Changes In Infection Rates Research Articles

A review of big data analytics models for assessing non-pharmaceutical interventions for COVID-19 pandemic management

Before vaccine development during the COVID-19 pandemic, Non-Pharmaceutical Interventions (NPIs) were the only solutions to mitigate COVID-19 infections. Governments continued to use them even after starting vaccine administration. In this research, we review different big data analytics models that assess and optimize the effectiveness of NPIs. These models are categorized into three big data analytics groups: descriptive, which measures the infection rate changes caused by NPIs; predictive, which predicts the future of the pandemic by implementing several NPIs; and data-driven prescriptive, which suggests optimal control policies. We further analyze each method's basic assumptions, limitations, and applicability during different pandemic phases and under different scenarios. This review of COVID-19 NPI evaluation methods will be beneficial for decision-makers to know which model to select for policy-making in possible future pandemics, which are more likely recently due to globalization. Finally, we suggest some future research directions.

Device and surgical procedure-related infections in Canadian acute care hospitals, 2018-2022.

Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2018 to 2022. Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt (CSF) SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Between 2018 and 2022, 2,258 device-related infections and 987 surgical procedure-related infections were reported. A significant rate increase was observed in adult mixed intensive care unit CLABSIs (1.07-1.93 infections per 1,000 line days, p=0.05) and a non-significant rate increase was observed in SSIs following knee arthroplasty (0.31-0.42 infections per 100 surgeries, p=0.45). A fluctuating rate trend was observed in CSF shunt SSIs over the time period and a significant rate decrease in paediatric cardiac SSIs was observed (68%, from 7.5-2.4 infections per 100 surgeries, p=0.01). The most commonly identified pathogens were coagulase-negative staphylococci (22.8%) among CLABSIs and Staphylococcus aureus (42%) among SSIs. Epidemiological and microbiological trends among selected device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

The GH3 Protein from the Clubroot Pathogen Plasmodiophora brassicae Causes Hormone-Related Phenotypes in Arabidopsis thaliana

In the genome of the obligate biotrophic protist Plasmodiophora brassicae, which causes clubroot disease in the Brassicaceae family, a single gene was identified with homology to the group of GH3 proteins synthesizing amino acid conjugates with carboxylic acids. In comparison to plant members the P. brassicae GH3 protein seems to be very promiscuous with respect to the substrates converted. In vitro assays showed conversion of three different auxins (indole-3-acetic, IAA; indole-propionic, IPA; and indole-3-butyric acids, IBA), jasmonic acid (JA) and also 12-oxo-phytodienoic acid (OPDA). Auxin and Methyl-JA responsive elements were found in the promoter sequence of PbGH3. For further analysis Arabidopsis thaliana was transformed with PbGH3. Seedlings with confirmed constitutive PbGH3 protein production were grown to adult plants that were shown to produce fewer inflorescences per plant. Growth on 10 µM IAA or JA levels also altered the phenotype of the seedlings, but not so much between wild types and transgenic lines. The hormone profiles in seedlings and adult plants were examined for IAA, JA, OPDA, and respective conjugates. Transgenic seedlings displayed changes that could be partially attributed to the overexpression of a GH3 gene like lower levels of free IAA and the JA precursor cis-OPDA under control conditions, and higher levels of some auxin conjugates accumulated after IAA treatment compared to the corresponding wild types. However, the hormone patterns in adult plants were more complex and varied based on different tissue types analyzed. After inoculation with P. brassicae the transgenic plants did not show any changes in infection rate and disease index, but had higher shoot and lower root weight in infected plants compared to controls. Based on the above findings we discuss a role for PbGH3 during pathogenesis.

