Hospital Surveillance Data Research Articles

PREDICTING RISK OF EMPLOYEE INJURY IN A PEDIATRIC HOSPITAL

PURPOSEHealthcare has one of the highest rates of non-fatal occupational injury as compared to other industries. Yet, evaluation of risk determinants and prediction algorithms in hospital settings remains limited. METHODSThis study examines risk factors for employee injuries in a large pediatric hospital and evaluates prediction algorithms using hospital surveillance data, incident reports, and work unit measures such as patient density and employee workload. We employed multiple statistical models and machine learning tools, including logistic regression (LR), random forest (RF), penalized logistic regression (PLR), Naïve Bayes, neural network (NN), XGBoost (XG), and mixed-effects logistic regression (GLMER) to predict employee injury risk for specific time periods. We used cross-validation and receiver-operator characteristic (ROC) curve analyses to assess model performance. RESULTSGLMER, LR, and PLR were superior to other models, with higher AUC values (∼0.76), indicating good discrimination ability, though accuracy and specificity varied across models. RF showed high accuracy and specificity and comparable AUC with the top performing models. Further analyses using GLMER revealed variability in employee injury risk across months, days, and hospital units, identifying peaks on Tuesdays and Saturdays and in April and July, with lows in March and June. CONCLUSIONOur findings highlight the significance of monitoring specific risk factors within pediatric hospital settings and pairing them with appropriate predictive algorithms to effectively predict and mitigate employee injuries. These insights indicate that continuous monitoring may help enhance employee safety. Future work should evaluate additional predictors that may be obtained from individual hospital units, which may inform targeted prevention strategies.

Characteristics of health care workers with SARS-CoV-2 at a COVID-19 hospital in Türkiye: Homologous versus heterologous vaccination.

Given the limited studies on types of vaccination and infection rates among health care workers (HCWs) in Türkiye, we analyzed the demographic, clinical, and vaccination characteristics as well as the attitudes of HCWs who have been infected with COVID-19. We retrospectively analyzed demographic and clinical data on breakthrough COVID-19 infections in HCWs from hospital surveillance data collected between April 5, 2020, and November 1, 2022. The comparison was based on four subgroups that consisted of unvaccinated, one-shot-vaccinated, homologous vaccinated, and heterologous vaccinated individuals. Participants who received various combinations of Sinovac/CoronaVac and/or BioNTech/Pfizer vaccines were compared for detection of COVID-19. During a 33-month period of 744 HCWs who contracted COVID-19, women (65.3%) and nurses (28.9%) were the most affected, followed by doctors (25.8%). Of the infected HCWs, only 1.3% required hospitalization, 0.3% required ICU support, and 98.4% were outpatients. By vaccination status, 143 of the HCWs (19.2%) were unvaccinated, 292 (39.2%) were homologously vaccinated, 294 (39.5%) were heterologously vaccinated, 15 (2%) received a single shot, 206 (27.7%) received two shots, and 165 (22.2%) received three shots. All HCWs contracted COVID-19 at a mean of 134-days (range:1-539) after vaccination. While the proportions of homologously and heterologously vaccinated HCWs were similar, the time elapsed from vaccination to contracting COVID-19 varied (mean 143.4±106.7 vs.126.4±82.43 days). Among both outpatients and inpatients with COVID-19, women HCWs outnumbered men HCWs. HCWs who received homologous vaccination contracted COVID-19 later than those who received heterologous vaccination.

Effect of nirsevimab on hospitalisations for respiratory syncytial virus bronchiolitis in France, 2023–24: a modelling study

