Infectious Disease Service Research Articles

1853. Relevance of Actinomyces Bacteremia

Abstract Background Actinomyces species are Gram-positive anaerobic bacilli colonizing the human oropharynx, gastrointestinal tract, and urogenital tract asso­ciated with a wide range of infections. The isolation of Actinomyces spp. from sterile clinical samples is regarded as significant. We reviewed the risk factors, clinical features, and outcomes in patients with Actinomyces bacteremia. Methods We conducted a retrospective study of all inpatients with Actinomyces bacteremia from two tertiary care centers from 1/1/06 -9 /26/19 . Data were collected on demographic and clinical characteristics, co-morbidities, primary source of infection, treatment received and duration of therapy and outcomes. True bacteremia was defined as Actinomyces bacteremia with systemic manifestations of infection. Results A total of 82 cases of positive blood cultures were identified of which 33 were true bacteremia, based on clinical criteria among 19 females and 14 males ranging from 19-93 years (63.8 ±19.5). Majority of patients were blacks (70%). Clinical risk factors predominantly were diabetes mellitus (21%), chronic renal failure (18%) and active malignancy (12%). Majority of blood cultures were positive within 48 hrs. of admission 84.8%. Skin and soft tissue (27%) was the most common source followed by respiratory (15%), intrabdominal (15%), osteomyelitis (12%), odontogenic (6%), endovascular (6%) genitourinary (3%) and unknown source (16%). In 27 (81%) cases, bacteremia was isolated to species level: A.meyeri 8 (30%), A.odontolyticus 7 (26%), A.israelli 7 (26%), A.turicensis 4 (15%) and A.neuii 1 (4%). The infectious diseases service was consulted in 20 cases of true bacteremia. Duration of antibiotics ranged between 0-84 days (17.6 ±20.7). All-cause mortality during hospitalization was 24% (8). Conclusion Not all Actinomyces bacteremia may be relevant and can represent transient bacteremia. Better awareness and involvement of infectious disease service is recommended in understanding of the clinical significance, to ensure appropriate therapy for patients thereby implementing antibiotic stewardship to improve antibiotic use and, patient safety and improve outcomes. Further research will help to identify the true significance of these isolates. Disclosures All Authors: No reported disclosures.

164. BioFire FilmArray Pneumonia Panel Implementation: Examining Appropriate Usage and Opportunities for Diagnostic Stewardship

Abstract Background The BioFire FilmArray Pneumonia Panel (PnaP) is a novel diagnostic tool for rapid diagnosis of lower respiratory tract infections. However, appropriate usage and optimal implementation strategy in the clinical setting remain poorly characterized. The PnaP assay was introduced along with institutional guidance restricting use to intensive care units (ICUs) and Infectious Disease and Pulmonary consultative services. Examining guideline compliance and clinically appropriate PnaP usage highlights the role of diagnostic stewardship in improving management of pneumonia in hospitalized patients. Methods PnaP testing was obtained retrospectively from hospitalized adults over a 6-month period (January 1 - June 30, 2021). Outpatient and pediatric (< 18 years of age) testing was excluded. Appropriate use criteria based on institutional guidance are defined in Figure 1. Primary outcomes included PnaP results with respect to utilization appropriateness. Statistical analyses included chi squared testing with p-value < 0.05 considered statistically significant. Results PnaP testing was performed on 574 respiratory samples from 440 patients (Table 1). Overall compliance with institutional guidance was 84% (n=482/574) but varied with respect to level of care (ICU 89% vs non-ICU 72%, p < 0.001) and location (Table 2). Repeated testing was the most common reason for non-compliance, accounting for 59% of inappropriate use. Positivity rates varied significantly respect to guideline compliance and level of care, with distinct pathogen isolation profiles seen among ICU and non-ICU patients. Pathogen isolations was not significantly impacted by respiratory sample type (Table 3). Conclusion Multiplex panels can isolate significant more pathogens compared to traditional diagnostic testing, with the potential to identify additional variables that factor into pneumonia pathology. PnaP assay results and appropriateness of use appear intertwined, with criteria compliance significantly impacting positivity rates, with distinct pathogens isolated among ICU and non-ICU patient groups. Our study highlights specific target areas for intervention, with the potential to promote clinically appropriate diagnostic testing by adjusting ordering restrictions at our hospital. Disclosures Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant.

