Good Infection Control Research Articles

The Impact of Antibiotic Misuse in Adult Patients: A Review of Contributing Factors, Consequences, and Strategies for Mitigation.

Antibiotic misuse, characterized by inappropriate use, over-prescription, and self-medication, is a severe threat to health in that it increases the rate at which antibiotic-resistant bacteria develop. This paper provides a review of antibiotic misuse concerning adult patients, an outline of factors that perpetuate it, the consequences, and the possible mitigation strategies. We discuss patient-related issues, such as lack of knowledge and non-compliance, problems with healthcare providers in terms of over-subscription and poor training, and system problems like poor stewardship programs and lack of regulatory efforts. In addition, the authors debate the environmental consequences of poor antibiotic stewardship coming from agriculture use and contamination. The consequences of misuse include the development of antibiotic-resistant pathogens and deleterious drug reactions, but also imply significant costs to the health system. The review calls for increased antibiotic stewardship, improved patient education, the development of new antimicrobial agents, and good policy infection control. This review is essence, a call to multifaceted efforts in the fight against the misuse of antibiotics and stresses that continuous research works are required to change policies. Antibiotic misuse is emerging as a global problem because addressing this problem not only ensures sustainability in the existing antibiotics but also assures that public health is protected.

HBcrAg values may predict virological and immunological responses to pegIFN-α in NUC-suppressed HBeAg-negative chronic hepatitis B

ObjectiveSelected populations of patients with chronic hepatitis B (CHB) may benefit from a combined use of pegylated interferon-alpha (pegIFN-α) and nucleos(t)ides (NUCs). The aim of our study was to assess...

MID-TERM RESULTS OF THE NEW ENDO-SPACER TECHNIQUE IN TWO-STAGE SEPTIC EXCHANGE SURGERY FOR PERIPROSTHETIC JOINT INFECTION OF THE HIP

Mechanical failure due to dislocation, fracture and acetabular wear as well as persistence of infection are the main complications associated with the use of hip spacers in the treatment of periprosthetic joint infections (PJI).We have developed a novel, custom-made spacer as part of two-stage septic hip replacement and present the two- to five-year results after reimplantation.We prospectively examined a total of 73 patients over our study period in whom our new spacer technique was used. The technique includes a dual mobility inlay and a cemented straight stem in combination with antibiotic-loaded PMMA bone cement which allows full weight bearing meanwhile the interim period. The follow-up ranged between 24 and 60 months after reimplantation as second stage of a two-stage approach. The patients were contacted as part of the follow-up using a questionnaire concerning reoperation, reinfection as well as hip function by using the Harris Hip Score.72 patients (98,6%) could be reimplanted, one patient is still using the spacer prothesis for 45 months because of excellent functional results with a Harris Hip Score of 95, nevertheless reimplantation is planned. The reinfection rate was less than 7% after reimplantation. The dislocation rate was 5%, and in total there was an overall complication rate of less than 10%. The Harris Hip Score was significantly improved.The ENDO spacer surgical technique is a promising option in the treatment of periprosthetic joint infections (PJI) for two-stage septic exchange with a low dislocation rate and good infection control after reimplantation. In addition, it enables early mobilization with the possibility of full weight-bearing in the interval between spacer implantation and reimplantation.

Knowledge, Attitude, and Practice of Standard Infection Control Precautions Among Medical Students at King Khalid University Hospital.