Experiences and Impacts of the COVID-19 Pandemic: A Thematic Analysis

The COVID-19 pandemic prompted global public health restrictions that impacted Canadians in multiple ways. The effects of the pandemic are well examined in specific populations and in researcher-defined areas (e.g., mental health, physical activity, social connections, and financial impacts). Few studies explore the complex perspectives of adults who experienced and were impacted by the pandemic. The purpose of this study was to understand Canadian adults’ perspectives of pandemic impacts over time. Methods: A sample of 347 Canadian adults were recruited during the first six months of the COVID-19 pandemic to respond to open-ended questions about the pandemic’s impacts, administered every two weeks between April 2020 and January 2021. The responses were amalgamated into epochs, defined by dates that paralleled infection rates and public health responses in Canada. Qualitative thematic analysis identified major themes for each epoch and changes in themes over time. Results: The participants predominately reported adverse impacts of the pandemic during each epoch assessed, particularly with respect to mental health, future-oriented worry, activity restrictions, and social, and employment disruptions. Key concerns were potentially driven by changes in infection rates and public health policy changes. Conclusions: The COVID-19 pandemic impacted individuals in predominantly negative and complex ways that varied over time with public health responses. Findings from the present study may direct future pandemic responses to mitigate adverse effects to best prevent infection while preserving wellbeing.

Can single disease payment impact hospitalization expenses and quality in district hospital? A case study in Fujian, China

BackgroundChina is exploring payment reform methods for patients to address the escalating issue of increasing medical costs. While most district hospitals were still in the stage of Single Disease Payment (SDP) due to conditions, there is a scarcity of research on comprehensive assessment of SDP. This study aims to evaluate the implementation of SDP in a district hospital, and provided data support and scientific reference for improving SDP method and accelerating medical insurance payment reform at district hospitals.MethodsData was collected from 2337 inpatient medical records at a district hospital in Fuzhou, China from 2016 to 2021. These diagnoses principally included type 2 diabetes, planned cesarean sections, and lacunar infarction. Structural variation analysis was conducted to examine changes in the internal cost structure and dynamic shifts in medical expenses for both the insured (treatment group) and uninsured (control group) patients, pre- and post-implementation of the SDP policy on August 1, 2018. The difference-in-differences (DID) method was employed to assess changes in hospitalization expenses and quality indicators pre- and post-implementation. Furthermore, subjective evaluation of medical quality was enhanced through questionnaire surveys with 181 patients and 138 medical staff members.ResultsThe implementation of SDP decreased the medical expenses decreased significantly (P < 0.05), which can also optimize the cost structure. The drug cost ratio descended significantly, and the proportion of laboratory fee rose slightly. The changes in infection rate, cure rate, and length of stay indicated enhanced medical quality (P < 0.05). The satisfaction of inpatients with SDP was high (89.2%). Medical staff expressed an upper middle level of satisfaction (77.2%) but identified difficulties with the implementation such as “insufficient coverage of disease types”.ConclusionAfter the implementation of SDP in district hospitals, considerable progress has been achieved in restraining medical expenses, coupled with notable enhancements in both medical quality and patient satisfaction levels. However, challenges persist regarding cost structure optimization and underutilization of medical resources. This study suggests that district hospitals can expedite insurance payment reform by optimizing drug procurement policies, sharing examination information, and strengthening the management of medical records.

Impact of removing the healthcare mask mandate on hospital-acquired COVID-19 rates

Mandatory mask-wearing policies were one of several measures employed to reduce hospital-acquired SARS-CoV-2 infection throughout the pandemic. Many nations have removed healthcare mask mandates, but there remains a risk of new SARS-CoV-2 variants or epidemics of other respiratory viruses. To demonstrate the impact of removing the healthcare mask mandate. SARS-CoV-2 infections were analysed in a large teaching hospital for 40 weeks in 2022 using a controlled interrupted time-series design. The intervention was the removal of a staff/visitor surgical mask-wearing policy for the most wards at week 26 (intervention group) with a subset of specific wards retaining the mask policy (control group). The hospital-acquired SARS-CoV-2 infection rate was adjusted by the underlying community infection rate. In the context of a surge in SARS-CoV-2 infection, removal of the mask mandate for staff/visitors was not associated with a statistically significant change in the rate of nosocomial SARS-CoV-2 infection in the intervention group (incidence rate ratio: 1.105; 95% confidence interval: 0.523-2.334; P= 0.79) and there was no post-intervention trend (1.013; 0.932-1.100; P= 0.76) to suggest a delayed effect. The control group also showed no immediate or delayed change in infection rate. No evidence was found that removal of a staff/visitor mask-wearing policy had a significant effect on the rate of hospital-acquired SARS-CoV-2 infection. This does not demonstrate that masks were ineffective through the pandemic, but provides some objective evidence to justify the removal of healthcare mask mandates once there was widespread immunity and reduced disease severity.

