Incidence Of Infections In Patients Research Articles

Incidence of infection in patients with acute myeloid leukemia receiving high-dose cytarabine consolidation.

Infection risk during high-dose cytarabine (HiDAC) consolidation following induction therapy for acute myeloid leukemia (AML) is not well understood complicating decisions regarding antimicrobial prophylaxis during this period. We performed a retrospective chart review of adult patients with AML undergoing HiDAC consolidation between June 2016 and November 2021 at our institution. The primary endpoint was microbiologically confirmed infection within 30 days of HiDAC administration. This study included 111 patients who received a total of 264 cycles of HiDAC therapy. 36% of patients undergoing HiDAC consolidation had at least 1 infection over the course of their consolidation therapy. Infection complicated 18% of HiDAC cycles. The majority of infections were bacterial (81%), primarily caused by gram-negative organisms. Fluoroquinolone prophylaxis was associated with a lower hazard of bacterial infection (HR 0.46, 95% CI 0.24, 0.88). However, 26% of bacterial infections broke through antibiotic therapy with multiple cases concerning for fluoroquinolone resistance. Viral and fungal infections were rare (14% and 3% of infections respectively).

Infection risk with JAK inhibitors in dermatoses: a meta-analysis.

Evolving evidence suggests that Janus Kinase Inhibitors (JAKi) may predispose to certain infections, including tuberculosis and human herpes viruses. This review aimed to compare the infection risk in patients on a systemic JAKi for a dermatologic indication to a placebo. A systematic review was carried out from inception to June 2023, using the EMBASE, Medline, SCOPUS, and Cochrane Library of Registered Trials databases. Eligible studies included placebo-controlled randomized trials that investigated the incidence of infection in patients with a dermatologic indication. Primary outcomes included the most commonly reported infections pertaining to serious and opportunistic infections, upper respiratory tract infections, nasopharyngitis, herpes simplex, varicella zoster, tuberculosis, neutropenia, and lymphopenia. A meta-analysis of incidence ratios was conducted to determine odds ratios (OR), with a 95% confidence interval (CI) analysis. The meta-analysis found no increased risk of serious (OR: 0.92, 95% CI: 0.61-1.43, P = 0.74) or opportunistic infections (OR: 0.65, 95% CI: 0.32-1.31, P = 0.23). The incidence of varicella-zoster infections was significantly higher in the JAKi cohort (OR: 1.72, 95% CI: 1.08-2.72, P = 0.022). From 25 studies, there was no overall increased risk of herpes simplex infections (OR: 1.43, 95% CI: 0.93-2.23, P = 0.102) to placebo; however, a significantly higher risk in those with atopic dermatitis to alopecia areata was demonstrated (OR: 1.73, 95% CI: 1.13-2.69, P = 0.013). The results of this analysis do not suggest an increased risk of serious and opportunistic infections in those on JAKi compared to placebo. However, they support an increased risk of varicella-zoster infections and a higher risk of herpes simplex infections in those with atopic dermatitis to alopecia areata. The results of this report support these agents' short-term safety but signal that vigilance should be practiced in patients at risk for serious or recurrent herpes virus infections.

Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction in Pakistan

Background: Intraoperative hypothermia, an unintentional drop in core body temperature during surgery, poses a significant risk in implant-based breast reconstruction. This condition can weaken immune function, slow blood flow, and increase the risk of postoperative infections. Objective: To evaluate the impact of intraoperative hypothermia on the incidence of infections in patients undergoing implant-based breast reconstruction in Pakistan. Methods: This retrospective cohort study was conducted at Jinnah Sindh Medical University from January 2023 to November 2023. The study included 195 female breast cancer patients aged 18 and above who underwent implant-based breast reconstruction. Patients with pre-existing infections, concurrent chemotherapy or radiotherapy during the perioperative period, and incomplete medical records were excluded. Detailed patient demographics, surgical specifics, and intraoperative temperature control measures were recorded. Patients were categorized into normothermic (core body temperature ≥ 36°C) and hypothermic (core body temperature <36°C) groups. Infection data post-surgery were collected through clinical assessments, blood tests, and imaging techniques. Data were analyzed using SPSS version 25, with descriptive statistics, chi-square tests for categorical variables, and independent t-tests for continuous variables. A p-value of less than 0.05 was considered statistically significant. Ethical approval was obtained, and informed consent was secured from all participants. Results: The mean age of patients was 45.23±3.45 years in the normothermic group and 46.01±2.89 years in the hypothermic group. The hypothermic group had a slightly higher average BMI (25.1 kg/m²) compared to the normothermic group (24.5 kg/m²). Total infections were observed in 26.3% of the hypothermic group versus 10% in the normothermic group. Superficial infections were reported in 12.6% of hypothermic patients compared to 6% of normothermic patients. Deep infections were more prevalent in the hypothermic group at 13.7%, compared to 4% in the normothermic group. The univariate odds ratio (OR) for intraoperative hypothermia was 3.2 (95% CI: 1.5-6.8) and the multivariate OR was 3.0 (95% CI: 1.3-6.5), both with a p-value of less than 0.01. Conclusion: Intraoperative hypothermia significantly increases the risk of postoperative infections in patients undergoing implant-based breast reconstruction. Effective temperature management strategies, such as preoperative warming and the use of intraoperative warming devices, are crucial to reducing infection rates and improving surgical outcomes

Albumin reprograms the B cell transcriptional landscape and improves neutrophil antimicrobial function in patients with decompensated cirrhosis

Background&AimPatients with acutely decompensated (AD) cirrhosis are immunocompromised and particularly susceptible to infections. This study investigated the immunomodulatory actions of albumin by which this protein may lower the incidence of infections. MethodsBlood immunophenotyping was performed in 11 AD patients and 10 healthy volunteers (HV). Bulk and single-cell (sc) RNA sequencing (RNA-seq) and flow cytometry were performed in peripheral blood mononuclear cells (PBMCs) from 20 AD patients and 34 HV exposed to albumin. Albumin’s effects on degranulation, phagocytosis, chemotaxis, and swarming of neutrophils from 6 AD patients and 9 HV were assessed by myeloperoxidase enzymatic activity, engulfment of fluorescent-labeled Escherichia coli and zymosan and interactions at single-cell resolution of neutrophils with Candida albicans in microfluidic chambers, respectively. Whole blood RNA-seq analyses were performed in 45 patients admitted for severe AD of whom 30 received albumin during hospitalization. ResultsCompared to HV, AD patients showed severe lymphopenia and defective neutrophil anti-microbial function. Bulk and scRNA-seq analyses revealed significantly (false discovery rate (FDR)<0.05) increased signatures related to B cells, myeloid cells and CD4+ T cells in PBMCs incubated with albumin. Changes in the B cell population were confirmed by flow cytometry. Neutrophils exposed to albumin also exhibited augmented chemotactic and degranulation responses, enhanced phagocytosis, and increased pathogen-restrictive swarming. Analysis of RNA-seq data in patients who had received albumin revealed specific upregulation of signatures related to B cells and neutrophils together with transcriptional changes in CD4+ T cells (FDR<0.05). ConclusionsThe finding that albumin promotes the transcriptional reprogramming and expansion of the B cell compartment and improves neutrophil antimicrobial functions indicates mechanisms that may lower the incidence of infections in patients with severe AD receiving albumin therapy.

Application and Prognostic Analysis of Vacuum Sealing Drainage in the Incision Infection in Patients With Stage II-III Colorectal Cancer.