Background Healthcare-associated infection (HAI) risk extends beyond patients to healthcare workers and medical students. However, many HAIs are preventable by adhering to standard infection control precautions (SICPs). This study assesses medical students' knowledge, attitudes, and practices regarding SICPs at the College of Medicine, King Saud University. Methodology A cross-sectional study was undertaken at the College of Medicine, King Saud University, Riyadh, Saudi Arabia, involving interns and medical students from years 1 to 5. The researchers constructed and validated an electronic questionnaire, which was used for data collection from December 2022 to June 2023. The estimated sample size was 371 students and interns, stratified by sex and educational level. The data collected included demographic characteristics, knowledge, attitudes, and practices regarding SICPs. Results Out of371 participants, approximately a quarter (25.1%) had a good knowledge score, 25.6% had a positive attitude, and 26.7% had good infection control practice. There was an association between good knowledge and male gender; being in clinical years 3, 4, 5, and interns; and attending infection control training (p < 0.05). A significant difference in practice was noted among females (p = 0.002). Conclusions This study showed low-to-moderate knowledge, attitude, and practice toward SICPs. These findings indicate a gap between the recommended guidelines and their implementation in healthcare settings, highlighting the necessity for integrating infection control education throughout the medical curriculum. Further research involving a larger sample from multiple institutions is warranted.

Single-stage revision for total shoulder arthroplasty infection. Results at a minimum 2 years follow-up

IntroductionSimilar to the management of periprosthetic joint infections of the lower limb, one-stage revision in total shoulder arthroplasty (TSA) infections is an option that has been highlighted in scientific publications since the early 2010s. However, there are only a few studies which validate this treatment and determine its scope of application in relation to two-stage treatment. HypothesisSingle-stage revision for infected TSA is a reliable treatment allowing good infection control and satisfactory functional results. MethodsThis single-center retrospective series of 34 consecutive patients operated on between 2014 and 2020 for a one-stage prosthetic revision was evaluated at a minimum of 2 years of follow-up. All of the patients included underwent revision shoulder arthroplasty during this period with the diagnosis of infection confirmed by microbiological analysis of surgical samples. Patients who did not benefit from a bipolar revision were excluded. All patients were followed at least 2 years after the intervention. Clinically suspected recurrence of infection was confirmed by a periprosthetic sample under radiographic guidance. Functional clinical outcomes as well as mechanical complications were also reported. ResultsThe average follow-up was 40.4 months (24–102±21.6). A septic recurrence was observed in three patients (8.8%). A mechanical complication was present in four patients (14.7%), and three (11.8%) required at least one surgical revision. The mean Constant-Murley score at the last follow-up was 49 (42–57±21.83). DiscussionSingle-stage revision for shoulder periprosthetic joint infection results in a success rate of 91.2% with satisfactory functional results after more than 2 years of follow-up. Level of evidenceIV; retrospective study.

Utilizing an antibiotic-eluting articulated cemented spacer in the two-stage management of infected total hip arthroplasty: a technical note.

Two-stage revision is generally preferred to eradicate chronic periprosthetic infections after total hip arthroplasty (THA) because of its good infection control and promising results. During two-stage revision, a temporary antibiotic-impregnated cement spacer was initially used for the local delivery of antibiotics, thereby reducing the risk of infection recurrence. Many researchers have reported various techniques for fabricating cemented spacers; however, there is no established standard technique. We share our cost-effective and easily reproducible technique for creating an articulated cemented spacer for managing infected THA.

A descriptive model featuring expansive clinical microbiology approaches and antimicrobial stewardship to control antimicrobial resistance in low- and middle-income countries

The upsurge and escalation of antimicrobial resistance (AMR) poses a major worry on the global scene. Effective antimicrobial stewardship (AMS) programs are critical to combat this challenge, and applied knowledge in clinical microbiology serves as the cornerstone for the successful implementation. Despite technological advances, many low- and middle-income countries (LMICs) still adopt traditional phenotypic techniques in clinical microbiology laboratories. An expansive implementation of clinical microbiology approaches can bridge this apparent gap. Good laboratory assessment, hospital epidemiology, and infection prevention and control, which are the sub-divisions of the expansive clinical microbiology approaches, can be deployed to implement AMS appropriately in LMICs. In this paper, we describe a model featuring a functional AMS equipped with expansive clinical microbiology approaches to control AMR in LMICs. &amp;nbsp;