Investigation of Changes in Infection Rates in the Reconstructed Anesthesia Intensive Care Unit

Enfeksiyon, yoğun bakım ünitelerinde önemli mortalite ve morbidite nedenidir. Yoğun bakım ünitesinde dirençli organizmaların üremesini ve bulaşmasını azaltmak için önerilen stratejilerden biri, organizmaların komşu yataklardan bulaşma olasılığını azaltmak ve enfeksiyon kontrol önlemlerine uyumu artırmak için hastaları tek yataklı odalara yerleştirmektir. Açık koğuş sistemi ile yönetilen yoğun bakım ünitesi yeniden yapılandırılarak kapalı koğuş sistemi ile yönetilmeye başlandı. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte yatan hastalardaki enfeksiyon oranlarını retrospektif olarak incelemeyi amaçladık. Yeni yoğun bakım ünitesinde 6 aylık periyodda 274 hasta (grup A) takibi yapılmış ancak çalışma kriterlerine uygun 35 hasta, eski yoğun bakım ünitesinde 6 aylık periyodda yatan (grup B) 203 hastadan 23 hasta çalışmaya dahil edildi. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte en az 1 hafta yatışı olan mekanik ventilatör desteği alan hastalar çalışmaya dahil edildi. Dış merkezlerden kabul edilen hastalar ile entübe halde kabul edilen hastane içi hastalar çalışma dışı bırakıldı. Bilgisayar data sistemi kullanılarak hastaların APACHE II, GKS, yaş, cinsiyet, yatış nedeni ve kültür sonuçları ile kaçıncı gün üreme olduğu kayıt edildi. Bu kayıtlara göre hastalardaki enfeksiyonların görülme yerleri, sıklıkları, etkenler ve dirençli mikroorganizmaların üreme oranları karşılaştırıldı. İstatistiksel analiz sonucunda kolistin dirençli üreme sonuçları yönünden anlamlı bir fark olduğu (p&amp;lt;0,05), Grup B hastalarında kolistin direnci gelişme oranının daha yüksek olduğu bulunmuştur. Trakeal aspirat kültür sonuçları incelendiğinde Grup B’de istatistiksel olarak anlamlı bir fark olduğu (p&amp;lt;0,05) üreme oranlarının daha yüksek olduğu bulunmuştur. Sonuç olarak; yoğun bakım ünitelerinde çoklu ilaca dirençli bakterilerin ortaya çıkmasını ve yayılmasını önlemeye yönelik stratejiler antimikrobiyal tedavinin etkinliğini ve kullanımını artırmaya çalışan stratejilerin yanısıra enfeksiyon kontrol önlemleri arasında hasta izolasyonu önem arzetmektedir. Çalışmamızın sonucunda izole oda yoğun bakım ünitesinde daha az dirençli mikroorganizma üreme oranı olduğu gösterilmiştir.

Device and surgical procedure-related infections in Canadian acute care hospitals, 2017-2021.

Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2017 to 2021. Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Between 2017 and 2021, 2,898 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units representing 69% (n=2,002) of all reported infections under surveillance. Significant rate increases were observed in adult mixed intensive care unit CLABSIs (1.08-2.11 infections per 1,000 line days, p=0.014) while decreases were observed in SSIs following knee arthroplasty (0.34-0.27 infections per 100 surgeries, p=0.05). No changes in trends were observed in the other reported HAIs. Of the 3,089 pathogens identified, the majority were gram-positive (66%), followed by gram negative (23%) and fungi (11%). Coagulase-negative staphylococci (22%) and Staphylococcus aureus (17%) were the most frequently isolated pathogens. Epidemiological and microbiological trends among select device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicenter cohort study.

Post-traumatic related limb osteomyelitis (PTRLO) is a complex bone infection. Currently, there are no available microbial data on a national scale that can guide appropriate antibiotic selection, and explore the dynamic changes in dominant pathogens over time. This study aimed to conduct a comprehensive epidemiological analysis of PTRLO in China. The study was approved by the Institutional Research Board (IRB), and 3,526 PTRLO patients were identified from 212,394 traumatic limb fracture patients at 21 hospitals between January 1st, 2008- December 31st, 2017. A retrospective analysis was conducted to investigate the epidemiology of PTRLO, including changes in infection rate (IR), pathogens, infection risk factors, and antibiotic resistance and sensitivity. The IR of PTRLO increased gradually from 0.93%-2.16% (Z=14.392, P<0.001). Monomicrobial infection (MI, 82.6%) was significantly higher than polymicrobial infection (PI, 17.4%) (P<0.001). The IR of Gram-Positive (GP) & Gram-Negative (GN) pathogens showed a significant increase from the lowest 0.41% to the highest 1.15% (GP) or 1.62% (GN), respectively. However, the longitudinal trend of GP versus GN's composition did not show any significance (Z=+/-1.1918, P>0.05). The most prevalent Gram-positive strains were MSSA (17.03%), MRSA (10.46%), E. faecalis (5.19%), and S. epidermidis (4.87%). In contrast, the dominant strains Gram-negative strains were Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E.coli (9.47%), Acinetobacter Baumannii (7.92%) and Klebsiella Pneumoniae (3.33%). In general, the high-risk factors for PI include opened-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). It is important to note that the antibiotics resistance and sensitivity analysis of the pathogens may be influenced by complications or comorbidities. This study provides the latest data of PTRLO in China and offers trustworthy guidelines for clinical practice. (China Clinical Trials.gov number, ChiCTR1800017597).

Spatiotemporal distribution of schistosomiasis transmission risk in Jiangling County, Hubei Province, P.R. China.

This study aims to explore the spatiotemporal distribution of schistosomiasis in Jiangling County, and provide insights into the precise schistosomiasis control. The descriptive epidemiological method and Joinpoint regression model were used to analyze the changes in infection rates of humans, livestock, snails, average density of living snails and occurrence rate of frames with snails in Jiangling County from 2005 to 2021. Spatial epidemiology methods were used to detect the spatiotemporal clustering of schistosomiasis transmission risk in Jiangling county. The infection rates in humans, livestock, snails, average density of living snails and occurrence rate of frames with snails in Jiangling County decreased from 2005 to 2021 with statistically significant. The average density of living snails in Jiangling County was spatially clustered in each year, and the Moran's I varied from 0.10 to 0.26. The hot spots were mainly concentrated in some villages of Xionghe Town, Baimasi Town and Shagang Town. The mean center of the distribution of average density of living snails in Jiangling County first moved from northwest to southeast, and then returned from southeast to northwest after 2014. SDE azimuth fluctuated in the range of 111.68°-124.42°. Kernal density analysis showed that the high and medium-high risk areas of Jiangling County from 2005 to 2021 were mainly concentrated in the central and eastern of Jiangling County, and the medium-low and low risk areas were mainly distributed in the periphery of Jiangling County. The epidemic situation of schistosomiasis decreased significantly in Jiangling County from 2005 to 2021, but the schistosomiasis transmission risk still had spatial clustering in some areas. After transmission interruption, targeted transmission risk intervention strategies can be adopted according to different types of schistosomiasis risk areas.