This study aims to explore the application value of vacuum sealing drainage (VSD) technology in the treatment of incision infection dehiscence after surgery in patients with stage II-III colorectal cancer and analyze its impact on prognosis. This retrospective study included patients who experienced incision infection dehiscence after surgery for colorectal cancer between February 2014 and August 2019. Clinical and pathological data, short-term outcomes, and long-term outcomes were compared between the traditional group and the VSD group. A total of 97 patients were included in this study. There was no significant difference in clinical and pathological data between the traditional group and the VSD group (P > 0.05). The VSD group had fewer dressing changes, lower pain scores during dressing changes, and better granulation tissue growth grading than the traditional group, with statistical significance (P < 0.05). The VSD group started adjuvant chemotherapy earlier and had a higher proportion of ≥4 cycles of chemotherapy. The three-year overall survival rate in the VSD group was better than the traditional group, but the difference was not statistically significant (P > 0.05). The application of VSD technology can promote granulation tissue growth, accelerate incision healing, and facilitate patients to complete subsequent adjuvant chemotherapy. However, further verification of its long-term impact on prognosis requires longer-term follow-up results.

Characteristics and incidence of infections in patients with multiple myeloma treated by bispecific antibodies

Characteristics and incidence of infections in patients with multiple myeloma treated by bispecific antibodies

Diagnostic value of procalcitonin in infections in patients with malignant hematologic diseases.

The incidence of infections in patients with malignant hematologic diseases is extremely high and significantly affects their prognosis. Identifying early and precise biomarkers for infection is crucial for guiding the treatment of infections in these patients. Previous studies have shown that procalcitonin (PCT) can serve as an early diagnostic marker for bloodstream infections in patients with malignant hematologic diseases. This study aims to compare serum PCT levels in these patients with different pathogens, disease types, infection sites, and severity levels. Clinical data and laboratory results of infected patients with malignant hematologic diseases treated at the Department of Hematology, the Third Xiangya Hospital of Central South University from January 2018 to August 2023 were collected. General patient information was retrospectively analyzed. Serum PCT levels were compared among patients with different pathogens, types of malignant hematologic diseases, infection sites, and infection severity; Receiver operator characteristic (ROC) curves were used to determine the cut-off values and diagnostic value of serum PCT levels in diagnosing bloodstream infections versus local infections and severe infections versus non-severe infections. Mortality rates after 4-7 days of anti-infective treatment were compared among groups with rising, falling, and unchanged PCT levels. A total of 526 patients with malignant hematologic diseases were included. The main pathogens were Gram-negative bacteria (272 cases, 51.7%), followed by Gram-positive bacteria (120 cases, 22.8%), fungi (65 cases, 12.4%), viruses (23 cases, 4.4%), and mixed pathogens (46 cases, 8.7%). The main types of malignant hematologic diseases were acute myeloid leukemia (216 cases, 41.1%), acute lymphoblastic leukemia (107 cases, 20.3%), and lymphoma (93 cases, 17.7%). Granulocyte deficiency was present in 68.3% (359 cases) of the patients during infection, with severe infection in 24.1% (127 cases). Significant differences in serum PCT levels were found among patients with different types of pathogens (P<0.001), with the highest levels in Gram-negative bacterial infections. Significant differences in serum PCT levels were also found among patients with different types of malignant hematologic diseases (P<0.05), with the highest levels in lymphoma patients. Serum PCT levels were significantly higher in systemic infections and severe infections compared to local infections and non-severe infections (both P<0.001). ROC curve analysis showed that the cut-off values for diagnosing bloodstream infections and severe infections were 0.22 and 0.28 ng/mL, with areas under the curve of 0.670 and 0.673, respectively. After 4-7 days of anti-infective treatment, the mortality rates of the PCT declining, PCT unchanged, and PCT rising groups were 11.9%, 21.2%, and 35.7%, respectively, and pairwise comparisons were statistically significant (all P<0.05). PCT can be used as an auxiliary indicator for early identification of different pathogens, infection sites, and severity levels in patients with malignant hematologic diseases combined with infections. Dynamic monitoring of PCT levels after empirical antibiotic treatment provides important guidance for assessing patient's prognosis.

Association between serum IgG concentrations and the incidence of infections in patients with chronic lymphocytic leukemia and secondary immunodeficiency under treatment with Privigen.

