Infection-related Health Care Research Articles

Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based study

Much remains unknown surrounding the disease-modifying drugs (DMDs) used to treat multiple sclerosis and infection-related healthcare use in the 'real-world' setting. We examined if DMD exposure was associated with altered infection-related healthcare use. We assessed if DMD (versus no) exposure was associated with altered infection-related hospitalizations, physician claims, and prescriptions filled in British Columbia, Canada (1996-2017). Healthcare use was assessed using negative binomial and proportional means regression models, reported as sex-/age-/comorbidity-/calendar year-/socioeconomic-adjusted rate and hazard ratios [aRR, aHR], with 95% confidence intervals [CIs]). We identified 19,360 multiple sclerosis cases (13,940/19,360; 72.0% women; mean age at study start=44.5 standard deviation, SD=13.3; mean follow-up=11.7 [SD=7.3] years). Relative to unexposed periods, exposure to any DMD was associated with a lower infection-related rate of physician claims (aRR=0.88; 95% CI:0.85-0.92) and hazard of hospitalization (aHR=0.64; 95% CI:0.56-0.73), and a higher rate of infection-related prescriptions (aRR=1.14; 95% CI:1.08-1.20). Exposure to any injectable or oral DMD was associated with a lower infection-related rate of physician claims (injectable aRR=0.88; 95% CI:0.84-0.92, oral aRR=0.83; 95% CI:0.77-0.90) and hazard of hospitalization (injectable aHR=0.65; 95% CI:0.56-0.75, oral aHR=0.54; 95% CI:0.38-0.77), whereas intravenous DMD exposure was not (aRR=0.99; 95% CI:0.86-1.14, aHR=0.73; 95% CI:0.49-1.09). Exposure to any injectable or intravenous DMD was associated with a higher rate of infection-related prescriptions (injectable aRR=1.15; 95% CI:1.08-1.22, intravenous=1.34; 95% CI:1.15-1.56), whereas oral DMDs were not (aRR=0.98; 95% CI:0.91-1.05). DMD exposure for the treatment of MS was associated with differences in infection-related healthcare use. While infection-related hospitalizations and physician visits were lower, prescription fills were higher. How these differences in infection-related healthcare use affect outcomes in persons with multiple sclerosis warrants consideration. Canadian Institutes of Health Research (CIHR); German Research Foundation (DFG).

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

765. The Burden of Illness Associated with Recurrent Clostridioides difficile Infection: A Claims-based Analysis

Abstract Background Clostridioides difficile infection (CDI) is a significant public health concern and the leading cause of infection related healthcare utilizations in adults in the United States. A considerable proportion of CDI patients suffer recurrent episodes of CDI (rCDI). The objective of this study was to describe the impact of CDI on healthcare resource utilization (HCRU) and patient burden. Methods A retrospective analysis of patients with a CDI diagnosis claim was conducted using the HealthVerity database. Continuous enrollment with medical and pharmacy benefits was required for 12 months before and after the first occurrence of CDI diagnosis (index date). Patients were stratified by total number of CDI episodes. rCDI episodes were defined as episodes that occurred within 12 weeks of the previous episode. Baseline demographics, treatment by episode, and HCRU data were captured. Results 5,964 patients with a CDI episode were identified. The average age was 56.6 years with 30.2% of the population being ≥ 65 years old. 65.7% of patients were female and 61.2% had a claim for ≥ 1 antibiotic in the 90 days leading up to the index date. Vancomycin was the predominant treatment used across all episodes (54-67%). Use of fecal microbiota transplant (FMT) increased with number of CDI episodes (12.6% for the 3rd episode; 20.7% for 5th episode). Fidaxomicin was used for initial CDI treatment in 7.5% of cases. Prior to the initial CDI episode, 24% of patients had ≥ 1 emergency department (ED) visit, 64% had an outpatient office visit and 49% had an inpatient admission due to any cause. In the post-index period, 73% of patients experienced ≥ 1 ED visits, 95% had an outpatient office visit and 72% were admitted to the hospital for any cause. As the number of CDI episodes increased, the number of ED visits, inpatient admissions and ICU admissions trended upwards. Conclusion Results from this observational analysis suggest that the presence of CDI seems to lead to a considerable increase in HCRU after the initial episode. Despite variation in treatment patterns by episode, some HCRU seems to increase with additional episodes. Disclosures Rachel M. Black, PharmD, Seres Therapeutics (Consultant) Richard Stanford, PharmD, MS, AbbVie (Consultant)Sanofi-Genzyme (Consultant)Seres Therapeutics (Consultant) Dan Gratie, PharmD, MS, Seres Therapeutics (Consultant)