Effects of Discontinuation of Weekly Surveillance Testing on Methicillin-Resistant Staphylococcus aureus in the NICU.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is a major cause of serious morbidity and mortality in the neonatal intensive care unit (NICU). There is no clear consensus on infection control measures. Some approaches to MRSA colonization management may be burdensome with unclear benefits. The objective of this study was to determine if stopping weekly MRSA surveillance with active detection and contact isolation (ADI) was associated with a change in infection rate. This is a retrospective cohort study of infants admitted to two affiliated NICUs. The ADI cohort infants received weekly nasal MRSA cultures and were placed in contact isolation if MRSA colonized for the duration of their hospitalization. The No Surveillance cohort infants were only placed in isolation if there was active MRSA infection or if MRSA colonization was identified incidentally. The rates of infection were determined between the cohorts. There were 8,406 neonates representing 193,684 NICU days in the comparison period. In the ADI cohort, MRSA colonization occurred in 3.4% of infants and infection occurred in 29 infants (0.4%). There were no differences between cohorts in the percent of infants with a MRSA infection at any site (0.5 vs. 0.5%, p = 0.89), rate of MRSA infections per 1,000 patient-days (0.197 vs. 0.201, p = 0.92), rate of bloodstream infections (0.12 vs. 0.26%, p = 0.18), or in the overall mortality rate (3.7 vs. 3.0% p = 0.13). ADI represented an annual cost of $590,000. The rates of MRSA infection did not change when weekly ADI was discontinued and was associated with a decrease in cost and resource utilization. · Placing MRSA-colonized infants in contact isolation is a common practice.. · Data are limited with respect to efficacy in the NICU.. · This study provides evidence that active detection and contact isolation for MRSA colonization may not be beneficial..

Prevention Techniques Have Had Minimal Impact on the Population Rate of Prosthetic Joint Infection for Primary Total Hip and Knee Arthroplasty: A National Database Study

BackgroundSeveral studies over the years have offered modalities that may greatly decrease the rate of periprosthetic joint infection when implemented. As a result, one would expect a drastic decrease in infection rate among the implementing population with its widespread use. The purpose of this study was to assess whether there exists a decrease in infection rate over time, after accounting for available confounding variables, within a large national database. MethodsA large national database from 2005 to 2019 was queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). In total, 221,416 THAs and 354,049 TKAs were performed over the study period. Differences in 30-day infection rate were assessed with time and available preoperative risk factors using multinominal logistic regressions. ResultsRate of infection overall trended downward for both THA and TKA. After accounting for confounding variables, odds of THA infection marginally decreased over time (odds ratio 0.968 [0.952-0.985], P < .0001), while the odds of a TKA infection marginally increased with time (odds ratio 1.037 [1.020-1.054], P < .0001). ConclusionIndividual peer-reviewed publications have presented infection control modalities demonstrating dramatic decreases in infection rate while analysis at a population level shows almost no changes in infection rate over a 15-year time period. This study supports continued investigation for influential modalities in preventing periprosthetic joint infection and care in patient selection for primary hip and knee arthroplasty.

Population-level predictors of sexually transmitted infection rate changes in Missouri: an ecological study

BackgroundSexually transmitted infection rates continue to increase across the US, further developing health disparities and economic burdens of disease, especially as migration occurs. In this study, we aim to assess the relationship between STI rates and population-level variables from 2008 to 2017 at the county level in Missouri.MethodsTwo data sources were used: STI rates of chlamydia, gonorrhea, syphilis, HIV reported to Missouri DHSS and ACS 1-year county population estimates. Linear regression models and ANOVA tests were conducted in SPSS for each STI from year-to-year and 2008–2017. Covariates included in the analyzes were county-level income, employment rate, race, ethnicity, age, and percent poverty. Further, Akaike Information Criterion tests were performed to indicate the best predictor models and averaged standardized beta values.ResultsSignificant relationships among STI rates and population growth were identified. Chlamydia, syphilis, and HIV were positively associated with population growth from 2008 to 2017 (β = 0.15; β = 0.01; β = 0.05, respectively). Gonorrhea was negatively associated with population growth (β = − 0.02) but positively associated with unemployment rates (β = 0.01) highlighting the need to address population growth, as well as other variables in a population.ConclusionsThere seems to be a positive relationship among population change and rates of STIs. As populations change, rates of STIs change. Moving forward, quantitative work should be conducted in various states and the nation to understand this relationship in different contexts. Future studies should be qualitative word focused on county health departments and community health improvement plans. Lastly, public policy should be implemented to buffer the impact of migration on health outcomes.