Unilateral neuroretinitis as manifestation of syphilitic disease

AbstractPurpose: Syphilis is a systemic sexually transmitted disease caused by the spirochete Treponema Pallidum. Ocular symptoms indicate neurological compromise, corresponding to 5%–8% of syphilis cases. The clinic is varied and involvement of practically any of the ocular structures has been described. The most frequent presentation is uveitis, which can be posterior, intermediate, anterior or panuveitis, unilateral or bilateral, granulomatous or not. It is responsible for 1%–2% of uveitis cases. This clinical experience aims to reinforce the existence of this entity and the importance of early treatment and adequate control of symptoms.Methods: A 35‐year‐old man presented blurred vision in the left eye of sudden onset of 2 days of evolution. On examination, visual acuity of right eye 1.0 and left eye 0.05 according to decimal scale. Biomicroscopy shows Tyndall, without retrokeratic precipitates or synechiae. Transparent cornea and isochoric normoreactive pupils. The eye fundus shows obliterated papillae with fibrinoid‐like material, vasculitis, scattered haemorrhages and macular folds. Right eye without alterations. He reports the possibility of a risky sexual relationship. In serological tests, IgM for Syphilis is detected. He is admitted to the Infectious Diseases service for intravenous treatment with Benzylpenicillin 4 million Ul/ 4H.Results: One month later, inflammation of the anterior pole has disappeared, but the fundus shows persistent neuroretinitis with edema of the optic nerve, macular star exudates and a focus of vasculitis in the superior temporal artery. Ozurdex is indicated. One month later, he shows visual acuity of 1 in left eye, and reduced inflammation of the optic nerve, exudates and haemorrhages.Conclusions: Ocular syphilis is an entity that is still present, as well as the importance of actively searching for it. It is a potentially serious disease that affects young adults, with a good response to treatment if the diagnosis is made early.

A Case Report on a Chemotherapy Treatment to a SARSCOV2 PCR Positive, Non-Hodgkins Lymphoma Filipino Patient

SARSCOV2 causing the COVID-19 infection has spread to a pandemic scale and putting the vulnerable population at risk of infection such as those with malignancies. Cancer treatment remains to be controversial in this time of pandemic such that recommendations were either delay treatment, reduce hospital exposure, or to balance the risk of disease progression(e.g. malignancy) and acquiring the disease (COVID-19). Information on COVID-19 positive cancer patients receiving chemotherapy remains to be limited. Thus, this case is reported. The case is a 64 year old male, newly diagnosed, Non-Hodgkins lymphoma who presented with severe anemia and weight loss. He was diagnosed through the bone marrow findings of CD20, Ki67, BCL2 positive B cell Non-Hodgkins lymphoma, NOS. He underwent induction chemotherapy with Prednisone, Cyclophosphamide and Vincristine. Thereafter he diagnosed to have COVID-19 infection, moderate. He remained to be PCR positive but with noted negative IgM Antibody. He showed signs of worsening anemia thus was given succeeding chemotherapy while admitted in the COVID unit of the hospital. Malignancy in general poses greater risk of severe infection with COVID-19 and possibly a worse outcome.8 The decision to proceed with chemotherapy treatment at the time when cases in the Philippines were not clear due to few testing capacity in the different institutions was based on the symptomatic persistence of severe anemia and weight loss as well as reduction in the functional capacity of the patient. The focus of efforts of oncologists and hematologists as recommended by their respective societies was on the reduction of the possibility of acquiring COVID-19 infection. There is paucity of data among those patients who have been diagnosed with COVID-19 and was given chemotherapy. Although, several studies have shown that among patients with COVID-19 and cancer as co-morbidity, the mortality can reach as high as 21% to 33% or can present with severe type of infection. Recommendations given by National Cancer Center Network(NCCN), American Society of Clinical Oncology(ASCO), European Society for Medical Oncology(ESMO, National Institute for Health and Care Excellence(NICE), World Health Organization(WHO), and Center for Disease Control(CDC) consistently revolve around the shifting of follow-up consults via teleconsultation to reduce travel to the hospital, delay or reduction of immunosuppressive treatments if possible, careful and holistic, multidisciplinary individualized approach in chemotherapeutic treatment, and withholding chemotherapy once positive with SARSCOV2 PCR positive test. In this case, the patient remained to be asymptomatic, non-oxygen requiring but remained to be positive on his 3rd PCR test done (20 days from initial positive test). The infectious disease service considered this as a false positive test and only a reflection of SARSCOV2 RNA remnants in the patient's upper airway. The clinical presentation of this cancer patient to the COVID infection is contradictory to those seen in most studies reviewed. Based on the limited knowledge on the pathophysiology of COVID-19, hyperinflammatory response occur in a robust immune system that causes Systemic inflammatory response syndrome(SIRS) and cytokine storm or hypoinflammatory response leading to multiple secondary bacterial infection.10 But neither was seen in this case. It is therefore possible that details of the mechanism of COVID-19 infection and its association with co-morbidities (malignancy) to severity are yet to be elucidated. All of the knowledge that is learned in this time of pandemic stems from a continuous trial and error efforts of clinicians who, through a sound theoretical foundation, first hand clinical experience and outcome endlessly refine approaches to produce the best outcome for those who are infected with the virus, most importantly, to the vulnerable population, such as those who is burdened by malignancies and COVID-19 infection. The treatment of COVID-19 positive patients with hematologic malignancy should be individualized and should focus on the balance between disease severity and risk of worsening COVID-19 infection.