A case series and literature review of multiple sclerosis and COVID-19: Clinical characteristics, outcomes and a brief review of immunotherapies.

Background:In view of the emerging coronavirus pandemic, the demand for knowledge about the impact of SARS-CoV-2 on people with Multiple Sclerosis (MS) continues to grow. Patients receiving disease modifying therapy (DMT) for MS have a higher background risk of infection-related health care utilization when compared to the general population. Therefore, there is a need of evidence-based recommendations to reduce the risk of infection and also managing MS patients with SARS-CoV-2.Case Description:We present three patients with history of Multiple Sclerosis (MS) on DMTs presenting with worsening MS symptoms likely pseudo exacerbation who were diagnosed with COVID-19.Discussion:An extensive review of 7 articles was performed, in addition to a brief review on DMTs use in MS patients with COVID-19. In our cases, all patients were on DMT and severe course of disease was noted in 2 cases. No fatality was observed.Conclusions:This review provides a base on the clinical characteristics, outcomes and the roles of DMTs in MS patients suffering from n-cov-2. Physicians need to be vigilant about considering COVID-19 infection related relapse in the MS patients, especially in this COVID-19 pandemic era and look for pseudo-exacerbation. As most cases are found to have mild course and full recovery on DMTs, further research is needed to formulate evidence-based guidelines. This review will particularly be helpful for the researchers and registries to collect future data on MS and COVID-19.

Respiratory tract infection-related healthcare utilisation in children with Down\u2019s syndrome

PurposeChildren with Down’s syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS.MethodsRetrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank–sum test was used to compare length of stay by RTI type and time-to-hospitalisation.ResultsRTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62–1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82–6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19–2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls.ConclusionsChildren with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group.

Infection-related health care utilization among people with and without multiple sclerosis

Background: Little is known about infection risk in multiple sclerosis (MS). Objective: We examined infection-related health care utilization in people with and without MS. Methods: Using population-based health administrative data from British Columbia, Canada, people with MS were followed from their first demyelinating claim (1996–2013) until death, emigration, or study end (2013). Infection-related hospital, physician, and prescription data of MS cases were compared with sex-, age-, and geographically matched controls using adjusted regression models. Sex and age differences (18–39, 40–49, 50–59, 60+ years) were explored. Results: Relative to 35,837 controls, 7179 MS cases were over twice as likely to be hospitalized for infection (adjusted odds ratio: 2.39; 95% confidence interval (CI): 2.16–2.65), had 41% more physician visits (adjusted rate ratio (aRR): 1.41; 95% CI: 1.36–1.47), and filled 57% more infection-related prescriptions (aRR: 1.57; 95% CI: 1.49–1.65). Utilization was disproportionately higher in MS men than women and was elevated across all ages. MS cases had nearly twice as many physician visits and two to three times more hospitalizations for pneumonia, urinary system infections, and skin infections (aRRs ranged from 1.6 to 3.3) and over twice as many hospitalizations for intestinal infections (aRR = 2.6) and sepsis (aRR = 2.2). Conclusion: Infection-related health care utilization was increased in people with MS across all age groups, with a higher burden for men.