Respiratory syncytial virus (RSV) is a major cause of hospitalisations and deaths among infants worldwide. France was one of the first countries to implement a national programme (beginning on Sept 15, 2023) for administration of nirsevimab, a single-dose long-acting monoclonal antibody treatment, to infants born on or after Feb 6, 2023, to prevent lower respiratory tract infection caused by RSV. We aimed to estimate the effectiveness of nirsevimab and the number of hospitalisations averted in children younger than 24 months in real-world settings. In this modelling study, we developed an age-structured deterministic model characterising RSV transmission as well as plausible scenarios for the administration of nirsevimab doses based on maternity ward and community pharmacy supply data. We retrospectively estimated nirsevimab effectiveness in infants younger than 24 months during the 2023-24 RSV season in France (excluding overseas territories) and the number of averted hospitalisations for RSV bronchiolitis occurring after emergency department visits, by calibrating the model to hospital and virological surveillance data from Aug 21, 2017, to Feb 4, 2024, alongside serological data from a previous cross-sectional study. To assess the robustness of our estimates, we conducted sensitivity analyses in which we modified our assumptions about the number of doses administered, the reconstruction of the number of RSV-associated hospitalisations for bronchiolitis, the duration of maternal and post-infection immunity to RSV, and the number of contacts in children aged 0-2 months. We estimated that nirsevimab administration prevented 5800 (95% credible interval 3700-7800) RSV-associated hospitalisations for bronchiolitis after emergency department visits among children younger than 24 months, including 4200 (2900-5600) hospitalisations among those aged 0-2 months, between Sept 15, 2023 (the date nirsevimab was introduced), and Feb 4, 2024-a 23% (16-30) reduction in the total number of hospitalisations and a 35% (25-44) reduction in the 0-2 months age group, compared with the scenario without administration. In our baseline scenario, in which we estimated that 215 000 doses of nirsevimab were administered by Jan 31, 2024, the estimated effectiveness against RSV-associated hospitalisations for bronchiolitis was 73% (61-84), corresponding to one hospitalisation averted for every 39 (26-54) doses administered. In sensitivity analyses, nirsevimab remained effective against RSV-associated hospitalisations for bronchiolitis after emergency department attendance. Our findings show that nirsevimab administration campaigns could effectively reduce the RSV-related hospital burden of bronchiolitis in children younger than 24 months. European Commission, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases programme, and INCEPTION project.

Changes in the etiological structure of severe acute respiratory viral infections in children and adults under the influence of the COVID-19 pandemic

Introduction. The traditional surveillance system for influenza and ARVI provides a general description of epidemics, but does not provide information on the age-related characteristics of the etiology and clinical peculiarities of severe acute respiratory diseases (SARI) in hospitalized patients. Aim. To monitor the etiology of SARI in hospitalized children and adults, assessing the impact of the COVID-19 pandemic on this process. Materials and methods. Standardized clinical and laboratory monitoring of SARI among 18,458 hospitalized patients was carried out in hospitals in three cities of Russia with weekly PCR detection of 11 types of pathogens. Results. According to the investigation of hospitalized patients with SARI for the period from 2018 to 2023, the viral etiology of respiratory diseases was deciphered in 58.3% of cases. Weekly monitoring showed a change in the etiological mosaic of SARI pathogens during the SARS-CoV-2 pandemic with a sharp decrease in the frequency of detection of influenza and respiratory syncytial virus (RSV) during the 2020–2021 season against the background of a significant increase of metapneumovirus and rhinovirus infections in children. During the 2022-2023 season an increase in the proportion of RSV infection in children under 6 years of age (up to 36.2%) was noted against the background of a significant decrease in the frequency of SARS-CoV-2. In the intensive care units (ICU), RSV infection was most often in children during the post-pandemic period (up to 30.1–53.6% of positive cases, p 0.001); in adults, SARS-CoV-2 was mostly detected (76,5–100% of cases, p 0.001). Conclusion. Hospital surveillance data significantly complements the epidemiological information obtained in the traditional surveillance system. Monitoring of infections has shown a continuously changing etiological infrastructure of SARI, with the disappearance of influenza and RSV during the COVID-19 pandemic and their return to circulation in the post-pandemic period.

SG-APSIC1109: Redesign of outpatient clinic clean care to decrease postoperative SSIs after orthopedic implants

Objectives: Based on Sardjito Hospital surveillance data in 2020, the incidence of SSI in orthopedic implant surgery was 46 cases (4.7%), mostly in the outpatient clinic. We evaluated some of the potential risks and proposed redesign of infection prevention and control measures in April 2021 to improve the overall clean care at the orthopedic outpatient clinic. Methods: We conducted an operational study to redesign various components of clean care using a before-and-after evaluation of infection risk. The study was led by an IPC nurse and was supported by all levels of stakeholders at Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, during May–September 2021. Results: The redesigned components covered continuing professional development (CPD) through a workshop on clean care and wound care for doctors and nurses. The workshop also encouraged high-level management to make several important changes: (1) to redistribute medical staff schedules, (2) to start online patient registration to better distribute and decrease patient loads, (3) to set up the waiting room as well as the dressing room with strictly separate between dirty and clean areas, (4) to schedule daily general disinfection at noon during service hours, and (5) to perform routine air disinfection after daily clinic services as well as placing an additional portable HEPA filter for continuous air disinfection. After the these changes, during 2021, 7 SSIs occurred among postoperative orthopedic implant patients, a decrease of 85%. We observed more clean and neat rooms without patient overcrowding as well as easy and comfortable flow of patients and staff. Environmental pathogen germ counts decreased significantly. Conclusions: A redesign project at the orthopedic outpatient clinic reduced the incidence of postoperative SSIs and reduced the number of environmental pathogens. Overall clean care is a basic strategy in IPC for improving patient safety.