Quantifying Social Interventions for Combating COVID-19 via a Symmetry-Based Model.

The COVID-19 pandemic has revealed new features in terms of substantial changes in rates of infection, cure, and death as a result of social interventions, which significantly challenges traditional SEIR-type models. In this paper we developed a symmetry-based model for quantifying social interventions for combating COVID-19. We found that three key order parameters, separating degree (S) for susceptible populations, healing degree (H) for mild cases, and rescuing degree (R) for severe cases, all display logistic dynamics, establishing a novel dynamic model named SHR. Furthermore, we discovered two evolutionary patterns of healing degree with a universal power law in 23 areas in the first wave. Remarkably, the model yielded a quantitative evaluation of the dynamic back-to-zero policy in the third wave in Beijing using 12 datasets of different sizes. In conclusion, the SHR model constitutes a rational basis by which we can understand this complex epidemic and policymakers can carry out sustainable anti-epidemic measures to minimize its impact.

SARS-CoV-2 infection dynamics revealed by wastewater sequencing analysis and deconvolution

The use of RNA sequencing from wastewater samples is a valuable way for estimating infection dynamics and circulating lineages of SARS-CoV-2. This approach is independent from testing individuals and can therefore become the key tool to monitor this and potentially other viruses. However, it is equally important to develop easily accessible and scalable tools which can highlight critical changes in infection rates and dynamics over time across different locations given sequencing data from wastewater. Here, we provide an analysis of lineage dynamics in Berlin and New York City using wastewater sequencing and present PiGx SARS-CoV-2, a highly reproducible computational analysis pipeline with comprehensive reports. This end-to-end pipeline includes all steps from raw data to shareable reports, additional taxonomic analysis, deconvolution and geospatial time series analyses. Using simulated datasets (in silico generated and spiked-in samples) we could demonstrate the accuracy of our pipeline calculating proportions of Variants of Concern (VOC) from environmental as well as pre-mixed samples (spiked-in). By applying our pipeline on a dataset of wastewater samples from Berlin between February 2021 and January 2022, we could reconstruct the emergence of B.1.1.7(alpha) in February/March 2021 and the replacement dynamics from B.1.617.2 (delta) to BA.1 and BA.2 (omicron) during the winter of 2021/2022. Using data from very-short-reads generated in an industrial scale setting, we could see even higher accuracy in our deconvolution. Lastly, using a targeted sequencing dataset from New York City (receptor-binding-domain (RBD) only), we could reproduce the results recovering the proportions of the so-called cryptic lineages shown in the original study. Overall our study provides an in-depth analysis reconstructing virus lineage dynamics from wastewater. While applying our tool on a wide range of different datasets (from different types of wastewater sample locations and sequenced with different methods), we show that PiGx SARS-CoV-2 can be used to identify new mutations and detect any emerging new lineages in a highly automated and scalable way. Our approach can support efforts to establish continuous monitoring and early-warning projects for detecting SARS-CoV-2 or any other pathogen.

Device and surgical procedure-related infections in Canadian acute care hospitals from 2011 to 2020.