To investigate the association between serum immunoglobulin G (IgG) concentrations and the incidence of infections in patients with chronic lymphocytic leukemia (CLL) and secondary immunodeficiency receiving treatment with Privigen. Data was analyzed from a non-interventional study conducted in 31 centers in Germany and 1 in Austria. Adult CLL patients with hypogammaglobulinemia and recurrent infections were allowed to enter the study upon signing informed consent, if a prior decision for treatment with Privigen had been made. All infections requiring an antimicrobial treatment were subject to analysis. Patients were stratified according to their mean post-baseline serum IgG trough levels in a group with lower IgG trough levels (≤ 5.0 g/L), and a group with higher IgG trough levels (> 5.0 g/L). Overall, 89 patients and 840 treatment cycles were analyzed. Up to 11 treatment cycles (average duration 29 days) were documented in each patient. In the group with higher IgG trough levels (> 5.0 g/L, N = 72), significantly fewer infections were observed than in the group with lower IgG trough levels (≤ 5.0 g/L, N = 17), including fewer severe and serious infections. The Privigen dosage was a major determinant of the post-baseline serum IgG levels. Overall tolerability of Privigen was assessed as very good or good in 91% of patients. This analysis confirms the association of serum IgG trough levels with the incidence of infections and highlights the importance of careful monitoring of IgG levels during treatment of secondary immunodeficiencies in CLL patients.

High Rate of Undetected Infections in Failed Osteosynthesis of Pertrochanteric Fractures.

The objective of this study was to assess the incidence of infection in patients with cutout after proximal femur fracture (PFF) osteosynthesis. Retrospective cohort study. Third-level trauma center. Patients presenting with a cutout following PFF (OTA/AO 31A) osteosynthesis, between January 2007 and December 2020. The primary outcome was infection according to the European Bone and Joint Infection Society criteria. Sixty-seven patients presenting with a cutout were included, with mean age of 83.3 years (range 63-96), and 51 (76.1%) were women. Of all cases, 16 (24.7%) presented a concomitant infection. The presence of concomitant infection was suspected preoperatively in only 3 of the cases. A subgroup analysis was performed between the cases with infection and those without infection, the groups being comparable in terms of demographic data and postoperative radiological criteria. Patients with underlying infection had a higher rate of surgical wound complication (56.3% vs. 22%, P = 0.014) and higher rates of leukocytosis (11.560 vs. 7.890, P = 0.023). Faced with a cutout after osteosynthesis of a PFF, underlying infection should be considered as a possible etiological factor. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Characteristics and incidence of infections in patients with multiple myeloma treated by bispecific antibodies: a national retrospective study

ObjectivesBispecific antibodies (BsAbs) are an effective treatment used in relapsed or refractory multiple myeloma. Despite a well-tolerated safety profile, infectious events appear to be frequent in clinical trials. Real-world data on epidemiology, characteristics, risk factors, and outcomes of infections in patients treated with BsAb are still needed. MethodsA retrospective, multicentre study in BsAb-treated patients with multiple myeloma was performed in 14 French centres from December 2020 to February 2023. The primary objective was to describe the incidence of infections that required hospitalization, specific treatment, or adaptation in BsAb administration. ResultsAmong 229 patients with multiple myeloma treated with BsAb, 153 (67%) received teclistamab, 47 (20%) received elranatamab, and 29 (13%) talquetamab. We reported a total of 234 infections, including 123 (53%) of grade of ≥3. Predominant infections affected the respiratory tract (n = 116, 50%) followed by bacteraemias (n = 36, 15%). The hospitalization rate was 56% (n = 131), and 20 (9%) infections resulted in death. Global cumulative incidence of the first infection was 70% in all patients, 73% in patients treated with B-cell maturation antigen-targeting, and 51% with GPRC5D-targeting BsAb. In univariate analyses, corticosteroids for cytokine release syndrome (CRS)/immune effector cell-associated neurotoxicity syndrome (ICANS) were associated with a higher risk of first infection (HR = 2.13; 95% CI, 1.38–3.28), whereas GPRC5D-targeting BsAb and anti-bacterial prophylaxis were associated with a lower risk (HR = 0.53; 95% CI, 0.3–0.94 and HR = 0.65; 95% CI, 0.46–0.9). Fine and Gray multivariate model found that only corticosteroids for CRS/ICANS were correlated with a higher risk of first infection (HR = 2.01; 95% CI, 1.27–3.19). DiscussionsThe implementation of preventive measures that aim to mitigate the risk of infection under BsAb is pivotal, notably in patients who received corticosteroids for CRS/ICANS.