Quality of stillbirth and neonatal death audit in Malawi: A descriptive observational study

WHO developed a guideline for implementing stillbirth and neonatal death audits at healthcare facilities in 2016. Like many other poor resource countries, stillbirths and neonatal deaths rates remain high in Malawi despite implementation of audit. This paper assesses the quality of facility-based stillbirth and neonatal death audit implementation in Malawian hospitals and provides recommendations for improvement. In accordance with the WHO audit guidelines, we applied mixed methods to determine the quality of audit implementation in seven hospitals in Malawi. We reviewed hospital surveillance data; audit document forms and action plans. We sought staff perceptions and opinions through a questionnaire and interviews and observed audit meetings. Quantitative data was analysed using IBM SPSS 26.0 and presented using frequencies and proportions. Qualitative data were analysed using predefined themes in a survey guide. The frequency of audits and number of stillbirth and neonatal deaths audited varied significantly between hospitals. No hospital had national audit guidelines. Deficiencies included limited information on neonatal death audit data collection and reporting tools, incomplete documentation, lack of senior staff commitment and a blame or shame atmosphere. Audit meetings often did not start with review of ward statistics, previous minutes and follow-up as to whether previous recommendations had been implemented. Challenges in analysing audit information and recommending solutions resulted in lowquality action plans. No objective evidence was found that audit recommendations were implemented. Assessed according to WHO guidelines, audits were of low quality resulting in challenges in identifying and addressing factors contributing to mortality. We recommend regular audit implementation, with completion of audit cycles for audit to contribute to mortality reduction.

Predicting COVID-19 progression in hospitalized patients in Belgium from a multi-state model.

To adopt a multi-state risk prediction model for critical disease/mortality outcomes among hospitalised COVID-19 patients using nationwide COVID-19 hospital surveillance data in Belgium. Information on 44,659 COVID-19 patients hospitalised between March 2020 and June 2021 with complete data on disease outcomes and candidate predictors was used to adopt a multi-state, multivariate Cox model to predict patients' probability of recovery, critical [transfer to intensive care units (ICU)] or fatal outcomes during hospital stay. Median length of hospital stay was 9 days (interquartile range: 5-14). After admission, approximately 82% of the COVID-19 patients were discharged alive, 15% of patients were admitted to ICU, and 15% died in the hospital. The main predictors of an increased probability for recovery were younger age, and to a lesser extent, a lower number of prevalent comorbidities. A patient's transition to ICU or in-hospital death had in common the following predictors: high levels of c-reactive protein (CRP) and lactate dehydrogenase (LDH), reporting lower respiratory complaints and male sex. Additionally predictors for a transfer to ICU included middle-age, obesity and reporting loss of appetite and staying at a university hospital, while advanced age and a higher number of prevalent comorbidities for in-hospital death. After ICU, younger age and low levels of CRP and LDH were the main predictors for recovery, while in-hospital death was predicted by advanced age and concurrent comorbidities. As one of the very few, a multi-state model was adopted to identify key factors predicting COVID-19 progression to critical disease, and recovery or death.

Human Metapneumovirus-Associated Hospitalization in HIV-1 Exposed Uninfected and HIV-1 Uninfected Children Less Than 5 Years in South Africa.

Using hospital surveillance data, we estimated Human metapneumovirus (hMPV) hospitalization incidence by age and HIV-exposure status. hMPV-associated hospitalization incidence was highest in <1-year children. Incidence rate ratios of HIV-exposed over unexposed children were 1.5 (95%CI 0.9-2.4) for <6-month children, 1.4 (95%CI 0.7-2.4) for 6- to 11-month children and 0.9 (95%CI 0.4-1.9) for 12- to 59-month children.