Healthcare-associated infections (HAIs) continue to place a burden on patient health and safety as well as on the healthcare system. In Canada, national surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes ten years of device and surgical procedure-related HAI epidemiology in Canada from 2011 to 2020. Data were collected from over 40 Canadian sentinel acute care hospitals between January 1, 2011, and December 31, 2020, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions, and antimicrobial resistance are presented. Between 2011 and 2020, 4,751 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units (ICUs) representing 67% (n=3,185) of all reported infections. Over the surveillance period, significant rate increases were observed in adult mixed ICU CLABSIs (0.8 to 1.6 per 1,000 line days, p=0.004) while decreases were observed in neonatal ICU CLABSIs (4.0 to 1.6 per 1,000 line days, p=0.002) and SSIs following knee arthroplasty (0.69 to 0.29 infections per 100 surgeries, p=0.002). No trends were observed in the other reported HAIs.Of the 5,071 pathogens identified, the majority were gram-positive (68%), followed by gram-negative (23%) and fungi (9%). Coagulase-negative staphylococci (27%) and Staphylococcus aureus (16%) were the most frequently isolated pathogens. This report describes epidemiological and microbiological trends among select device and surgical procedure-related HAIs, essential for benchmarking infection rates nationally and internationally, to identify any changes in infection rates or antimicrobial resistance patterns and to help inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

The Effectiveness of Preoperative Antibiotic Prophylaxis in Ulnar Nerve Release at the Cubital Tunnel.

Although the literature supports not using preoperative antibiotic prophylaxis for clean soft tissue procedures around the hand, there is limited data for soft tissue procedures around the elbow, such as cubital tunnel release. Complications of postoperative infection include scarring, stiffness, and rarely, amputation. The purpose of this study is to determine if preoperative antibiotic prophylaxis decreases the risk of surgical site infection for cubital tunnel release. A retrospective review of 919 in situ, subcutaneous transposition, and submuscular transposition cubital tunnel surgery at a tertiary care center was performed. Patient records were searched to determine preoperative antibiotic status and infection within 30 days of surgery. In addition, comorbidities and demographics such as age, race, sex, and past medical history were also identified. Comorbidities with qualitative variables were analyzed with odds ratio, Chi-squared, and Fisher's Exact test, linear variables analyzed with t-test. There were 5/296 (1.7%) infections in patients without preoperative antibiotics, and 17/623 (2.7%) infections in patients with preoperative antibiotics. Patients who had received preoperative antibiotics had no significant change in infection rate (95% odds ratio: 0.597-1.633). Other variables, such as age, body mass index, race, surgeon, insurance type, diabetes, depression, anxiety, arthritis, concurrent surgeries, and hyperlipidemia were also not significant for risk of infection. Preoperative antibiotics do not demonstrate benefit for patients undergoing uncomplicated ulnar nerve releases at the elbow. Preoperative antibiotics do not significantly decrease the risk for postoperative infections in patients, regardless of patient comorbidities.Type of Evidence: Level 4-retrospective study.

Linear and Machine Learning modelling for spatiotemporal disease predictions: Force-of-Infection of Chagas disease.

Chagas disease is a long-lasting disease with a prolonged asymptomatic period. Cumulative indices of infection such as prevalence do not shed light on the current epidemiological situation, as they integrate infection over long periods. Instead, metrics such as the Force-of-Infection (FoI) provide information about the rate at which susceptible people become infected and permit sharper inference about temporal changes in infection rates. FoI is estimated by fitting (catalytic) models to available age-stratified serological (ground-truth) data. Predictive FoI modelling frameworks are then used to understand spatial and temporal trends indicative of heterogeneity in transmission and changes effected by control interventions. Ideally, these frameworks should be able to propagate uncertainty and handle spatiotemporal issues. We compare three methods in their ability to propagate uncertainty and provide reliable estimates of FoI for Chagas disease in Colombia as a case study: two Machine Learning (ML) methods (Boosted Regression Trees (BRT) and Random Forest (RF)), and a Linear Model (LM) framework that we had developed previously. Our analyses show consistent results between the three modelling methods under scrutiny. The predictors (explanatory variables) selected, as well as the location of the most uncertain FoI values, were coherent across frameworks. RF was faster than BRT and LM, and provided estimates with fewer extreme values when extrapolating to areas where no ground-truth data were available. However, BRT and RF were less efficient at propagating uncertainty. The choice of FoI predictive models will depend on the objectives of the analysis. ML methods will help characterise the mean behaviour of the estimates, while LM will provide insight into the uncertainty surrounding such estimates. Our approach can be extended to the modelling of FoI patterns in other Chagas disease-endemic countries and to other infectious diseases for which serosurveys are regularly conducted for surveillance.