INFECTIOUS COMPLICATIONS IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS AND INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Primary sclerosing cholangitis (PSC) is a cholestatic immune-mediated liver disease that can be associated with inflammatory bowel disease (IBD) in up to 80% of patients. Those with concurrent PSC-IBD exhibit a distinct disease phenotype with increased risk of complications such as malignancy and pouchitis; however, the risk of infections is not yet clearly defined in this population. AIMS The aims of this systematic review and meta-analysis are (1) to determine the incidence of infections in patients with PSC-IBD and (2) to identify risk factors for infections in this population. METHODS MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to March 24, 2022 for primary studies that reported incidence or risk factors for infection in adult and pediatric patients with PSC and IBD. Case reports and case series with less than five patients were excluded, as were any studies where infection rates in PSC-IBD patients could not be separated from those with PSC or IBD alone. The primary outcome of this study was incidence of all-cause infections including bacterial, viral, or fungal infections, and sepsis. The secondary outcomes included incidence of site-specific infections and mortality due to infection. A random-effects model was used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI) comparing incidence of all-cause infections in PSC-IBD to those with PSC alone or IBD alone. RESULTS Seventy-one studies were included. The pooled incidence of all-cause infections in patients with PSC-IBD was 21.8% (95% CI 0.17-0.26, I2=95.9%), 31.1% (95% CI 0.16-0.46, I2=93.4%) in those with PSC alone, and 4.4% (95% CI -0.01-0.10, I2=99.2%) in those with IBD alone. Patients with PSC-IBD had an over three-fold increased odds of all-cause infection compared to those with isolated IBD (OR 3.67, 95% CI 2.07-6.50). Patients with PSC-IBD were more likely to develop sepsis (OR 3.35, 95% CI 2.29-4.90) and have infections resulting in mortality (OR 11.25, 95% CI 2.03-62.37) compared to those with IBD. The most common infections in the PSC-IBD group were sepsis followed by clostridioides difficile infection. There was no significant difference in the odds of infection between patients with PSC-IBD and those with PSC alone (OR 1.21, 95% CI 0.68-2.18). However, on sub-group analysis, patients with PSC-IBD undergoing liver transplantation (LT) were more likely to develop infection post-LT compared to those with PSC alone (OR 4.86, 95% CI, 2.32-10.17), with cytomegalovirus (CMV) being the most commonly reported infection. CONCLUSION Compared to those with IBD, patients with PSC-IBD appear to be at a higher risk of infection and resultant complications such as sepsis and death. Future studies are needed to elucidate specific risk factors such as immunosuppressive therapy and disease activity.

Analysis of the effectiveness of COVID-19 coronavirus vaccination in patients with chronic heart failure at the outpatient stage of treatment