Antimicrobial susceptibility pattern and mupirocin resistance among methicillin-resistant Staphylococcus aureus isolated from skin and soft-tissue infection patients attending a tertiary care hospital in North India

Background: Antimicrobial susceptibility among bacterial isolates varies from center to center. Mupirocin is a topical antibacterial antibiotic used to treat wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Aim and Objectives: This study was conducted to know the prevalence of high and low levels of mupirocin resistance along with antimicrobial susceptibility in MRSA isolates from skin and soft-tissue infection in patients admitted to a tertiary care hospital in North India. Materials and Methods: A total of 97 non-repetitive isolates of MRSA from various pus samples over a period of 1 year were included in this study. These strains were identified as per standard laboratory protocols given by the Clinical Laboratory Standards Institute. High- and low-level mupirocin resistance of the isolates was tested by using mupirocin discs of 200 μg and 5 μg, respectively. Mupirocin strips of 256 μg and 512 μg were used for the E-test to detect low-level and high-level mupirocin resistance, respectively. The isolates were reported as sensitive to mupirocin, with minimum inhibitory concentrations of &lt;4 mg/L. Results: Overall, 9.27% of mupirocin resistance was found, of which 2.06% of isolates were high-level resistant to mupirocin, while 7.21% had low-level resistance. All MRSA strains were susceptible to vancomycin, followed by linezolid (94.84%), teicoplanin (91.75%), and fusidic acid (88.65%). Conclusion: Regular monitoring, good infection control practices, and proper awareness about utilizing mupirocin therapeutically and prophylactically may help prevent the emergence of mupirocin resistance in health-care facilities.

Interventional knowledge, attitude and practice study of standard precautions among health care workers at a tertiary care hospital in Western India

Standard precautions are the backbone of any efficient infection control program. Compliance with standard precautions has been a major challenge for health care workers, especially in developing countries. To access the impact of the training program on health care workers (HCW) knowledge, attitude, and practice towards standard precautions. We conducted an interventional Knowledge, Attitude, and Practice (KAP) study among 150 HCW (50 Doctors, 50 Nurses, and 50 Technicians) in a tertiary care hospital from June 2019 to December 2019. We carried out educational interventions through training sessions with pre- and post-test questionnaires. We compared pre and post questionnaire mean scores to access the impact of short educational videos and seminars on HCWs using unpaired t-tests.HCWs have poor KAP on important aspects of standard precautions. Pre-intervention KAP mean scores were highest among doctors, followed by lab technicians and nurses. After training intervention, improvement in knowledge, attitude, and practice among all 3 types of HCWs were statistically significant (P-value &amp;#60;0.005, unpaired t-test). Low pre-intervention knowledge and attitude practice scores regarding standard precautions among doctors, nurses, and lab technicians were improved after training significantly. Hence, we recommend training programs regarding standard precautions should be regularly conducted in health-care facilities to promote good infection control practices and mitigate the risk of hospital-acquired infection. This has future implications in terms of reduced morbidity and mortality in resource limited settings.

Tuberculosis infection control practice and associated factors among health care workers in Ethiopia: Systematic review and meta-analysis

Background The poor practice of tuberculosis infection control may increase the risk of transmission of tuberculosis in healthcare settings. Thus, this study aimed to determine the pooled magnitude of good tuberculosis infection control practice and associated factors among healthcare workers in Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was followed for this review and meta-analysis. The electronic databases (Pub Med, Cochrane Library, Google scholar and grey literatures) were searched to retrieve articles by using keywords. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of studies. Heterogeneity was assessed using the I2 statistic. The meta-analysis with a 95% confidence interval using STATA 17 software was computed to present the pooled practice and odds ratio of the determinant factors. Publication bias was assessed visually by inspecting the funnel plot asymmetry and using statistical tests using the eggers and begs test. Results Seven studies were included in this meta-analysis, with a total of 3256 health workers. The overall pooled magnitude of good tuberculosis infection control practice was 46.44% (95% CI: 34.21%, 58.67%). In subgroup analysis, the highest practice was in Addis Ababa 51.40% (95% CI: 47.40, 55.40%) and the lowest prevalence of tuberculosis infection control practice was in Amhara region 40.24% (95% CI: 15.46, 65.02%). Working in TB clinics (AOR; 7.42, 95% CI: 3.89, 14.13) and good TB related knowledge (AOR; 4.40, 95% CI: 1.76, 10.97) were the significant predictors of good TB infection control practice. Conclusions Only less than half of the health care workers had good practice of TB infection control. Working in TB clinics and having good TB related knowledge were statistically significant predictors of TB infection control practice. Periodic shifting of health care workers to work in TB clinics and an emphasis on TB infection control related skill based training was recommended to increase the TB infection control practice.