Avaliação da Qualidade do Processo de Desinfecção em Superfícies Inanimadas de Unidades Básicas de Saúde por Pesquisa de Biomarcadores

A Infecção Relacionada à Assistência à Saúde – IRAS pode ocorrer pela transmissão exógena por meio da contaminação de superfícies contaminadas. A presente pesquisa teve como objetivo verificar a qualidade do processo de desinfecção de superfícies inanimadas de Unidades Básicas de Saúde – UBS de um município do noroeste paulista, através da presença de Staphylococcus aureus e Escherichia coli. Foram avaliadas sete UBSs, em horários e dias aleatórios, abrangendo as seguintes superfícies: maçaneta da sala de curativos, torneiras e bebedouros, mesa do consultório, guichê da recepção. Swabs estéreis foram friccionados em 20 cm2 das superfícies e transportados em meio Stuart ao Laboratório Didático de Análises Clínicas do UNIFEV. As amostras foram cultivadas em Ágar Sangue e MacConkey, a 35±1oC por 24 horas, em jarra de microaerofilia e aerobiose, respectivamente. O Staphylococcus aureus foi identificado por meio da produção de hemolysin, catalalase and coagulase. Já a Escherichia coli, via os seguintes testes bioquímicos: TSI,citrato urease, indole, lysine, ornithine and arginina. Das 105 amostras analisadas, 6,66% apresentaram positivas para S. aureus e 2,85% para E. coli. As superfícies que apresentaram a presença dos bioindicadores foram: o guichê da recepção, guichê da farmácia, maçaneta da sala de curativos, torneira da sala de curativos e bebedouro. Esses resultados corroboram outros estudos que demonstram que as superfícies inanimadas são importantes fontes de contaminação no ambiente de assistência à saúde, contribuindo com a contaminação cruzada e, consequentemente, com o aumento de infecção ao paciente que está sujeito aos procedimentos nesse contexto. Dentro desse contexto, o poder público, através das políticas públicas de saúde, é responsável pela capacitação dos profissionais da saúde, contribuindo na promoção e prevenção da saúde coletiva.

Disparities in Health Services for HIV/AIDS, Hepatitis C Virus, and Sexually Transmitted Infections: Role of Substance Abuse Treatment Programs

This report focused upon the availability of infection-related health services in substance abuse treatment programs with and without addiction services tailored for special populations (women and non-white populations). In a cross-sectional, descriptive design, treatment program administrators across the United States within the National Drug Abuse Treatment Clinical Trials Network provided information on program characteristics, the availability of infection-related services (four medical services and three non-medical services for HIV, HCV, and STI), and barriers to providing infection-related services. Of 319 programs, 269 submitted surveys (84% response rate). Of these, 80% provided addiction services for special populations. Programs providing addiction services designed for at least one special population, were more likely to provide infection-related health services, especially HIV-related education (94% versus 85%, p = 0.05) and patient counseling (76% versus 60%, p = 0.03) and were more likely to include outpatient addiction services (86% versus 57%, p<0.001) and outreach and support services (92% versus 70%, p=0.01). Barriers to providing infection-related services included funding (cited by 48.3% to 74.7% of programs), health insurance (cited by 28.9% to 60.8% of programs), and patient acceptance (cited by 23.2% to 54.3% of programs). Despite many barriers, infection-related healthcare is available in programs with addiction treatment services tailored for special populations, especially for African Americans and Latino Americans. Tailoring substance abuse treatment along with reducing barriers to infection-related care represent public health interventions with potential to reduce the burdens and disparities associated with these infections.

Effect of Prophylactic Fluconazole on the Frequency of Fungal Infections, Amphotericin B Use, and Health Care Costs in Patients Undergoing Intensive Chemotherapy for Hematologic Neoplasias

Fungal infections are a major problem in patients with hematologic malignancy. Attempts to reduce their frequency with antifungal agents have not been successful. A double-blind, controlled, single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy. Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions. End points were amphotericin B use, fungal infection, stable neutrophil count > 0.5 x 10(9)/L, toxicity precluding further fluconazole use, and death. By Kaplan-Meier estimation, the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole (P = .003). Also, fluconazole reduced the number of febrile days by 20% (P = .002) and prevented oropharyngeal candidiasis (1/75 vs. 9/76, P = .018). The frequency of deep mycoses (8/76 vs. 8/75) and outcome were unaffected. Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia (P = .01).