Objective. To analyze the dynamics of COVID-19 coronavirus infection incidence in patients with chronic heart failure (CHF) on the background of vaccination against SARS-CoV-2 virus, to evaluate the role of vaccination in preventing decompensation of chronic heart failure, reducing mortality, primary disability in patients with cardiovascular diseases complicated by CHF.Materials and methods. The study included 200 people who were included in the Register of patients with CHF of the State Healthcare Institution “Gomel City Clinical Polyclinic No. 5 named after S. V. Golukhova”. Patients were divided into two equal in number groups: Group 1 unvaccinated against COVID-19 coronavirus infection (n = 100) and Group 2 vaccinated patients (n = 100). The follow-up was conducted for one year (2021) in an outpatient setting.Results. The incidence rate in the group of unvaccinated patients was 3.2 times higher. The incidences of COVID-19 coronavirus infection in the two groups were 16 (16 %) and 5 (5 %), respectively (χ2 = 5.32, p = 0.0210). The incidence of hospitalization for decompensation of CHF was 3.2 times higher in the unvaccinated group than in the vaccinated group (χ2 = 14.93, p = 0.0001). Lethality among the unvaccinated was recorded 1.8 times higher than in the vaccinated group (χ2 = 2.166, p = 0.1410). When comparing the rates of primary disability due to CVD, there was a tendency for increased disability in the unvaccinated cohort (χ2 = 0.592, p = 0.4420).Conclusion. It has been established that vvaccination contributes to the reduction of hospitalization for decompensation of CHF, reducing the risk of mortality.

Antibiotic prescription pattern in pediatric intensive care unit in a tertiary care hospital: A cross-sectional study

Background: Incidence of infections in patients admitted to the Pediatric intensive care unit (PICU) is high which results in the use of antimicrobials for a prolonged duration and numbers. The rising incidence of antibiotic resistance has made it obligatory for antibiotics to be prescribed reasonably in pediatric patients. Aims and Objectives: The objective of this study was to analyze the antibiotic prescription pattern for patients admitted in pediatric intensive care unit in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted in PICU. Two hundred and seventy-five pediatric patients were incorporated in this study. The patients’ data were collected from the case sheets, recorded, and analyzed. Results: The majority (80%) of patients admitted in PICU received antibiotic(s). About 68.18% of patients were prescribed only one antibiotic. Patients in the age group of 1 m–&lt;1 year (58.18%) received more antibiotics. Pneumonia emerged to be the foremost reason for antibiotic use (45%), followed by Meningitis (14.54%). Ceftriaxone (28.27%) was the antibiotic prescribed most often. About 80.34% of antibiotics were prescribed by their generic names and 5.86% of antibiotics were prescribed as fixed-dose combinations. Conclusion: Antimicrobial resistance has become a global issue that should be tackled with extreme prudence and vigilance. This study provides insight on antibiotic prescription pattern in PICU and can prevent unnecessary use of antimicrobials.

The Efficacy of an Over-the-Counter Multivitamin and Mineral Supplement to Prevent Infections in Patients With Inflammatory Bowel Disease in Remission With Immunomodulators and/or Biological Agents: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Patients with inflammatory bowel disease (IBD) treated with immunomodulators or biologic therapy are at increased risk of infections. Malnutrition and vitamin or mineral deficiencies are common among patients with IBD. The results of various studies have indicate that vitamin deficiencies might increase the risk of infections. To evaluate the efficacy of a multivitamin and mineral supplement on the incidence of infections in patients with IBD treated with immunomodulators, biologic therapy, or combination therapy. This was a single-center, randomized, double-blind, placebo-controlled clinical trial to compare a multivitamin and mineral supplement (supplemented group) vs identical-in-appearance placebo (placebo group) in a total of 320 non-vitamin-deficient patients with IBD (Crohn's disease or ulcerative colitis) in remission with immunomodulators, biologic therapy, or combination therapy. Participants were asked to take a daily multivitamin and mineral supplement or placebo and report the occurrence of infections during a 24-week period of follow-up. Treatment arms consisted of 162 and 158 patients for the supplement and placebo, respectively. In both treatment groups, 107 patients reported an infection during the 24-week follow-up period (unadjusted odds ratio, 0.93; 95% confidence interval, 0.56-1.48). In the supplemented group, 32 patients received antibiotics for an infection compared with 21 patients in the placebo group (unadjusted odds ratio, 1.61; 95% confidence interval, 0.88-2.93). An over-the-counter multivitamin and mineral supplement did not reduce the risk of infection for patients with IBD in remission with immunomodulators, biologic therapy, or combination therapy.