Global and regional sepsis and infectious syndrome mortality in 2019: a systematic analysis

BackgroundInfections can lead to sepsis, a life-threatening reaction in which a dysregulated host response to the infection leads to organ dysfunction. Infectious syndromes can be either infectious underlying causes of death, or intermediate causes of death leading to sepsis. Therefore, infections participate in the cause-of-death chain of communicable, maternal, neonatal, and nutritional diseases, non-communicable diseases, and injuries. Infectious syndromes contribute substantially to global mortality, but data are scarce and neither sepsis nor infectious syndromes are included in standard Global Burden of Disease, Injuries, and Risk Factors Study estimates. Therefore, accurate estimates of infectious syndromes burden are needed to improve health-care policies. MethodsWe used 126 million individual death records from multiple causes of death, hospital, linkage, and mortality surveillance data covering 16 countries. Our analysis captures infectious syndromes in the blood, bone, heart, CNS, peritoneum, abdomen, respiratory system, skin, urogenital system, and other locations, as well as specific diseases such as tuberculosis, gonorrhoea, chlamydia, and salmonella infections. We assigned each record an infectious syndrome on the basis of the causes-of-death chain. Through a mixed-effects binomial logistic regression, we calculated infectious syndrome mortality fractions in 2019 by underlying Global Burden of Disease cause, age group, sex, and location, and multiplied on the sepsis mortality envelope in 2019 to obtain attributable deaths. FindingsIn 2019, 13·7 million people worldwide died from infectious syndromes, 5·2 million of which co-occurred with non-communicable diseases. 3 million of these deaths occurred in children under the age of 5 years. Globally, respiratory infections and bloodstream infections are the deadliest. Regional disparities are stark, with a death rate of 52·6 per 100 000 for bloodstream infections in sub-Saharan Africa, compared with 37·7 per 100 000 in high-income countries. The burden varies across age groups: adults aged 50–69 years face the highest burden from bloodstream infections, whereas children under the age of 5 years are most burdened by respiratory infections. InterpretationIn 2019, infectious syndromes contributed substantially to mortality, especially in non-communicable disease. Infectious syndrome mortality rivalled ischemic heart disease (9 million deaths) and neoplasms (10 million deaths), suggesting that infections, both as underlying and intermediate causes, are an immense source of mortality and must be recorded, analysed, and treated. FundingBill & Melinda Gates Foundation, Wellcome Trust, and Fleming Fund.

COVID-19 Cases and Hospitalizations by COVID-19 Vaccination Status and Previous COVID-19 Diagnosis - California and New York, May-November 2021.

By November 30, 2021, approximately 130,781 COVID-19-associated deaths, one in six of all U.S. deaths from COVID-19, had occurred in California and New York.* COVID-19 vaccination protects against infection with SARS-CoV-2 (the virus that causes COVID-19), associated severe illness, and death (1,2); among those who survive, previous SARS-CoV-2 infection also confers protection against severe outcomes in the event of reinfection (3,4). The relative magnitude and duration of infection- and vaccine-derived protection, alone and together, can guide public health planning and epidemic forecasting. To examine the impact of primary COVID-19 vaccination and previous SARS-CoV-2 infection on COVID-19 incidence and hospitalization rates, statewide testing, surveillance, and COVID-19 immunization data from California and New York (which account for 18% of the U.S. population) were analyzed. Four cohorts of adults aged ≥18 years were considered: persons who were 1) unvaccinated with no previous laboratory-confirmed COVID-19 diagnosis, 2) vaccinated (14 days after completion of a primary COVID-19 vaccination series) with no previous COVID-19 diagnosis, 3) unvaccinated with a previous COVID-19 diagnosis, and 4) vaccinated with a previous COVID-19 diagnosis. Age-adjusted hazard rates of incident laboratory-confirmed COVID-19 cases in both states were compared among cohorts, and in California, hospitalizations during May 30-November 20, 2021, were also compared. During the study period, COVID-19 incidence in both states was highest among unvaccinated persons without a previous COVID-19 diagnosis compared with that among the other three groups. During the week beginning May 30, 2021, compared with COVID-19 case rates among unvaccinated persons without a previous COVID-19 diagnosis, COVID-19 case rates were 19.9-fold (California) and 18.4-fold (New York) lower among vaccinated persons without a previous diagnosis; 7.2-fold (California) and 9.9-fold lower (New York) among unvaccinated persons with a previous COVID-19 diagnosis; and 9.6-fold (California) and 8.5-fold lower (New York) among vaccinated persons with a previous COVID-19 diagnosis. During the same period, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates in California followed a similar pattern. These relationships changed after the SARS-CoV-2 Delta variant became predominant (i.e., accounted for >50% of sequenced isolates) in late June and July. By the week beginning October 3, compared with COVID-19 cases rates among unvaccinated persons without a previous COVID-19 diagnosis, case rates among vaccinated persons without a previous COVID-19 diagnosis were 6.2-fold (California) and 4.5-fold (New York) lower; rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19. During the same period, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates in California followed a similar pattern. These results demonstrate that vaccination protects against COVID-19 and related hospitalization, and that surviving a previous infection protects against a reinfection and related hospitalization. Importantly, infection-derived protection was higher after the Delta variant became predominant, a time when vaccine-induced immunity for many persons declined because of immune evasion and immunologic waning (2,5,6). Similar cohort data accounting for booster doses needs to be assessed, as new variants, including Omicron, circulate. Although the epidemiology of COVID-19 might change with the emergence of new variants, vaccination remains the safest strategy to prevent SARS-CoV-2 infections and associated complications; all eligible persons should be up to date with COVID-19 vaccination. Additional recommendations for vaccine doses might be warranted in the future as the virus and immunity levels change.

Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response.

There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA). To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19. Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values &lt;0.001. Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites. The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.

Insights into the association of ACEIs/ARBs use and COVID-19 prognosis: a multistate modelling study of nationwide hospital surveillance data from Belgium

ObjectivesThe widespread use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) by patients with chronic conditions raised early concerns on the potential exacerbation of COVID-19 severity and fatality....

Opportunities for the use of routinely collected data for the generation of large randomized evidence in Colombia

Randomized clinical trials are the cornerstone design for the evaluation of the safety and efficacy of health interventions. Furthermore, morbidity and mortality rates could be reduced if evidence of better interventions is sought and used to inform medical practice. However, only small to moderate, yet worthwhile, effects can be expected from such interventions. Therefore, moderate random error and moderate biases must be avoided during the design, conduct and analysis of trials. Routinely collected data, such as vital statistics, hospital episode statistics and surveillance data, could be used to enhance recruitment and follow-up a large number of patients, reducing both random error and moderate biases. Here, we discuss the opportunities and challenges for the use of these data for clinical studies in Colombia.

Modelling the impact of respiratory syncytial virus (RSV) vaccine and immunoprophylaxis strategies in New Zealand

BackgroundMathematical models of respiratory syncytial virus (RSV) transmission can help describe seasonal epidemics and assess the impact of potential vaccines and immunoprophylaxis with monoclonal antibodies (mAb). MethodsWe developed a deterministic, compartmental model for RSV transmission, which was fitted to population-based RSV hospital surveillance data from Auckland, New Zealand. The model simulated the introduction of either a maternal vaccine or a seasonal mAb among infants aged less than 6 months and estimated the reduction in RSV hospitalizations for a range of effectiveness and coverage values. ResultsThe model accurately reproduced the annual seasonality of RSV epidemics in Auckland. We found that a maternal vaccine with effectiveness of 30–40% in the first 90 days and 15–20% for the next 90 days could reduce RSV hospitalizations by 18–24% in children younger than 3 months, by 11–14% in children aged 3–5 months, and by 2–3% in children aged 6–23 months. A seasonal infant mAb with 40–60% effectiveness for 150 days could reduce RSV hospitalizations by 30–43%, 34–48% and by 14–21% in children aged 0–2 months, 3–5 months and 6–23 months, respectively. ConclusionsOur results suggest that either a maternal RSV vaccine or mAb would effectively reduce RSV hospitalization disease burden in New Zealand. Overall, a seasonal mAb resulted in a larger disease prevention impact than a maternal vaccine.

Abstract P184: Effect of Acute Stroke Care Hospital Networks in Korea

Purpose: Stroke patients generally transport stroke patients either to nearest stroke hospital with secondary transfers or to hub hospitals in selective cases. This study aimed to determine the stroke community of close networks and to evaluate their role for the access the endovascular treatment (EVT). Methods: Using the nationwide acute stroke hospital (ASH) surveillance data assessed the major quality indicators of all stroke patients of South Korea, triage information both initial visit and secondary interhospital transfers were extracted according to the hospitals. Based on them, stroke community with dense linkages were partitioned using the network-based Louvain algorithm. The hierarchical model estimated the function of stroke community for the EVT. Results: For 6-month surveying period, 19113 subjects admitted to the 246 ASHs. Of them, 1831 (9.6%) were transferred from 763 adjacent facilities not ASH, while 1283 (6.7%) from the other ASHs. The algorithm determined the 113 stroke communities where composed median 7 hospitals (2 ASHs and 5 adjacent facilities) and treated about 30 subjects per month. Most of communities formed the spindle shape with higher centralization index and located within 150 Km (Figure). Stroke communities significantly affected 11% of EVT after adjustments. Conclusions: Network analysis method effectively contoured the high centralizing stroke communities and helped the functions on the EVT accessibility.

