (11.5%) were the most common. Age and sex were not significant risk factors.
Conclusion: HAIs in neurosurgical patients are associated with malnutrition and procedural urgency. Targeted infection control, early nutrition support, and antimicrobial stewardship are essential to improving outcomes.
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Cellulitis in Pediatric Patients: Recognition and Management in the Era of Evolving Resistance.
Authors: Glennon CM et al
Abstract
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Antimicrobial susceptibility trends of S. Typhi and S. Paratyphi in a post-COVID-19 pandemic India, from a multicenter surveillance network.
Authors: Sahai N et al
Abstract
A multicenter surveillance study was conducted to identify changes in antimicrobial susceptibility patterns of Salmonella Typhi and S. Paratyphi in India since the COVID-19 pandemic began. S. Typhi and S. Paratyphi isolates were collected from blood or bone marrow culture-confirmed enteric fever cases at eight sites in seven cities across India between 2021 and 2024. The antibiotic susceptibility of 1150 S. Typhi isolates and 265 S. Paratyphi isolates wsa tested via disc diffusion and determined their minimum inhibitory concentrations (MICs) of ceftriaxone and azithromycin via broth dilution. 18 S. Typhi isolates were identified from Ahmedabad that were resistant to ceftriaxone, indicating a larger emergence of third-generation cephalosporin-resistant S. Typhi in Western India with a novel plasmid profile. Furthermore, an yearly increases in the mean, median and 90th percentile of azithromycin MICs for S. Typhi and S. Paratyphi isolates was observed throughout India between 2021 and 2023. Finally, it was found that only 0.70% of S. Typhi isolates and 1.13% of S. Paratyphi isolates exhibited susceptibility to ciprofloxacin. These results indicate the necessity for a shift from ciprofloxacin in the treatment of enteric fever, and the importance of implementing long-term monitoring of resistance to alternative antibiotics such as azithromycin and ceftriaxone.
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Bacteremia due to Hungatella effluvii in a patient with end-stage renal failure requiring hemodialysis: a case report and literature review of human infections caused by Hungatella spp.
Authors: Ito Y et al
Abstract
Hungatella effluvii infections in humans are rare. This is a reported case of H. effluvii bacteremia in a Japanese male with chronic kidney disease identified via 16S rRNA gene sequencing after initial misidentification as Clostridium sp. Despite treatment, the patient died of sepsis related to a nephrostomy catheter infection. A literature review suggests that Hungatella spp. infections may be associated with severe diseases, such as sepsis and necrotizing fasciitis. This case highlights the difficulty in microbial identification, as biochemical methods were insufficient, requiring molecular biological methods. Antimicrobial susceptibility testing (AST) revealed resistance to benzylpenicillin and moxifloxacin, consistent with prior reports. This is the third documented case of H. effluvii infection, emphasizing the need for accurate pathogen identification and AST to guide optimal treatment in rare infections.
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Invasive pneumococcal disease in a tertiary hospital in Madrid: are we using pneumococcal vaccine correctly?
Authors: María Isabel Serrano-Tomás
Abstract
Introduction: Invasive pneumococcal disease (IPD) is of concern. We describe the epidemiology and assess the vaccination schedule adequacy of IPD episodes (2019–2021) in northern Madrid.
Methods: Clinical, laboratory and vaccination data were collected from clinical/epidemiological records. Antimicrobial susceptibility testing was performed according to EUCAST and serotyping by Pneumotest-agglutination/Quellung.
Results: IPD was identified in 103 patients (71 [IQR 23.5] year-old; 50.4% males), 85.4% associated with bacteremia and a high mortality rate (19.4%). Serotypes 8 (29.9%), 3 and 22F (8% each) were dominant (45.9%), all antibiotic-susceptible. β-Lactams increased MICs and macrolide resistance were mainly linked to serotypes 19A, 23F, 24F, 6C, and 15A. Only 10.5% of adults eligible for vaccination had an adequate vaccine regimen before IPD being 40% due to nonvaccine-preventable serotypes (13, 23B, 24F, 31).
Conclusion: IPD episodes were dominated by antibiotic-susceptible ST8 and frequently occurred in adults at risk. Despite recommendations, vaccination adherence rates were very low.
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Neonatal sepsis: Epidemiology and comparison between preterm and term newborns
Authors: Eduardo Rubio-Mora
Abstract
Introduction: Neonatal sepsis is a severe clinical syndrome that continues to be a common and significant health care burden. Knowledge of the local epidemiology allows for a better empirical treatment and improves morbidity and mortality. The aim of this study was to determine the prevalence, epidemiology, and etiology of blood culture-proven sepsis in neonates and to determine whether there are differences between preterm and term newborns.