Barriers to infection prevention and control in patients' homes.

While there is a lot of emphasis on the need for good infection prevention and control practices and acute care, the increasing complexity of patients being cared for in their own homes means that there is an increased risk for infection. Good practice is required by community nurses to minimise this risk. Patients' own homes can present particular challenges in complying with good practice and this article looks at some of the barriers to optimum infection prevention and control precautions in this setting.

Descriptive study of COVID-19 vaccinations and infections within an NHS workforce.

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced. Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic. Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022. There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates. NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

High Proportion of Mucosal Barrier Injury- Laboratory Confirmed Bloodstream Infection Among Paediatric Oncology Patients in a Cancer Centre in Eastern India

Abstract Introduction Blood stream Infections (BSI) is associated with increased morbidity, mortality, health care costs and healthcare resource utilization. The 2022 version of CDC/NHSN criteria for mucosal barrier injury-associated laboratory-confirmed bloodstream infection (MBI-LCBI-1) included isolation of any intestinal organism from blood culture in a patient with absolute neutrophil count &amp;lt;500/mm3. Children with malignancy have a high risk for infections due to neutropenia, immunosuppressive therapy, individual immune and nutritional status, chemotherapy infusion, radiotherapy, impaired mucosal barrier, and presence of different types of indwelling catheters. CLABSI is defined as an LCBI where an eligible BSI organism is identified, and an eligible central line is present on the LCBI date of event or the day before. Device Utilisation Ratio (DUR) is a ratio comparing the number of device days to the number of patient days for the included time period. Methods A retrospective analysis of all BSI-s in the paediatric unit of a tertiary oncology hospital in a low-middle income country (LMIC) for 43 months (April 2019-October 2022) was performed. The primary objective was to assess the burden of MBI-LCBI-1 in children with cancer. The secondary objective was to assess the CLABSI rate and compare it to the DUR. MBI-LCBI-1, CLABSI and DUR were determined using the standard CDC/NHSN criteria. The adapted CDC/NHSN bloodstream infection case report form included microbiological (type of pathogen) and clinical (signs, symptoms, and underlying conditions such as neutropenia) information. Neutropenia (absolute neutrophil count &amp;lt;500 cells/mm3) was the underlying condition in the MBI-LCBI cases. Blood cultures were done using BACT-ALERT system and antibiotic susceptibility testing performed using VITEK2 system (Biomerieux). Results A total of 47 positive blood cultures were obtained from 46 patients during the study period. Thirty-three cases of MBI-LCBI-1 (33/47= 70%) from 28 patients (median age 14 years; range 4-20 years) and 3 cases of CLABSI (3/47= 6.3%) from 3 patients (median age 7 years; range 3-9 years) were detected giving a CLABSI rate of 0.60 per 1000 central line days. Total Patient days and central line days was 15,002 and 14,764 respectively. The device utilization ratio of central line was 0.98. There were 48 isolates from 47 cases of BSI. Forty-three (90%) were Gram negative bacilli (GNB), 2 (4%) Gram positive cocci (GPC) and 3 (6%) Candida species. Klebsiella pneumoniae (28%) was the commonest GNB. Amongst the multi-drug resistant organisms (MDRO) associated with MBI-LCBI-1, carbapenem-resistant enterobacterales (CRE) was detected in 14/43 (32.5%), carbapenem-resistant Acinetobacter baumanii complex (CRAb) in 1/43 (2.3%), carbapenem-resistant Pseudomonas aeruginosa (CRPseu) in 2/43 (4.7%). Candida auris was detected in 1/3 Candida isolates. Six out of 46 patients with BSI died within 30 days of BSI (all-cause mortality). Four of these patients had CRE, 1 had CRAb and 1 had Candida auris. There were no isolates of Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE). Conclusion All patients who died had MDRO isolates. Strict adherence to standard and contact precautions, with high level of awareness is necessary for lowering the incidence of BSI. Low incidence of CLABSI is a good indicator of good infection control practices.