Legal Obligation to Notify Severe Clostridiodes difficile Infections - Data from Frankfurt am Main, Germany. Overview and Discussion

Clostridioides difficile (C. difficile) is the most frequently identified causative agent of antibiotic-associated diarrhea in industrialized countries. As early as 2007, severe C. difficile infections (CDI) were to be notified in Germany as a "threatening disease with an indication of grave danger to the general public". In 2016, the Notification Adjustment Ordinance put in force a duty to notify CDI with a clinically severe course. Here, the necessity and suitability of mandatory notification of severe CDI in Frankfurt am Main, Germany, 2014-2018 is examined. Cases of CDI reported to the health department Frankfurt am Main were compared with the C. difficile-associated deaths in Frankfurt for 2014-2018. The results were compared with data from the literature, the national reporting data according to the Infection Protection Act (IfSG), the mortality statistics, the hospital treatment data as well as the hospital surveillance data of the German hospital infection surveillance system for C difficile-associated diarrhea (CDAD). With the entry into force of the new Notification Adjustment Ordinance, the number of CDIs reported annually in Frankfurt am Main increased from 5-8 to 13-14; however, in all years (with the exception of 2016), the number of deaths (death-leading illness or previous cause) was -17-50 per year and thus well above the number of reported CDI-cases according to the German Infection Protection Act. The notification data from Frankfurt am Main show an approx. 2-fold lower score compared to the CDI-associated deaths. From the data of the Hospital Surveillance System (CDAD-KISS), it can be estimated that the majority of the cases are not notified. While an increase in CDI notifications is reported nationwide, there is a decrease in data from nationwide death statistics, hospital treatment data and CDI prevalence, and an increase in incidence of severe CDI. Therefore, and taking into account legal requirements of the IfSG and the options for action of the health authorities according to § 23 (4) Infection prevention act (IfSG), and regarding European recommendations and available data on CDI surveillance, the obligation to notify CDI should be lifted.

Hospitalization of Pediatric Enteric Fever Cases, Dhaka, Bangladesh, 2017-2019: Incidence and Risk Factors.

BackgroundEnteric fever causes substantial morbidity and mortality in low- and middle-income countries. Here, we analyzed Surveillance for Enteric Fever in Asia Project (SEAP) data to estimate the burden of enteric fever hospitalization among children aged <15 years and identify risk factors for hospitalization in Bangladesh.MethodsSEAP used hospital surveillance paired with a community-based health-care utilization assessment. In SEAP hospital surveillance, blood was obtained for culture from children aged <15 years with ≥3 days of fever. In the hospital catchment area, a health-care utilization survey (HCUS) was conducted to estimate the proportion of febrile children hospitalized at the study hospitals. We analyzed hospital surveillance and HCUS data to estimate the health care–adjusted incidence of enteric fever hospitalization, and conducted univariable and multivariable logistic regressions.ResultsFrom July 2017 through June 2019, 2243 laboratory-confirmed enteric fever cases were detected in 2 study hospitals; 673 (30%) were hospitalized. The health care–adjusted incidence of enteric fever hospitalization among children <15 years old was 303/100 000 children/year (95% confidence interval [CI], 293–313). Salmonella Typhi contributed most to the enteric fever hospitalization incidence (277/100 000 children/year; 95% CI, 267–287). The incidence was highest among children aged 2 to <5 years (552/100 000 children/year; 95% CI, 522–583), followed by those aged <2 years (316/100 000 children/year; 95% CI, 288–344). Factors independently associated with enteric fever hospitalization included fever duration, diarrhea, vomiting, abdominal pain, and leukocytopenia.ConclusionsWe estimated a high burden of hospitalization due to enteric fever among children aged <5 years in Bangladesh. The introduction of a typhoid conjugate vaccine would protect children from typhoid and avert typhoid hospitalizations.

Development of a 51-hospital Chicagoland regional antibiogram and comparison to local hospital and national surveillance data.