Methods: A retrospective study was carried out in a tertiary hospital in Madrid, Spain, during 2021, including 1443 patients at risk of developing sepsis.
Results: The majority of sepsis episodes occurred in preterm newborns (64.81%) and most of them were very low birth weight infants (74.29%). Late-onset sepsis represented 94.92% of all the episodes reported with an incidence of 11.4 (95% CI 8.8–14.8) per 1000 live newborns. Early onset sepsis incidence was 0.6 (95% CI 0.2–1.8) per 1000 live newborns. Coagulase-negative staphylococci took the first place as causative agents of sepsis (66.10%), causing in all the episodes late onset catheter-related bloodstream infection. When the newborns who developed sepsis were compared with those who did not developed sepsis, the presence of venous/arterial access device was significantly associated with sepsis in both preterm (odds ratio (OR) 8.12, 95% CI 0.47–141.40) and term newborns (OR 16.58, 95% CI 1.00–275.20). Recent surgery was nevertheless the main risk factor in term newborns (OR 45.29, 95% CI 13.70–149.70). Among those patients who developed sepsis, no differences between preterm and term newborns were found regarding time onset, mechanism of transmission, etiological agents, and mortality. A 100% of the preterm and 42.11% of the term newborns presented two or more risk factors. The mortality rate observed here has been 1.85% (95% CI 0.33–9.77%).
Conclusión: The main risk factors for sepsis were venous/arterial access device (for both preterm and term newborns) and recent surgery (term newborns). Prematurity and being a catheter carrier were strongly associated with late-onset neonatal sepsis, mainly due to coagulase-negative staphylococci. The mortality rate was lower than that observed in other high-income countries.
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Infection prevention and control professionals: Stress, resilience, personality traits and views about their workforce and profession
Authors: Brett G. Mitchell
Abstract
Background: The COVID-19 pandemic placed considerable strain on the infection control professional workforce, who were at the forefront of pandemic response in their organisations and beyond. In order to support infection control professionals and inform future initiatives, it is important to further understand the infection control workforce. The objective of this study was to determine stress and resilience levels, personality traits and workforce intentions of infection control professionals in Australia and New Zealand.
Methods: We undertook an anonymous, cross-sectional online survey of infection control professionals in Australia and New Zealand. Validated tools, the brief resilience tool, workforce stressor tool and the Big Five personality test, were used to evaluate levels of stress, resilience and personality traits.
Results: Three hundred and fifty-six infection control professionals started the survey, with representation from all Australian jurisdictions and New Zealand. The mean stress score was 4.28 (SD 3.39) and 3.34 (SD 0.65) for resilience. Younger participants and those with less experience in infection control had higher levels of stress and lower levels of resilience. Individual personality traits vary by age, level of education and credentialing status. Approximately one-fifth of participants indicated that they planned to leave the IC workforce in the next three years.
Conclusions: Our study was the largest published study involving infection control professionals in Australia and New Zealand. Findings highlight the need for mentoring, peer support and wellbeing initiatives to support the profession. Understanding personality traits may also be beneficial for further enhancing communication and interpersonal relationships.
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Exploring challenges and policy considerations in point-of-care testing for hospital preparedness ahead of infectious disease emergencies: A qualitative study
Authors: Oluremilekun Oyefolu
Abstract
Background: Despite the uncertainty raised by several studies regarding the practicality of Point-of-Care Testing (POCT) in hospital settings, the urgency prompted by the COVID-19 pandemic led many hospitals to invest in these rapid diagnostics. As the COVID-19 pandemic showcased the potential of POCT in emergency situations, an urgent call arises to leverage the successes and lessons learned for the long-term benefit of healthcare systems, particularly in preparation for the next pandemic of viral respiratory nature.
Methods: We conducted semi-structured interviews with nine emergency care and hospital laboratory stakeholders with expertise and responsibility over POCT operations within hospital systems during the COVID-19 pandemic in Maryland, USA. The grounded theory approach was utilized, and the transcripts were thematically analyzed through an iterative process.
Results: Three distinct themes were identified as barriers to POCT implementation: Regulatory barriers encompassed inconsistencies between the federal and state regulations and a regulatory structure that lags technological advancements. Staffing and operational barriers comprised a shortage of POCT workforce including nurses and Point of Care coordinators. Economic barriers were linked to the overall cost of integrating new POCT devices into the existing testing menu at emergency departments.
Conclusion: We conclude with strategies, including policy considerations, to enable and sustain decentralized POCT programs within hospitals. Some of these strategies include expanding the workforce trained in the regulatory procedures required to support POCT; harmonizing state and federal regulations for diagnostic testing, especially for FDA-waived POCT; and sustained funding for POCT development and use for public health preparedness.