Incidence of infections in patients with psoriatic arthritis and axial spondyloarthritis treated with biological or targeted disease-modifying agents: a systematic review and meta-analysis of randomised controlled trials, open-label studies and observational studies

ObjectiveTo estimate the incidence of infections among patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), two distinct phenotypes included in the large group of spondyloarthritis (SpA), treated with tumour...

Real-World Incidence and Determinants of Infection in Patients With Rheumatoid Arthritis Treated With Golimumab After a Median Follow-Up Time of 27 Months.

To characterize the long-term incidence of infection in patients with rheumatoid arthritis (RA) treated with subcutaneous golimumab (GOL) in Canadian routine care, assess the effect of infections on GOL retention, and explore factors associated with infection incidence. Patients with RA enrolled in the Biologic Treatment Registry Across Canada (BioTRAC) initiating GOL treatment were included. The incidence density rates (IDRs) of total infection (TI), serious infection (SI), and nonserious infection (NSI) were calculated for the overall follow-up (90 months) and by 6-month intervals. Determinants of infection over time or within the first 6 months were explored using generalized estimating equation models and logistic regression, respectively. Five hundred thirty patients were included; mean baseline age was 57.7 years and RA duration was 8.0 years. Over an average follow-up of 27.0 months, the IDR for TIs was 35.1 events per 100 person-years (PYs), the majority occurring during the first 6 months; IDRs for NSIs and SIs were 32.9 and 2.2 events per 100 PYs, respectively. No predictors were identified for infection incidence within 6 months. Comorbid pulmonary disease was associated with significantly higher odds of TIs and NSIs over time, whereas higher age and high corticosteroid (CS) dose (> 5 mg/day) predicted higher odds of SIs. Incidence of SIs, but not NSIs, was associated with significantly higher odds of GOL discontinuation. Long-term GOL treatment was associated with relatively low infection rates, most being nonserious and occurring during the first 6 months. Pulmonary disease, higher age, and high CS dose were identified as significant predictors of infections. SIs, but not NSIs, predicted higher odds of GOL discontinuation. (ClinicalTrials.gov: NCT00741793).

Dynamic control and timely correction of blood glucose levels in diabetic patients undergoing traumatic spinal vertebral fracture surgery to reduce surgery site infection

ObjectivesThis study was designed to clarify the impact of precise and dynamic control and timely correction of accurate blood sugar control in reducing the rate of post-spinal fracture surgery infections in impaired glucose tolerance or diabetic patients by posterior approach. MethodsIn this single-blinded clinical trial, a total of 290 patients with diabetes or impaired glucose tolerance candidate for traumatic spinal vertebral fracture by posterior approach (PSF) were randomly assigned to either a blood glucose control group (n = 145) or a control group (n = 145). The blood glucose control group received precise control of blood sugar levels before, during, and after surgery, while the control group did not. The incidence of SSI was compared between the two groups at one- and six months post-surgery using statistical tests and SPSS software version 22. ResultsBased on intergroup comparisons, the rate of infection at the site of surgery one month after spinal vertebral fracture surgery (PSF) in patients in the blood glucose control group was significantly higher than the control group (P < 0.05, 4.8%, and 11.7%). There was no significant difference between the rate of infection in the surgical site six months after spinal vertebral fracture surgery (PSF) in patients of the two groups studied (P > 0.05, 4.1%, and 4.8%). According to intragroup comparisons, there was no significant difference between the infection rate of the surgical site one month and six months after spinal vertebral fracture surgery in the patients of the blood sugar control group (P > 0.05). In patients in the control group, the infection rate at the surgery site of surgery 6 months after surgery was significantly lower than at the site of surgery one month after surgery (P < 0.05). Logistic multivariate regression analysis revealed that malnutrition variables, malignancy, duration of stay in the ICU after surgery, and blood sugar correction intervention statistically correctly contributed significantly to the classification of patients with infection and predicted the incidence of infection in Patients (P < 0.05). ConclusionAccurate and timely blood sugar control before, during, and after spinal vertebral fracture surgery by posterior approach is crucial in reducing the risk of SSI in diabetic or impaired glucose tolerance patients. The study highlights the importance of both dynamic control and timely correction of blood glucose levels, not only in the early postoperative period but also in preventing later infectious complications.

Leukocytosis and C-Reactive Protein Levels as Indicators of Infection in Children With Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is one of the serious complications of type 1 diabetes mellitus and may be aggravated by infection. Diagnosing an infection in a patient with DKA is often complicated because of the overlap of symptoms and the presence of leukocytosis in both conditions. Reliable indicators for the diagnosis of bacterial infection in DKA may reduce unnecessary use of antibiotics and enable closer monitoring of patients at risk. This is a retrospective study. The study cohort included 180 children and adolescents with type 1 diabetes mellitus who were admitted to the Pediatric Emergency Department at Shaare Zedek Medical Center and had blood test results. We compared white blood cell count, C-reactive protein (CRP) levels, blood glucose levels, pH, the degree of acidosis, and the incidence of infection in patients with and without DKA. The incidence of probable bacterial infection in the entire cohort was 13.9%: 15.7% in the DKA group and 7.5% in the non-DKA group (P = 0.65). The incidence of leukocytosis was significantly higher in patients with DKA (P = 0.0003), although this was not related to bacterial infection. The CRP levels were higher in the DKA group with infection than without infection, and this was statistically significant (P = 0.008). Our findings suggest that leukocytosis in DKA is not a reliable indicator of concomitant bacterial infection. In contrast, CRP levels were not related to the DKA or degree of acidosis and were significantly higher in patients with infection within the DKA group, and are therefore a more reliable indicator of concomitant infection in these patients.

Incidence Of Infections In Patients With Severe, Uncontrolled Asthma Treated With Tezepelumab: A Pooled Analysis Of The Phase 2b PATHWAY And Phase 3 NAVIGATOR Studies

Tezepelumab is a humanized monoclonal antibody that blocks the activity of thymic stromal lymphopoietin (TSLP), an epithelial cytokine implicated in asthma pathogenesis. This post hoc analysis describes the incidence of infection-related adverse events (AEs) in patients treated with tezepelumab, using pooled data from the phase 2b PATHWAY (NCT02054130) and phase 3 NAVIGATOR (NCT03347279) studies.

16 Spectrum of infections during juvenile idiopathic arthritis

BackgroundThe incidence of infections in patients with chronic inflammatory rheumatic disease is increased. It is often due to the disease itself and to the immunosuppressive treatments used.ObjectivesTo assess the incidence of infections during JIA.MethodsWe conducted a repeated cross-sectional study including 29 patients followed for JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period from 1994 to 2022. Sociodemographic and anthropometric parameters, clinical data, biological assessments, and prescribed therapies were collected. We identified patients who had at least one infectious episode during their follow-up.ResultsThere were 17 women and 12 men. The mean age was 35.69 ± 11.72 [18–61] years. The polyarticular form was seen in 55.2% of cases. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average disease duration was 24.48 ± 12.76 [1–47] years.Diabetes and arterial hypertension were the main comorbidities associated with JIA, observed in 13.8% of cases each. At least one extra-articular manifestation was noted in 16 cases: pulmonary (3 cases), cardiac (4 cases), renal (2 cases), cutaneous (4 cases) and ocular (7 cases).The most prescribed DMARDs was Methotrexate in 79.3% (n = 23), biotherapy was used in 3 (10.3%), NSAIDs and corticosteroids were used in 62.1% (n = 18) and 69% (n = 20) respectively.All the infections observed in our population were of community origin. Urinary tract infection was the most common infection (n = 5). Bronchopulmonary infections were observed in 2 cases including a case of tuberculosis. Sub periosteal abscess of the femur was also seen in one of the patients.Regarding the SARS-CoV-2 infection, 6 patients were infected, 2 of whom required hospitalization, including one in the intensive care.ConclusionThe risk of infections is increased during JIA. This is due to the immunosuppression induced by the disease, the treatment, and comorbidities.