Nurses' Performances Regarding Infection Control Standard Precautions at Shar Teaching Hospital in Sulaimani City

Background: Standard precautions include hand washing, protective equipment, respiratory hygiene, sharps safety, injection techniques, patient care, waste disposal, and disinfected surfaces for infection control. Aim: the study aimed to evaluate Nurses' Performances Regarding Infection Control Standard Precautions, and the Association between the Practices of Nurses and Sociodemographic Characteristics. Methods: This study used a descriptive observational design to study 212 nurses in all departments at Shar Teaching Hospital in Sulaimani. A probability-based sampling method was used, and data were collected from March 15, 2022, to September 20, 2022. The questionnaire involved questions about the nurses' demographics and their work environment. Results: The result of the study indicates that (39.6%) of the nurses have good performance regarding infection control standard precautions, and there was a statistically significant association between nursing performance concerning age, level of education and employment Conclusion: only half of the participants had good infection control practices. Factors that affected this level of practice were found.

Hidden bugs in a newly opened hospital: the distribution of skin microbiota among healthcare workers in a newly opened teaching hospital.

Background. Skin is a reservoir for millions of micro-organisms, all of which make up the skin microbiota. Hospitals have been identified as a favourable environment for transmitting micro-organisms and thus, it is important to know the distribution of skin microbiota among healthcare workers (HCWs), as such findings may provide baseline information for the distribution of skin microbiota in hospitals.Hypothesis. There is no significant association between the factors (age, gender, type of skin microenvironment, hand hygiene practices, usage of skin care products, current healthcare practices and previous workplace) and the distribution of the skin microbiota among HCWs.Aim. The study aims to identify type of skin microbiota and associated factors (age, gender, type of skin microenvironment, hand hygiene practices, use of skincare products, current healthcare practice, and previous workplace) that influence the growth of skin microbiota.Method. About 102 bacterial isolates were obtained from the skin of 63 healthcare workers in a newly opened teaching hospital, namely Hospital Pengajar Universiti Putra Malaysia (HPUPM). All isolated bacteria were subjected to phenotypic identification according to standard microbiological procedures.Results. The most common isolated skin microbiota were Gram-positive bacteria (84.3%), followed by Gram-negative bacteria (15.7%). A Chi-square test of independence was used to analyse the above factors and there was a significant association between the type of skin microenvironment and the distribution of skin microbiota (P=0.03) (type of skin microenvironment influences the distribution of skin microbiota).Conclusion. Coagulase-negative Staphylococcus spp. was the most common bacteria isolated from the skin of the healthcare workers. Even though coagulase-negative staphylococci (CoNS) are low pathogenic bacteria, but it may cause serious infection in high risk group of patients. Therefore, it is important to emphasize on the good hand hygiene practices and implement strict infection control measures to minimize the risk of HAI in newly opened hospitals.