A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals.

Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2-31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5-8] days vs 5 [3-7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01-0.98). An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs.

S2600 Gastric Mucormycosis: A Case of a Rare Infectious Cause of Upper GI Bleeding

Introduction: Gastric mucormycosis is a rare clinical entity that mandates upper endoscopic evaluation and specific histopathologic findings for a diagnosis. Due to its non-specific clinical presentation, it poses a diagnostic challenge for providers. We present a case of gastric mucormycosis in a critically ill and immunosuppressed patient that was discovered in the setting of evaluation of upper gastrointestinal bleeding. Case Description/Methods: A 66-year-old man with a history of a kidney transplant two years prior, with a recent diagnosis of post-transplant lymphoproliferative disorder (PTLD) and who had recently undergone an initial round of R-CHOP chemotherapy four weeks prior was admitted to the hospital with altered mentation and neutropenia. His hospital course was prolonged with multiple cardiac arrests in the setting of septic shock from his profound neutropenia. He was noted to have dark blood from his nasogastric tube and a concomitant drop in his hemoglobin, for which the Gastroenterology service was consulted. He underwent urgent upper endoscopic evaluation and was found to have both significant clot in his stomach and an ulcerated fungating lesion along the greater curvature of the stomach which was biopsied. Pathology results showed fungal organisms with special GMS stain showing morphologic features consistent with mucormycosis. The Infectious Diseases service was urgently consulted and he was started on triple anti-fungal therapy with amphotericin, micafungin and posaconazole. Otolaryngology evaluated the patient due to these endoscopic findings, with laryngoscopy negative for head and neck involvement of this infection. Surgery was consulted for evaluation of subtotal gastrectomy, but he was deemed an unsuitable surgical candidate. The patient eventually succumbed to this and passed away during his hospitalization. Discussion: Gastric mucormycosis is a rare infection that often manifests in the setting of immunosuppression as seen in solid organ transplant recipients or in patients with diabetes. The most often clinical manifestation is upper gastrointestinal bleeding, and thus endoscopic evaluation is part of the work-up to exclude other diseases that could mimic its presentation. This diagnosis often results in fatal outcomes, so early recognition is critical for both medical management with anti-fungal therapy, along with surgical management given the high failure rate of medical management alone for this diagnosis.

Multi-year comparison of VITEK® MS and 16S rRNA gene sequencing performance for the identification of rarely encountered anaerobes causing invasive human infections in a large Canadian region: can our laboratory abandon 16S rRNA gene sequencing?