Global prediction model for COVID-19 pandemic with the characteristics of the multiple peaks and local fluctuations

BackgroundWith the spread of COVID-19, the time-series prediction of COVID-19 has become a research hotspot. Unlike previous epidemics, COVID-19 has a new pattern of long-time series, large fluctuations, and multiple peaks. Traditional dynamical models are limited to curves with short-time series, single peak, smoothness, and symmetry. Secondly, most of these models have unknown parameters, which bring greater ambiguity and uncertainty. There are still major shortcomings in the integration of multiple factors, such as human interventions, environmental factors, and transmission mechanisms.MethodsA dynamical model with only infected humans and removed humans was established. Then the process of COVID-19 spread was segmented using a local smoother. The change of infection rate at different stages was quantified using the continuous and periodic Logistic growth function to quantitatively describe the comprehensive effects of natural and human factors. Then, a non-linear variable and NO2 concentrations were introduced to qualify the number of people who have been prevented from infection through human interventions.ResultsThe experiments and analysis showed the R2 of fitting for the US, UK, India, Brazil, Russia, and Germany was 0.841, 0.977, 0.974, 0.659, 0.992, and 0.753, respectively. The prediction accuracy of the US, UK, India, Brazil, Russia, and Germany in October was 0.331, 0.127, 0.112, 0.376, 0.043, and 0.445, respectively.ConclusionThe model can not only better describe the effects of human interventions but also better simulate the temporal evolution of COVID-19 with local fluctuations and multiple peaks, which can provide valuable assistant decision-making information.

SARS-CoV-2 Infection Among Pregnant People at Labor and Delivery and Changes in Infection Rates in the General Population: Lessons Learned From Illinois.

Objectives:The Illinois Department of Public Health (IDPH) assessed whether increases in the SARS-CoV-2 test positivity rate among pregnant people at labor and delivery (L&D) could signal increases in SARS-CoV-2 prevalence in the general Illinois population earlier than current state metrics.Materials and Methods:Twenty-six birthing hospitals universally testing for SARS-CoV-2 at L&D voluntarily submitted data from June 21, 2020 through January 23, 2021, to IDPH. Hospitals reported the daily number of people who delivered, SARS-CoV-2 tests, and test results as well as symptom status. We compared the test positivity rate at L&D with the test positivity rate of the general population and the number of hospital admissions for COVID-19–like illness by quantifying correlations in trends and identifying a lead time.Results:Of 26 633 reported pregnant people who delivered, 96.8% (n = 25 772) were tested for SARS-CoV-2. The overall test positivity rate was 2.4% (n = 615); 77.7% (n = 478) were asymptomatic. In Chicago, the only region with a sufficient sample size for analysis, the test positivity rate at L&D (peak of 5% on December 7, 2020) was lower and more stable than the test positivity rate of the general population (peak of 14% on November 13, 2020) and lagged hospital admissions for COVID-19–like illness (peak of 118 on November 15, 2020) and the test positivity rate of the general population by about 10 days (Pearson correlation = 0.73 and 0.75, respectively).Practice Implications:Trends in the test positivity rate at L&D did not provide an earlier signal of increases in Illinois’s SARS-CoV-2 prevalence than current state metrics did. Nonetheless, the role of universal testing protocols in identifying asymptomatic infection is important for clinical decision making and patient education about infection prevention and control.