The use of Stimulan in bone and joint infections

AimsMusculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections.MethodsBetween January 2019 and December 2022, 106 patients with bone and joint infections were treated by five surgeons in five hospitals. Surgical debridement and calcium sulphate bead insertion was performed for local elution of antibiotics in high concentration. In all, 100 patients were available for follow-up at regular intervals. Choice of antibiotic was tailor made for each patient in consultation with microbiologist based on the organism grown on culture and the sensitivity. In majority of our cases, we used a combination of vancomycin and culture sensitive heat stable antibiotic after a thorough debridement of the site. Primary wound closure was achieved in 99 patients and a split skin graft closure was done in one patient. Mean follow-up was 20 months (12 to 30).ResultsOverall, six out of 106 patients (5.6%) presented with sepsis and poorly controlled comorbid conditions, and died in the hospital within few days of index surgery. Out of the remaining 100 patients, control of infection was achieved in 95 patients (95%). Persistence of infection was noted in five (5%) patients. Out of these 95 patients that had good control of infection, four patients (4.2%) with gap nonunion needed Masquelet procedure to achieve union.ConclusionOur multicentre experience confirmed that surgical debridement along with calcium sulphate bead insertion was effective in treating bone and joint infections without any side effects and complications.Cite this article: Bone Jt Open 2023;4(7):516–522.

Infection Prevention and Control Practices and Associated Factors Among Healthcare Cleaners in Gondar City: An Analysis of a Cross-Sectional Survey in Ethiopia.

Healthcare-associated infections are a global health problem and are more prevalent in developing countries such as Ethiopia, but there is a paucity of research on the infection prevention practices of cleaning staff. Therefore, this study aimed to assess infection prevention and control practices and associated factors among cleaners working in healthcare facilities in Gondar City, Ethiopia. A cross-sectional survey was conducted among healthcare cleaning staff from May to June 2022. A total of 428 cleaners took part in the survey. Data were collected using a semi-structured interviewer-administered questionnaire. The data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Among the 390 study participants included, 294 (75.1%) were female. Of the surveyed participants, 186 (47.7%) had good knowledge of infection prevention and control practices. This study revealed that out of the 390 healthcare cleaners, 204 (52.3%) had good infection prevention and control practices with 52.3% [95% CI (47.2, 56.4)]. Good knowledge of infection prevention and control [AOR: 1.56, 95% CI (1.03, 2.37)] and the availability of infection prevention and control guidelines in the workplace [AOR: 1.54, 95% CI (1.01, 2.33)] were significant factors associated with infection prevention and control practice. The present study found that almost half of the healthcare cleaners had poor IPC practices. The finding underlines the importance of good IPC knowledge and the accessibility of IPC guidelines to improve IPC practices among healthcare cleaning staff. The findings of this study also highlight that behavioral change interventions and paying attention, particularly to nonclinical staff such as cleaners in health care settings, are critical to reducing infection in health care settings.

MTOR signals regulate T cell exhaustion and T cell responses during PD-1 targeted immunotherapy in chronic viral infection.

Abstract Antigen-specific CD8 T cells gradually have impaired functions in chronic infection and cancers, which is termed T cell exhaustion. Since T cell exhaustion is associated with programmed death 1 (PD-1), the blockade of PD-1 pathway reinvigorates exhausted CD8 T cells, resulting in better control of infection and cancers. Stem-like CD8 T cells are important for maintenance of antigen-specific CD8 T cells during chronic infection and cancers because they have self-renewal ability and provide effector-like CD8 T cells which possess transiently cytotoxicity. PD-1 targeted therapies enhance functional T cells response by promoting differentiation of stem-like CD8 T cells toward effector-like CD8 T cells. mTOR is a serine/threonine kinase that regulates cellular functions and proliferation. However, the role of mTOR during T cell exhaustion and PD-1 targeted therapies remains elusive. Here, we found that mTOR inhibition enhanced accumulation of stem-like CD8 T cells at the early phase of infection, leading to improved efficacy of PD-1 blockade. In contrast, after the establishment of chronic LCMV infection, mTOR inhibition suppressed the transition to effector-like CD8 T cells from stem-like CD8 T cells. Mechanistically, a cell intrinsic mTOR signal was critical for differentiation of stem-like CD8 T cells into effector-like CD8 T cells during chronic infection as well as PD-1 targeted therapy. Thus, simultaneous treatments of PD-1 blockade with mTOR inhibition failed to induce effector-like CD8 T cells, resulting in reduced efficacy of PD-1 targeted therapy. Our data demonstrate that mTOR signals regulate T cell exhaustion and PD-1 targeted therapy and have important implications for combination cancer therapies with PD-1 blockade. Supported by grants from NIH (R01 AI139675)