BackgroundOur large regional laboratory routinely provides a definitive identification (ID) for 800-1,200 anaerobic bacteria per annum that cause invasive human infections. An increasing number of isolates (i.e., 10 to 13%) recovered from clinical specimens from these cases were more unusual or rarely isolated genera and/or species (i.e., ≤5 individual cases/annum). MethodsVITEK® MS (MALDI-TOF MS) is done initially on all anaerobic bacteria, but rare isolates undergo in-house PCR/sequencing when proteomics provides a wrong ID or no results despite repeat testing. A clinical microbiologist in consultation with the Infectious Diseases service approves molecular analyses. This multi-year comparison (2014-19) of the performance of MALDI-TOF MS and 16S rRNA gene sequencing using the IDNS® SmartGene bacterial dataset shows both method's abilities to provide a genus-level and/or species-level ID for rare isolates. Results489 rare anaerobes were recovered from a variety of clinical specimens: 57% blood cultures, 19% other sterile fluids, 14% sterile tissues, 8% deep wounds/abscesses, and 2% prosthetic implants. 16S rRNA gene sequencing gave an accurate genus-vs. species level ID for 487/489 (99.6%) and 401/489 (82.0%) of isolates respectively. Accurate genus-vs species-level ID were obtained by MALDI-TOF MS for 269/489 (53.4%) and 187/489 (37.3%) of isolates respectively. MALDI-TOF MS gave wrong or no results for 35.1% of Gram-negative anaerobic cocci (GNAC), 62% of Gram-negative anaerobic bacilli (GNAB), 30.8% of Gram-positive anaerobic cocci (GPAC) and 46.3% of Gram-positive anaerobic bacilli (GPAB). Neither method gave an ID for one GNAB and one GPAC isolate. MALDI-TOF MS genus-level ID of GNAC and genus/species-level ID of GPAB improved during the study but its performance remained stable for genus- or species-level ID of other organism groups. ConclusionsMALDI-TOF MS provides accurate ID for most common anaerobes, but molecular analyses need to be available for rare isolates. Large complex laboratories should have a workflow for sending rare isolates for 16S rRNA gene sequencing in invasive cases where a definitive ID is clinically required.

Social determinants of health and the double burden of disease in Nepal: a secondary analysis

BackgroundAs the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal’s health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal.MethodsThis is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden.ResultsThe ‘high-burden’ combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94–5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05–51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22–0.47]) and lower indigenous population (adjOR0.20[95%CI0.06–0.65]) compared to the ‘low-burden’ category on multivariable analysis. ‘High-burden’ of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45–2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74–8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83–1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18–0.001]), indigenous population (adjOR0.32[95%CI0.11–0.91]), average people per household (adjOR0.44[95%CI0.26–0.73]) and households with no piped water (adjOR0.21[95%CI0.09–0.49]), compared to the ‘low-burden’ category on adjusted analysis. ‘High burden’ of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05–6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25–1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85–82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29–1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20–0.79]) (‘moderate-burden’ category only) compared to ‘low-burden’.ConclusionsWhile this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal.

INTRAORAL TUBERCULOSIS CLINICALLY MIMICKING MALIGNANCY: CASE REPORT

Tuberculosis (TB) is a chronic granulomatous disease caused by <i>Mycobacterium tuberculosis</i> infection, classified clinically as pulmonary and extrapulmonary disease, depending on the involved area. Oral manifestations by TB are uncommon, and when they occur, they usually present as superficial ulcers, patches, papillomatous lesions, or indurated soft tissue lesions. A 52-year-old man was referred for management of asymptomatic ulcerated lesion on the palate with 6-month of evolution. The main clinical differential diagnosis was squamous cell carcinoma. An incisional biopsy was performed and microscopic analysis showed intense chronic granulomatous inflammation with the presence of epithelioid cells and multinucleated giant cells, permeated by areas of necrosis. Histochemical analysis showed negativity for PAS and Grocott-Gomori and Warthin-Starry stains. However, Ziehl-Neelsen stain revealed the presence of mycobacteria. The diagnosis of TB was established, and the patient was referred to the service of infectious diseases. Although rare, TB should be included in the differential diagnosis of oral ulcers.

Editorial introductions.