To develop a regional antibiogram within the Chicagoland metropolitan area and to compare regional susceptibilities against individual hospitals within the area and national surveillance data. Multicenter retrospective analysis of antimicrobial susceptibility data from 2017 and comparison to local institutions and national surveillance data. The analysis included 51 hospitals from the Chicago-Naperville-Elgin Metropolitan Statistical Area within the state of Illinois. Overall, 18 individual collaborator hospitals provided antibiograms for analysis, and data from 33 hospitals were provided in aggregate by the Becton Dickinson Insights Research Database. All available antibiogram data from calendar year 2017 were combined to generate the regional antibiogram. The final Chicagoland antibiogram was then compared internally to collaborators and externally to national surveillance data to assess its applicability and utility. In total, 167,394 gram-positive, gram-negative, fungal, and mycobacterial isolates were collated to create a composite regional antibiogram. The regional data represented the local institutions well, with 96% of the collaborating institutions falling within ±2 standard deviations of the regional mean. The regional antibiogram was able to include 4-5-fold more gram-positive and -negative species with ≥30 isolates than the median reported by local institutions. Against national surveillance data, 18.6% of assessed pathogen-antibiotic combinations crossed prespecified clinical thresholds for disparity in susceptibility rates, with notable trends for resistant gram-positive and gram-negative bacteria. Developing an accurate, reliable regional antibiogram is feasible, even in one of the largest metropolitan areas in the United States. The biogram is useful in assessing susceptibilities to less commonly encountered organisms and providing clinicians a more accurate representation of local antimicrobial resistance rates compared to national surveillance databases.

Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants

Hydroxychloroquine (HCQ) has been largely used and investigated as therapy for COVID-19 across various settings at a total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (total 2400 mg over 5 days) was recommended for hospitalised patients with COVID-19. We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ monotherapy and supportive care (HCQ group) were compared with patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. Of 8075 patients with complete discharge data on 24 May 2020 and diagnosed before 1 May 2020, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, mortality was lower in the HCQ group compared with the no-HCQ group [adjusted hazard ratio (aHR)=0.684, 95% confidence interval (CI) 0.617-0.758]. Compared with the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤5 days (n=3975) and >5 days (n=3487) after symptom onset [aHR=0.701 (95% CI 0.617-0.796) and aHR=0.647 (95% CI 0.525-0.797), respectively]. Compared with supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalised patients with COVID-19 diagnosed and treated early or later after symptom onset.

Hospital surveillance predicts community pneumococcal antibiotic resistance in Vietnam.

In Vietnam, Streptococcus pneumoniae is a leading cause of disease, including meningitis. Antibiotics are available without physician prescription at community pharmacies and rates of antibiotic non-susceptibility are high. Appropriate treatment and antibiotic stewardship need to be informed by surveillance data. To report community-based pneumococcal antibiotic susceptibility testing data from children enrolled in a pneumococcal conjugate vaccine trial in Ho Chi Minh City [the Vietnam Pneumococcal Project (ViPP)] and compare these with published hospital-based data from the nationwide Survey of Antibiotic Resistance (SOAR) to determine whether hospital surveillance data provide an informative estimate of circulating pneumococcal resistance. Pneumococcal isolates from 234 nasopharyngeal swabs collected from ViPP participants at 12 months of age underwent antibiotic susceptibility testing using CLSI methods and the data were compared with SOAR data. Antibiotic susceptibility testing identified penicillin-non-susceptible pneumococci in 93.6% of pneumococcus-positive ViPP swabs (oral, non-meningitis breakpoints). Non-susceptibility to erythromycin, trimethoprim/sulfamethoxazole, clindamycin and tetracycline also exceeded 79%. MDR, defined as non-susceptibility to three or more classes of antibiotic, was common (94.4% of swabs). Low or no resistance was detected for ceftriaxone (non-meningitis breakpoints), ofloxacin and vancomycin. Antibiotic non-susceptibility rates in ViPP and SOAR were similar for several antibiotics tested. A very high proportion of pneumococci carried in the community are MDR. Despite wide disparities in population demographics between ViPP and SOAR, the non-susceptibility rates for several antibiotics were comparable. Thus, with some qualification, hospital antibiotic susceptibility testing data in Vietnam can inform circulating pneumococcal antibiotic non-susceptibility in young children, the group at highest risk of pneumococcal disease, to guide antibiotic prescribing and support surveillance strategies.