Facilitated Subcutaneous Immunoglobulin Treatment in Patients with Immunodeficiencies: the FIGARO Study

PurposeThe FIGARO study aims to provide insights on real-world utilization and tolerability of facilitated subcutaneous immunoglobulin (fSCIG) for primary immunodeficiency disease (PID) or secondary immunodeficiency disease (SID).MethodsThis prospective, multicenter, observational study, evaluated medical records, charts, and diaries of patients who had received at least 1 fSCIG infusion for PID or SID. Data were analyzed by cohort (PID, SID) and age groups (pediatric [< 18 years], adult [18–64 years], older adult [≥ 65 years]). Patients were followed up to 36 months.ResultsThe study enrolled 156 patients: 15 pediatric, 120 adult, 21 older-adult. Twelve-month follow-up data were available for 128 patients. fSCIG was mainly prescribed for PID among patients aged < 65 years and for SID among older adults. At inclusion, 75.6% received their fSCIG infusion at home, and 78.7% self-administered. Adults were more likely to receive their initial infusion at home and self-administer (81.7% and 86.6%, respectively) than pediatric patients (53.3% each) and older adults (57.1% and 52.4%, respectively). At 12 months, the proportion of patients infusing at home and self-administering increased to 85.8% and 88.2%. Regardless of age, most patients self-administered the full fSCIG dose at home every 3–4 weeks and required a single infusion site. The tolerability profile was consistent with previous pivotal trials. Acute severe bacterial infections occurred in 0%–9.1% of patients during follow-up visits (full cohort).ConclusionsFIGARO confirms the feasibility, tolerability, and good infection control of fSCIG in PID and SID patients across the age spectrum in both the home-setting and medical facility.Trial registration numberClinicalTrials.gov NCT03054181

Assessment and feedback of the COVID-19 pandemic’s effects on physicians’ day-to-day practices: good knowledge may not predict good behavior

ABSTRACT The importance of doctors’ knowledge and awareness of infectious diseases was felt worldwide during the COVID-19 pandemic. With this study, we aimed to evaluate the effect of the long and dynamic pandemic process on resident physicians’ knowledge and protective behaviors for infection control in a tertiary hospital setting and protective behaviors for infection control in a tertiary hospital setting. The population of this cross-sectional study consisted of assistant physicians working at Suleyman Demirel University Faculty of Medicine Training and Research Hospital. A questionnaire evaluating information and protective practices for COVID-19 was applied to the participants through face-to-face interviews using the convenience sampling method, with an interval of one year. In the second year of the pandemic, resident physicians’ awareness of the correct use of personal protective equipment decreased (p = 0.001). Despite the continuous training, it was determined that the residents preferred masks with high protection at a lower rate when they encountered patients who received oxygen support of 5 lt/min and above (p < 0.001). To prevent the spread of COVID-19 infection in the hospital as the pandemic progresses, it has been determined that resident physicians are less prone to evaluate possible infection symptoms in patients hospitalized for non-COVID-19 reasons (p = 0.013). As a result, the data we obtained showed that despite the regular training during the pandemic and the death of many health workers, the residents’ adherence to infection control and prevention practices, which also protect them, decreased significantly in the second year of the pandemic. These valuable data showed us that good knowledge does not predict good infection control and prevention practices. Our findings show that physicians need a new education system that motivates them. In addition, psychosocial determinants, physical and mental fatigue, and institutional control factors contributing to these results and affecting individual risk perception should be recognized and prevented.