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned to a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Genovefa A. PapanicolaouGenovefa A. PapanicolaouDr Genovefa A. Papanicolaou is the Director of Clinical Trials in the Infectious Disease Service at Memorial Sloan Kettering Cancer Center and Professor at Weill Cornell Medical College of Cornell University in New York, USA. Dr Papanicolaou is the current Chair of the Infectious Disease special Interest Group (ID-SIG) of the American Society for Transplantation and Cellular Therapy (ASTCT). Her research focuses on viral infections after stem cell transplantation and particularly cytomegalovirus (CMV). Her areas of interest are novel therapeutics, biomarkers and personalized infection management. Dionysios NeofytosDionysios NeofytosDionysios Neofytos is an Infectious Disease specialist with expertise in infectious disease complications in patients with hematologic malignancies and bone marrow and solid organ transplant recipients. Since the completion of his training in Infectious Diseases at Thomas Jefferson University Hospital in Philadelphia, PA, USA, in 2006 he has joined the Faculty and worked as an attending physician with the Transplant Infectious Disease Services at the Johns Hopkins University in Baltimore, MD, USA, and the Memorial Sloan Kettering Cancer Center in New York, NY, USA. Since 2016, he joined the Division f Infectious Diseases at the University Hospital of Geneva, in Geneva, Switzerland. His research and area of expertise are focusing on the epidemiology, diagnosis and management of viral and invasive fungal infections in immunocompromised hosts. Trish M. PerlTrish M. PerlTrish M. Perl, MD, MSc, is the H. Ben and Isabelle T. Decherd Chair in Internal Medicine (Infectious Diseases and Geographic Medicine) at UT Southwestern Medical Center in Dallas TX, USA. Dr Perl received her Medical Degree from the University of North Carolina (Chapel Hill), USA, and a Master of Science from McGill University in Montreal, Canada. She trained in Internal Medicine at the Royal Victoria Hospital and in Infectious Diseases and Clinical Epidemiology at the University of Iowa, USA. She rose through the ranks to Professor of Medicine at Johns Hopkins University School of Medicine, USA, and Epidemiology at the Bloomberg School of Public Health and is recognized globally for her innovation and research in healthcare associated infections, antimicrobial resistance, and their transmission and prevention. As the Hospital Epidemiologist at Johns Hopkins Hospital and Health System Epidemiologist, she developed extensive practical and research experience. Internationally, she has helped with outbreak management and mitigation including SARS, MERS CoV, Ebola and consults on guideline development and strategies to prevent emerging threats in healthcare. She is actively involved in monitoring the COVID-19 pandemic and supporting the national and local response.

Effect of the Pneumococcal Conjugated Vaccines on Burden of all Cause Pneumonia, Bacterial Pneumonia and Empyema in Children

The aim of this single-center retrospective study was to determine the changes in the burden of allcause pneumonia, bacterial pneumonia and empyema in children aged 0-18 years after the availability of 7-valent pneumococcal conjugated vaccine (PCV7) and 13-valent pneumococcal conjugated vaccine (PCV13) in our country. Children aged 0-18 years who were hospitalized with the diagnosis of pneumonia and treated in Ankara between January 1, 2006 and December 30, 2019 were included in the study. The burden of disease according to the years was calculated as follows: after determining the number of patients with all-cause pneumonia, bacterial pneumonia and the empyema who were admitted to the pediatric infectious diseases service, we divided those numbers to admission numbers to all outpatient clinics in that year as the ratio in 100 000. The years 2006-2007 were accepted as pre-vaccine period, 2009-2010 as PCV7 period and 2012-2019 as PCV13 period. As 2008 and 2011 were the years when PCV7 and PCV13 vaccines implemented into the routine vaccination schedule, they were accepted as transition years and the patient data from these years were not used. All of the patients data were obtained from the patient files. There was a significant decrease in the disease burden of all-cause pneumonia in 0-18 years age and 0-24 months age group after PCV13 period compared to PCV7 period (p<0.001 and p<0.001). A statistically significant decrease was found in all-cause pneumonia among children older than 60 months after PCV13 period compared to PCV7 period and pre-vaccine period (p<0.05 and p<0.01, respectively). When pre-PCV13 (PCV7 and pre-vaccine periods together) and post-PCV13 periods were compared; in 0-18 years age, 0-24 months age and 24-60 months age groups, there was a significant decrease in the burden of disease due to all-cause pneumonia after PCV13 (p<0.001, p<0.001 and p<0.05) period. When the bacterial pneumonia disease burden in PCV13 period was evaluated, bacterial pneumonia disease burden in 0-18 years and 0-24 months age group was found to be significantly lower than in both pre-vaccine and PCV7 periods (p<0.001 and p<0.001). After PCV13 vaccine, the disease burden due to bacterial pneumonia was found to be significantly lower in 0-18 years age, 0-24 months age and older than 60 months age groups compared to pre-PCV13 period (p<0.001, p<0.001 and p<0.01). When PCV7 and PCV13 periods were compared in 0-18 years age group, a significant decrease was found in hospitalizations due to empyema after PCV13 (p<0.05). In conclusion, PCV7 and PCV13 led to a significant reduction in the incidence of all-cause pneumonia and bacterial pneumonia in children.

Integrated use of laboratory services for multiple infectious diseases in the WHO European Region during the COVID-19 pandemic and beyond.

Technical advances in diagnostic techniques have permitted the possibility of multi-disease-based approaches for diagnosis and treatment monitoring of several infectious diseases, including tuberculosis (TB), human immunodeficiency virus (HIV), viral hepatitis and sexually transmitted infections (STI). However, in many countries, diagnosis and monitoring, as well as disease response programs, still operate as vertical systems, potentially causing delay in diagnosis and burden to patients and preventing the optimal use of available resources. With countries facing both human and financial resource constraints, during the COVID-19 pandemic even more than before, it is important that available resources are used as efficiently as possible, potential synergies are leveraged to maximise benefit for patients, continued provision of essential health services is ensured. For the infectious diseases, TB, HIV, hepatitis C (HCV) and STI, sharing devices and integrated services starting with rapid, quality-assured, and complete diagnostic services is beneficial for the continued development of adequate, efficient and effective treatment strategies. Here we explore the current and future potential (as well as some concerns), importance, implications and necessary implementation steps for the use of platforms for multi-disease testing for TB, HIV, HCV, STI and potentially other infectious diseases, including emerging pathogens, using the example of the COVID-19 pandemic.

Decreased quality of care for Staphylococcus aureus bacteremia during the COVID-19 pandemic

ObjectivesStaphylococcus aureus bacteremia (SAB) is one of the most frequent bloodstream infections. High mortality of SAB can be significantly reduced by regular infectious disease (ID) consultations and appropriate clinical management. Because the pandemic of coronavirus disease 2019 (COVID-19) has had a negative impact on hospital ID service, it can be assumed that it has also led to decreased quality of care for SAB patients.MethodsThis study enrolled all (n = 68) patients with proven SAB who were hospitalized in Military University Hospital, Prague, in 2019 and 2020 and the quality of care indicators for SAB patients were compared.ResultsA total of 33 and 35 patients with SAB were hospitalized in our hospital in 2019 and 2020, respectively. The significant difference between the pandemic year 2020 and year 2019 was in ID consultations performed (74% vs. 100%; p = 0.002) and fulfilment of all quality of care indicators (66% vs. 93%; p = 0.012). Next, higher in-hospital mortality was observed in 2020 than in 2019 (6% vs. 23%; p = 0.085). There was no significant difference in the percentages of patients with performed echocardiographic examinations (66% vs. 83%; p = 0.156) and collected follow-up blood cultures (85% vs. 94%; p = 0.428). In addition, there was no difference between the two years in the adequate antibiotic therapy, sources, and bacterial origin of SAB.ConclusionsThe quality of care of SAB patients significantly decreased during the COVID-19 pandemic in our institution.

65-Year-Old Man With Weight Loss and Dyspnea on Exertion

65-Year-Old Man With Weight Loss and Dyspnea on Exertion

The State of Hospital Infection Services in the UK: National Workforce Survey 2021

With the evolution of centralised ‘hub and spoke’ microbiology services, the expansion of infectious diseases as a medical specialty and the advent of joint infection training pathways, the infection services within the United Kingdom (UK) are experiencing a period of rapid change. Despite this, to date there has been no comprehensive description of the distribution of specialty staffing and service provision across the country. To this end, the British Infection Association (BIA), in conjunction with the Royal College of Pathologists (RCPath), has undertaken a national survey of National Health Service (NHS) infection services. Questions were compiled following consultation with an expert panel including BIA Council members. An online survey was distributed to clinical leads at all UK NHS acute trusts or health boards with inpatient beds and data were collected between April and August 2021. The overall response rate was 72% (108 respondents). The median number of infection consultant full time equivalents (FTE) per service was 6.1 overall (5.6 per 1000 acute beds) although this varied between the devolved nations and was lowest in centres with microbiology specialists only. Forty-three services had three or fewer FTE medically qualified infection specialists. Overall, 17.5% of all funded FTE consultant-level posts were vacant, although this was markedly higher for microbiology-accredited posts (20.3%) than for infectious diseases (ID) (9.3%) or medical virology (14.6%). There were fewer vacancies in centres with ID-accredited consultants; median 1.0 (IQR 0–2.2) versus those with microbiology only; 1.8 (IQR 0–2.9). Distribution of non-consultant staff was extremely heterogenous with 44 services having none and 25 having one or less FTE (most of which employed microbiology-only accredited consultants). 30% of organisations reported at least one vacant training post. Half of the responding organisations reported at least one consultant accredited in ID but only 28 provided inpatient care with a total of 520 ‘dedicated’ ID beds, of which 235 were negative pressure side-rooms. Geographically, several large areas of the country lacked inpatient ID capacity and/or ID-accredited consultant expertise. The burden of laboratory-related and reporting work in relation to staffing levels is disproportionately greater at smaller centres; there are a median 7.7 (IQR 5.9–9.5) hours/person/week at centres with three or fewer consultants and 4.0 (IQR 2.1–6.3) at larger centres. Microbiology specialists continue to provide the bulk of infection services across the UK and there is marked geographical variation in staffing with regards to other specialities. With Core Infection Training now producing dual-accredited consultants, there is an untapped potential to expand inpatient ID service provision although the requirement for placements on an existing inpatient ID unit may be limiting this currently. There are extremely high vacancies rates across the country but smaller, microbiology-only centres are hardest-hit with many barely attaining the consultant numbers required to staff a safe on-call rota. Workforce planning with utilisation of the valuable expertise of non-medically-trained staff, such as Clinical Scientists, is urgently needed. The results of this survey, in conjunction with Best Practice Standards recently published by the BIA, RCPath and Royal College of Physicians can inform commissioning and delivery of infection expertise in the context of the aftermath of the COVID-19 pandemic.

ORGANIZATION OF MEDICAL CARE FOR INFECTIOUS PATIENTS IN UKRAINE: THE PRIMARY ISSUES OF THE CURRENT TIME

Aim. Analyze changes in the performance of specialized institutions providing medical care to infectious patients in the context of the Covid-19 pandemic, compare them with the “pre-Covid” period (2015–2019) and suggest ways to improve the activities of the infectious service.&#x0D; Material and methods. The materials of the study were the official statistical data of the reports of the Center for Medical Statistics of the Ministry of Health of Ukraine "Medical personnel and the network of healthcare institutions of the system of the Ministry of Health of Ukraine" for 2015-2020.&#x0D; Results. The dynamics of providing medical care to infectious patients is analyzed. A decrease in the provision of the population with doctors and infectious beds against the background of a decrease in the incidence of certain infectious diseases was determined. The inefficient use of beds with an infectious profile was established. The main reasons for the problems of organizing an infectious disease service have been established, taking into account the experience of medical institutions in the context of the Covid-19 pandemic.&#x0D; Conclusions. Possible ways of optimizing medical care for infectious patients are identified: improving the epidemiological monitoring of infectious morbidity and calculating the needs of medical support, taking into account regional characteristics, improving the training of family doctors in the diagnosis and treatment of infectious diseases.

Practical teaching of pathophysiology to LAFFH at the IPD outpatient clinic of FMP/FASE: Historical Report

Background: Undergraduate students of UNIFASE/FMP, through the Academic League of Human Physiology and Pathophysiology (Liga Acadêmica de Fisiologia e Fisiopatologia Humana - LAFFH), participate in a supervised internship to outpatient at the Infectious and Parasitic Diseases Service of FMP/FASE, authorized by Clinical Direction (October 2018). Patients received conventional therapy in addition to complementary therapy with Homeopathy, for external use for cleaning skin lesions and modulating inflammatory responses, whose mechanisms of action are already described in the scientific literature and authorized by ANVISA. Aims: Make approach of undergraduate students to Homeopathic pathophysiology. Methodology: The supervised clinical internship of LAFFH students is in two service rooms with 6 students in each, based on prior appointment due to spontaneous demand, with medical records registered by the IPD outpatient service secretary. Outpatient clinical care addresses the pathophysiology and miasms of the symptoms and signs of neglected chronic parasitic diseases prevalent in our country, identified by anamnesis and physical examination. They are correlated to biological activities in plant chemistry classes, besides official homeopathic pharmacopoeia. So, it was adopted the external use of HUD Ledum palustre 6ch for the cleansing of skin lesions with torpid evolution at IPD. Results and discussion: Two patients with edema and varicose ulcers were treated with the ointment offered. Edema extension which was +++/4+ to both patients diminished to +/4+ in 30 days of interval. Indeed, ulcers remained at the same shape and size, but their bases were cleaned, without purulence. Novel clinical sessions did not occur because of social distancing needed. Conclusion: It has been developed a positive perception among patients and students about the action of homeopathic remedies. The practical teaching activity initiated encourages students in clinical reasoning about complementary therapeutic association with Homeopathy for patients whose evolution is below the expected prognosis with conventional therapy. Project of clinical observation will be elaborated to research ethics committee.

Severe bacterial infections in people who inject drugs: the role of injection-related tissue damage

BackgroundIn the context of the current U.S. injection drug use epidemic, targeted public health harm reduction strategies have traditionally focused on overdose prevention and reducing transmission of blood-borne viral infections. Severe bacterial infections (SBI) associated with intravenous drug use have been increasing in frequency in the U.S. over the last decade. This qualitative study aims to identify the risk factors associated with SBI in hospitalized individuals with recent injection drug use.MethodsQualitative analysis (n = 15) was performed using an in-depth, semi-structured interview of participants admitted to Bellevue Hospital, NYC, with SBI and recent history of injection drug use. Participants were identified through a referral from either the Infectious Diseases or Addition Medicine consultative services. Interviews were transcribed, descriptively coded, and analyzed for key themes.ResultsParticipants reported a basic understanding of prevention of blood-borne viral transmission but limited understanding of SBI risk. Participants described engagement in high risk injection behaviors prior to hospitalization with SBI. These practices included polysubstance use, repetitive tissue damage, nonsterile drug diluting water and multipurpose use of water container, lack of hand and skin hygiene, re-use of injection equipment, network sharing, and structural factors leading to an unstable drug injection environment. Qualitative analysis led to the proposal of an Ecosocial understanding of SBI risk, detailing the multi-level interplay between individuals and their social and physical environments in producing risk for negative health outcomes.ConclusionsStructural factors and injection drug use networks directly impact drug use, injection drug use practices, and harm reduction knowledge, ultimately resulting in tissue damage and inoculation of bacteria into the host and subsequent development of SBI. Effective healthcare and community prevention efforts targeted toward reducing risk of bacterial infections could prevent long-term hospitalizations, decrease health care expenditures, and reduce morbidity and mortality.

Impact of routine bedside infectious diseases service on clinical management and prognosis of patients with Candida fungemia – an example for Antifungal Stewardship at university level in Germany

BackgroundCandidemia is rare and has a high mortality rate. This study analyses the impact of bedside antifungal stewardship (AFS) on clinical management and prognosis of patients with candidemia at a university hospital in Germany. MethodsAll patients with at least one positive blood culture with Candida species between 2014 and 2016 received bedside AFS with standardized recommendations. Medical records were retrospectively analyzed. Results from the intervention period from 2014-2016 (n=109), with focus on 2016 (n=39), were compared with those from the pre-intervention period in 2013 (n=30). ResultsBedside AFS was performed in 24/35 (69%) surviving patients in 2016 within the first 3 days after diagnosis of candidemia. All surviving patients (n=35) in 2016 received antifungal treatment compared with 24/28 (86%) in 2013 (p=0.0344). Follow-up blood cultures were performed in 25/35 (71%) in 2016 compared with 10/25 (40%) in 2013 (p=0.0046). Survival in the intervention compared with the pre-intervention group did not differ significantly (p=0.58) one year after the diagnosis of candidemia was made. However, patients with candidemia often have multiple serious comorbidities. ConclusionsIndividualized bedside AFS significantly improves adherence to recommendations for patients with Candida fungemia, especially guideline-oriented diagnostics and therapy. Improving the prognosis of patients with candidemia remains a huge challenge for AFS.

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis