Infectious Disease Specialists Research Articles

Вульвит и инфекция мочевыводящих путей у девочек

Vulvitis is one of the most common disorders with which people come to visit obstetrician-gynecologist. nonspecific bacterial, atopic, infectious vulvitis and vulvitis associated with helminthiasis are most often found in girls under the age of 3 years. Hyperemic mucous membrane of the external genitalia, pain, burning, itching while urinating and at rest are specific clinical features of the disorder; abnormal genital discharge of various types can be also found. Vulvitis often comes along with perineal and perianal dermatitis. Labial fusion and urinary tract infections are common complications of nonspecific inflammation. obstetricians-gynecologists are recommended to conduct diagnosis, treatment, rehabilitation and further follow-up of such girls in cooperation with other related experts, involve pediatric urologist, gastroenterologist, pediatrician; if necessary – dermatovenerologist, enT physician, dentist, infectious disease specialist.

National survey in Switzerland calls for improved diagnosis and treatment in children with scabies.

The global prevalence of scabies is estimated to be up to 200 million cases annually, with young children particularly affected. In Europe, most cases are thought to originate in migrant populations. Scabies management is challenging in children. To identify knowledge gaps and research needs, we aimed to descriptively evaluate the management of children with scabies by different Swiss healthcare providers. An invitation for an anonymous online survey (36 questions) was sent to members of Swiss societies of dermatologists, general practitioners, paediatricians, paediatric dermatologists, paediatric infectious diseases specialists, and tropical medicine specialists, inviting clinicians to participate from 25thMay to 8thAugust 2020. One reminder invitation was sent. Hospital pharmacies and the distributor of permethrin were contacted to report consumption trends of scabicides in 2018 and 2019. The survey was completed by 248 clinicians: 146 (59%) paediatricians, 47 (19%) dermatologists, 28 (11%) general practitioners, 6 (2%) paediatric dermatologists, 13 (5%) paediatric infectious diseases specialists, and 8 (3%) tropical medicine specialists. Most consulted up to 10 scabies cases within a 16-month period, with similar numbers in migrant and Swiss children. Dermoscopy was used by 24% of non-dermatologists. Non-dermatologists did not consider co-treatment of close contacts in up to 59% of cases. While permethrin was the first-line treatment, treatment failures were frequently reported in children aged <5 years. Up to 67% of paediatric dermatologists regularly used oral ivermectin off-label in children weighing <15 kg. None of the paediatric dermatologists, 15% of the dermatologists, and 9% of the non-dermatologists used only one treatment cycle.Scabicide consumption increased. Treatment studies on ivermectin use in children weighing <15 kg had the highest research priority. In Switzerland, scabies is a frequent dermatosis in migrant and Swiss children. While accessible, optimal diagnostics are underutilised, and treatment is suboptimal. Permethrin resistance appears to be an increasing problem. Dermatologists regularly use ivermectin off-label in children weighing <15 kg. Treatment studies on ivermectin use in children weighing <15 kg, user-friendly diagnostic tools, new treatment protocols, and child-friendly dosage forms are needed to improve the diagnosis and treatment of children with scabies.

843. Prognostic Association of Liposomal Amphotericin B Doses Above 5 mg/kg in Mucormycosis: A Nationwide Epidemiologic and Treatment Analysis in Japan

Abstract Background Mucormycosis is a fatal fungal infection, and there is limited information on its epidemiology and treatment practices, including the optimal dosage of liposomal amphotericin B. Methods A retrospective nationwide analysis of 82 proven and probable cases of mucormycosis was performed. Cases were collected from 51 hospitals in Japan by hematologists and infectious disease specialists. Variables included annual incidence, site of infection, Mucorales genera, and patient and treatment characteristics. Comparison was made between patients who survived and those who died. Comparative analysis was performed between patients who received a liposomal amphotericin B dose of 5 mg/kg and those who received a dose of &amp;gt;5 mg/kg. Categorical variables were tested for differences using Fisher's exact test or χ-squared test. The association between liposomal amphotericin B dose and prognosis was evaluated using the Kaplan-Meier method, and differences were tested using the log-rank test. A Cox proportional hazards model was used to control for confounding.Figure 1.Patient selection Results The lung was the most commonly involved organ (70.7%), and 35.4% of cases were disseminated. Rhizopus spp., Cunninghamella spp., and Mucor spp. were the most common organisms. No significant differences in infected organs or distribution of Mucorales were observed between the survival and death groups. Longer duration of neutropenia was more common among deaths (p = 0.007). Mortality within 120 days was 54.2%. More cases in the survival group started liposomal amphotericin B before confirmed diagnosis (p = 0.028). Survival did not differ between patients receiving liposomal amphotericin B at 5 mg/kg and those receiving &amp;gt;5 mg/kg (p=0.873). Using Cox proportional hazards models adjusting for confounders, such as age ( &amp;gt;65 years), prolonged neutropenia, and resection of infected lesions, the hazard ratio for the effect of &amp;gt;5 mg/kg liposomal amphotericin B on 120-day prognosis was 0.93 (95% confidence interval, 0.4-2.3, p = 0.870) compared with 5 mg/kg. Conclusion This study provides important insights into the precise epidemiology and treatment practices of mucormycosis among hematologists and infectious disease specialists. There was no difference in prognosis between the 5 mg/kg and &amp;gt;5 mg/kg liposomal amphotericin B groups.Figure 2.Kaplan-Meier estimates of survival in the two groups of mucormycosis treated with different doses of liposomal amphotericin B. Disclosures Masato Tashiro, MD, PhD, Asahi Kasei Pharma Corporation: Advisor/Consultant|Asahi Kasei Pharma Corporation: Honoraria|Sumitomo Pharma Co., Ltd.: Honoraria Hiroshi Kakeya, MD, PhD, Asahi Kasei Pharma Corporation: Honoraria|Merck Sharp &amp; Dohme: Honoraria|Sumitomo Pharma Co., Ltd.: Honoraria Hiroshige Mikamo, M.D, Ph.D, Asahi Kasei Pharma Corporation: Grant/Research Support|Merck Sharp &amp; Dohme: Honoraria|Pfizer Inc.: Grant/Research Support|Pfizer R&amp;D Japan: Honoraria|Sumitomo Pharma Co., Ltd.: Grant/Research Support|Sumitomo Pharma Co., Ltd.: Honoraria Kazutoshi Shibuya, M.D., Ph.D., Sumitomo Pharma Co., Ltd.: Grant/Research Support Koichi Izumikawa, M.D., Ph.D., Asahi Kasei Pharma Corporation: Grant/Research Support|Asahi Kasei Pharma Corporation: Honoraria|Astellas Pharma Inc.: Honoraria|DAIICHI SANKYO COMPANY, LIMITED: Grant/Research Support|DAIICHI SANKYO COMPANY, LIMITED: Honoraria|KYORIN Pharmaceutical Co., Ltd.: Honoraria|Merck &amp; Co., Inc.: Honoraria|Pfizer Japan Inc.: Honoraria|Shionogi &amp; Co., Ltd.: Grant/Research Support|Shionogi &amp; Co., Ltd.: Honoraria|Sumitomo Pharma Co., Ltd.: Grant/Research Support|Sumitomo Pharma Co., Ltd.: Honoraria|TAIHO PHARMACEUTICAL CO., LTD.: Grant/Research Support

201. Characteristics of Streptococcal Toxic Shock Syndrome Caused by Different Beta-Hemolytic Streptococci Species: A Single-Center Retrospective Study

Abstract Background Streptococcal toxic shock syndrome (STSS) is a life-threatening condition caused by beta-hemolytic streptococci (BHS) with high mortality. Initially, it is described to be associated with Streptococcus pyogenes and its data and evidence were constructed based on S. pyogenes cases. Now many studies reported that other BHS, S. agalactiae or S. dysgalactiae could also cause STSS, but the clinical characteristics of STSS caused by other BHS were poorly understood. This study evaluates the likelihood of STSS development compared to non-STSS invasive infection among different streptococcal species. Methods We retrospectively searched for the adult medical records of invasive BHS cases in our hospital during 2002-2022. S. pyogenes, S. agalactiae, and S. dysgalactiae were categorized by the Lancefield group (GAS, GBS, and GGS, respectively). Each case was reviewed by infectious diseases specialists and classified into STSS or non-STSS groups. We conducted a multivariable analysis with bacterial species adjusted with age and diabetes mellitus, which were known risk factors. Also, GAS cases were propensity-matched (1:4) to non-GAS BHS cases. Results We identified 43 STSS cases and 285 non-STSS cases and the median [interquartile range] age was 74.0 [63.0-85.0] and 68.0 [57.5-76.5], percentage of men was 55.1% and 46.5%, respectively. We stratified the STSS cases with bacterial species; each GAS, GBS, and GGS accounted for 17, 13, and 13 cases. The crude mortality was around 35% in all groups (Table 1). Multivariable analysis suggested that STSS was less frequent in non-GAS BHS cases with odds ratio 0.24 (95% confident interval (CI): 0.10-0.54, p&amp;lt; 0.001) in GBS and 0.23 (95% CI: 0.10-0.55, p&amp;lt; 0.001) in GGS (Table 2). After propensity score matching, S. pyogenes seemed to cause STSS development more likely than other BHS cases, with odds ratio 3.28 (95% CI:1.21-8.77, p=0.010).Table 1.The characteristics of the STSS patients stratified by bacterial species. Data demonstrated as median [interquartile range] or number (percentage). Abbreviations: BMI, body mass index. DM, diabetes mellitus. CKD, chronic kidney disease. CVD, cerebrovascular disease. SOFA, sequential organ Failure assessment. NA, not applicable. AKI, acute kidney injury. ARDS, acute respiratory distress syndrome. * n=out of proven bacteremia casesTable 2.Multivariable logistic regression analysis of STSS risk factors.Abbreviations: CI, confidence interval. DM, diabetes mellitus. Conclusion This study is the first report to describe and compare the clinical characteristics of STSS caused by different BHS, and we demonstrated that S. pyogenes could be more likely to cause STSS than other BHS. Further studies for assessing the similarity and differences of STSS among different bacteria would be needed for better comprehension, prevention, and treatment of STSS. Disclosures All Authors: No reported disclosures

2490. Improving Hepatitis C Continuum of Care in an Outpatient Internal Medicine Population

Abstract Background According to the WHO, approximately 71 million people are infected with Hepatitis C virus (HCV), and more than 400,000 people die each year due to HCV-related liver diseases. Since the advent of safe and highly effective direct-acting antivirals (DAA) in 2014, treatment for HCV has been revolutionized with cure rates exceeding 90%. Although the detection of undiagnosed HCV infection itself likely has some inherent benefit, the impact of screening is greatly reduced if it does not lead to treatment and cure. Studies on the HCV continuum of care have concluded many patients are lost at each stage, highlighting the need to raise awareness among healthcare professionals and at-risk populations about hepatitis testing, referral, support, and care. A practical model to help fill care gaps in urban internal medicine clinics and improved treatment enrollment and adherence is necessary, which in turn will improve public health outcomes. Methods The objective of the study is to improve the continuum of care of HCV, from diagnosis to treatment of the disease at the outpatient Faculty Medical Center (FMC) Internal Medicine Clinic, and identify hurdles to treatment. We enrolled 31 patients who screened positive for hepatitis C antibody into a pooled cohort, where biweekly telephone encounters were initiated for 3 months to facilitate close follow-up, including scheduling labs and office visits and facilitating subspecialty referrals. (Table 1). Hepatitis C Continuum of Care Workflow HCV labs include HCV viral load and genotype, Fibroscan, Hepatitis B surface antigen, and antibody, Hepatitis A antibody, and HIV 1/2 antibody test. Results Six months post-study, 7 out of 31 (22%) patients enrolled in our intensive follow-up completed treatment. Among the patients who were lost to follow-up, the most common issue encountered was following up with specialists (58%). The most common communication barrier was patients having inactive phone numbers. Results Conclusion Our next step is to establish an HCV clinic within our FMC Internal Medicine Center to expand access to care for HCV-affected patients. The HCV clinic will include coordination with the Infectious Diseases specialist through E-Consult and TriHealth Specialty Pharmacy. The impact will be early treatment of HCV-affected patients, improved treatment success which ultimately reduces the risk of transmission and progression of the disease, and improved quality of life. Disclosures All Authors: No reported disclosures

2665. Health Care Provider Characteristics Associated with Anal Cancer Screening in an Academic Medical System

Abstract Background Anal cancer disproportionally affects persons living with HIV (PWH), sexual and gender minorities, and those with gynecologic cancers, condyloma acuminata, and solid organ transplantation. While expert guidance on anal cancer screening exists for PWH, there are no national guidelines for screening any of these populations. We analyzed clinician characteristics associated with anal cancer screening among providers who care for high-risk populations at an academic medical center including infectious disease (ID) specialists, primary care providers (PCPs), and obstetrician/gynecologists (OBGYNs). Methods We retrospectively reviewed medical charts for patients with HIV, gynecologic cancers, condyloma acuminata, solid organ transplantation, and sexual or gender minority status at Beth Israel Deaconess Medical Center and two affiliated clinics from 01/01/2015 - 08/01/2022. We extracted provider specialties, clinic locations, patient panel demographics, and dates of anal cytology and human papillomavirus (HPV) screening tests. We used chi-squared tests to identify provider factors associated with screening. Results Of 1,093 providers, at least one anal cytology test was performed by 93.8% (75/80) of ID providers, 55.2% (376/681) of PCPs, 28.3% (41/145) of OBGYNs, and 24.1% (45/187) of other providers (p &amp;lt; 0.001); among screeners, anal HPV co-testing was performed equally across specialties (54.2%, p = 0.23). Providers were more likely to screen if they cared for PWH (91.8% with 10-49 PWH vs 3.7% for no PWH, p &amp;lt; 0.001), majority cis-men (55.2%, p=0.003), or majority publicly insured patients (51.8%, p &amp;lt; 0.001). Providers were less likely to screen if they cared for majority cis-women (40.9%, p&amp;lt; 0.001) or majority privately insured patients (24.0%, p&amp;lt; 0.001). Screening practices did not differ by the racial composition of providers’ patient panels (p=.21). Conclusion While many ID specialists performed anal cancer screenings, other providers were less likely to screen. Providers caring for many PWH, cis-men, or publicly insured patients were more likely to screen. Additional research is needed to clarify screening guidance and optimize screening practices for all higher-risk populations, especially non-PWH groups. Disclosures Douglas Krakower, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support|U. North Texas Health Sciences Center: Funding for mentoring|UAB: Advisor/Consultant|UpToDate, Inc.: Royalties|Virology Education: Honoraria

Impact of preoperative bloodstream infection on outcomes of pediatric liver transplant recipients treated for acute liver failure.

Acute liver failure (ALF) is a component of multisystem organ failure that causes severe liver dysfunction in patients without underlying chronic liver disease. The patients with ALF are prone to have infections, including bacteremia. However, studies of the infectious impact for post liver transplantation (LT) in pediatric ALF are limited. We aimed to evaluate our current practice for pediatric LT cases of ALF with preoperative bacteremia. The records of all patients under 18 years old undergoing LT for ALF in our center from November 2005 to December 2021 were collected. They were divided into two groups: those with a preoperative bloodstream infection (BSI) and those without (NBSI). We compared the preoperative status and also reviewed the details of the BSI group. Intraoperative course and postoperative outcomes were also compared. There were 19 BSI patients and 66 NBSI patients. One BSI case was detected on the day of LT. This patient had no changes in vital signs and general condition. After evaluation and therapeutic intervention by pediatric infectious disease specialists, LT was performed on the same day. Five cases developed septic shock at the time of detection of BSI. All BSI patients were in stable condition on the operation day with proper interventions. There were no significant differences in mortality and hospital stay between both groups. LT might be able to be performed for pediatric ALF even with positive blood cultures. In addition, appropriate therapeutic intervention by specialists and patient's stable condition before LT are essential.

102. Assessing ChatGPT Performance in the Brazilian Infectious Disease Specialist Certification Examination

Abstract Background Advances in artificial intelligence have the potential to impact medical fields, including the use of natural language processing-based models, such as ChatGPT. The ability of the ChatGPT to provide insightful responses across diverse fields of expertise could assist in medical decision-making and knowledge management processes. ChatGPT has already demonstrated high accuracy in medical examinations such as the USMLE. To explore the potential of this tool in various contexts, our study aimed to evaluate the accuracy of the ChatGPT in the 2022 Brazilian Infectious Disease Specialist Certification Examination. Methods We conducted a test to evaluate the performance of GPT-3.5 and GPT-4 on the 2022 Brazilian Infectious Disease Specialist Certification Exam. A theoretical exam, consisting of 80 multiple-choice questions with five alternatives, was used to test performance. The GPT was given a command containing the question statement and alternatives, and a brief comment on the logic behind the answer was requested. Descriptive statistics were used to analyze the absolute performance of the correct answers in the ChatGPT-3.5 and ChatGPT-4 models. In addition, the degree of correlation between answers and performance throughout the test was estimated using Spearman's coefficient and a logistic regression curve, respectively. Results Of the 80 questions in the exam, four were excluded because they were invalidated in the final answer key. ChatGPT-3.5 had an accuracy of 53.95% (41/76), whereas ChatGPT-4 had an accuracy of 73.68% (56/76). Spearman's correlation coefficient between the two models was 0.585. There was a slight trend towards improvement in ChatGPT-4 performance throughout the test, as observed in the logistic regression curve. Comparison of Accuracy between ChatGPT 3.5 and ChatGPT4 The graph shows the percentage of accuracy for the two GPT models. The performance of ChatGPT-4 was superior to ChatGPT-3.5. Distribution of Correct and Incorrect Responses by ChatGPT-4 in Medical Test Questions The graph displays the distribution of responses generated by ChatGPT-4. The logistic regression curve shows a slight upward trend, indicating a slight improvement in performance as the questions were answered. Conclusion ChatGPT-4 achieved performance above the 60% minimum threshold required for the certification exam. This indicates that it is a promising technology in various fields, including infectious diseases. However, its potential applications and associated ethical dilemmas must be thoroughly assessed. This advancement also highlights the need for medical education to concentrate on developing competence, skills, and critical thinking rather than relying solely on memorization Disclosures All Authors: No reported disclosures

1308. Exploration of Infectious Disease Specialist Attitudes on Utilizing Oral Antimicrobials for the Treatment of Bone and Joint Infections

Abstract Background Despite recent literature supporting non-inferiority of oral therapy, many patients are treated with traditional extended intravenous (IV) antimicrobial courses. The objective of this study was to evaluate the attitudes of infectious disease (ID) specialists on utilizing oral antimicrobials (PO-A) for the treatment of bone and joint infections (BJI). Methods This was a multicenter clinician survey study of ID specialists from 1/10/23 – 1/31/23, regarding their attitude towards using PO-A for the treatment of BJIs. Survey respondents were presented with statements and rank order questions and asked to indicate their level of agreeance using a 5-point Likert scale. The primary outcome was agreement with the phrase ‘I am willing to prescribe PO-A for treatment of BJIs’. Secondary outcomes included patient case and ID specialist characteristics associated with willingness to prescribe PO-A. Study utilized descriptive statistics and univariate tests. Results A total of 216 surveys were distributed to ID specialists of which 65 recorded responses with 50 complete responses (30% overall response rate and 23% completion rate). Of the 50 complete surveys, the majority of respondents (60%) indicated they prescribe PO-A in ≤25% of their patient-case load as definitive treatment of BJIs. A total of 41/50 respondents (82%) indicated strong agreement with comfortability prescribing and dosing PO-A for BJIs (Table 1) and were most willing to prescribe PO-A ( &amp;gt;70%) in patients with diabetic foot infection (Table 2). ID specialists’ willingness to prescribe PO-A for treatment of BJIs significantly correlated with their current clinical practice. Respondents who disagreed with the statement ‘I am willing to prescribe PO-A’ currently prescribe PO-A in less than 25% of their BJI patients compared to respondents who agreed (37% prescribe PO-A 26-50% of their patients with 35% of those who strongly agree prescribe PO-A it in &amp;gt;50% of their BJI patients (p=0.004). The most common concern (62%) when prescribing PO-A for BJIs is the identified pathogen may not be susceptible to the preferred antibiotic (Table 3). Conclusion The findings of this survey suggest that most ID specialists in this sample are comfortable prescribing PO-A for treatment of BJIs and was significantly related to current practice. Disclosures Jessica Seidelman, MD, MPH, Uptodate: content editor for pelvic osteomyelitis page Kristen Dicks, MD, UpToDate: Advisor/Consultant

2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis

Septic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de santé [HAS]) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations.

Implementation of a Standardized Data Collection Tool for Febrile Episodes in Childhood Cancer Patients in Central America and the Caribbean

Abstract Fever is a common sign of infection and is associated with morbidity and treatment delay in childhood cancer patients. A multinational group of physicians identified the need to develop standardized measures to assess and intervene in the quality of care delivery as measured by adherence to the fever management guidelines published by this group in 2020. Our objective was to create an implement a febrile neutropenia registry that included data for quality assessment. Six sites in Central America and the Caribbean implemented a prototype of a Fever Registry for standardized data collection. Variables collected in the registry included demographic information and quality measures like the performance of selected laboratory tests (neutrophil count and blood culture) and time to antibiotic administration. Sites also collected clinical outcomes, including infection diagnosis, microbiologic diagnosis, critical care support requirements, length of hospital stay, and mortality. The initial implementation cohort included one dedicated pediatric oncology center and five oncology services situated within general pediatric hospitals. From September 9, 2021 to December 5, 2022, the six sites contributed 188 fever episodes from 148 unique patients. The maximum number of fever episodes entered for a single patient was 6 episodes. The distribution of cases entered in the database by site ranged between 5 to 54 cases (average patients enrolled per site=25). 84.9% of iCRFs(Case Report forms) had complete data. The most common incomplete data fields were: Initial antimicrobial administered (9/175=5.1%), nutritional status (6/181=3.3%), and was urinalysis performed at onset of fever (6/181=3.3%). Implementation strategies were developed incorporating responses to a survey based on the Consolidated Framework for Implementation Research. Infectious diseases specialists, who were the site leads, directed the implementation efforts at each site. The coordinating team encouraged sites to incorporate hematologists/oncologists and data managers as part of the team. However, team composition and internal meeting frequency were at the discretion of the site leads. Every site elected to use a paper data collection tool to facilitate centralized data entry, which was conducted by a data manager in all but one site. Staff at local sites received two initial trainings and a retraining by St. Jude staff to identify eligible patients and complete data fields appropriately. Group meetings with all site leads were conducted monthly to review progress and challenges and for quality assurance. The challenges most cited were personnel limitations for data collection and data entry. Surges exacerbated these challenges in caseloads related to respiratory illnesses, including SARS-CoV-2, influenza, and RSV. Conclusion: This group has created and implemented a tool to facilitate standardized data collection for a common clinical problem. Implementation challenges highlight the role of human resources and simplifying data collection to minimize data entry time. Current efforts include developing interim reports so clinicians can use data to improve the quality of care delivery in real-time. The group is also revising data fields to remove data points that are often unavailable or unnecessary to measure care quality. Project implementation in these six sites exposed opportunities to streamline the data collection system and optimize the implementation process.

Genital warts and women’s sexual challenges: is sexual compatibility possible? A qualitative study

BackgroundGenital warts, besides their importance as symptoms of sexually transmitted infections, can also threaten the sexual health of couples. The purpose of this study was to explore the sexual compatibility in women with active genital warts.MethodsA qualitative study with a conventional content analysis approach in Tehran, Iran, from January 2019 to February 2020 was conducted on a purposeful sample of data saturation achieved after interviewing 14 women with genital warts, 2 couples and 3 dermatologists, 1 sexologist and 1 infectious disease specialist. Data were collected through unstructured interviews and analyzed using conventional content analysis approach.ResultsAfter data analysis 224 initial codes, 5 main categories “change in the frequency of sexual activity”, “changing types of sexual intercourse”, “protected sexual intercourse”, “concealment of lesions”, “focusing on personal hygiene by couples after sexual activity” and finally a central theme of “adaptation to challenges of sexual intercourse” were extracted.ConclusionsThis study revealed the perceptions and experiences of women with active genital warts about the process of their sexual adaptation. The main concepts found in this study focus on challenges related to sexual intercourse. It seems that recognizing women’s sexual adaptation challenges after getting genital warts may help them take effective and practical measures to improve their sexual compatibility and health.

Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics.

This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Retrospective evaluation of an intervention bundle on OPAT implementation in a large non-university hospital

ABSTRACT Objectives Optimization of outpatient parenteral antimicrobial therapy (OPAT) requires interdisciplinarity and an operational algorithm. This report retrospectively assesses the impact of a multimodal quality-enhancement intervention bundle on the implementation rate, efficacy, and safety of a home OPAT program in a Belgian large community-based hospital. Methods OPAT recipients between 1 March 2019 and 30 June 2022 were included. The OPAT trajectories were divided into pre-intervention (from 1 March 2019 to 31 October 2020) and post-intervention (from 1 November 2020 to 30 June 2022) groups. The quality-enhancement intervention bundle consisted of the involvement of an infectious disease specialist, revision and implementation of a state-of-the-art prosthetic joint infection diagnosis and treatment protocol, weekly multidisciplinary discussion of all prosthetic joint infections, revision of the OPAT algorithm, and the introduction of teicoplanin as an OPAT-convenient antimicrobial. Results Eighty-five patients were included in a total of 96 OPAT trajectories (n = 33 pre-intervention; n = 63 post-intervention). After the intervention, the number of OPAT trajectories nearly doubled. The number of patients with a recurrent infection within 6 months after OPAT completion decreased 15%. The overall 6-month mortality and readmission rates during OPAT treatment decreased 8% and 10%, respectively. Mortality during OPAT treatment did not change. These differences between pre- and post-intervention did not achieve statistical significance, despite the higher risk for complications in the post-intervention group because of increased infection complexity and required treatment duration. Conclusion Within a Belgian, single, large community-based hospital, a multimodal intervention bundle resulted in increases in OPAT implementation, infection complexity, and required treatment durations without statistically significant differences in outcomes.

Diarrhea syndrome: current aspects of differential diagnosis and treatment at the stage of primary health care

Diarrhea is one of the most common syndromes encountered in the practice of a general practitioner, a general practitioner, a pediatrician at the stage of providing primary health care, as well as a gastroenterologist, an infectious disease specialist and a surgeon at the stage of providing specialized medical care. The first part of the review is devoted to the differential diagnosis of diarrhea, the main pathological conditions and nosological forms in which the development of diarrhea syndrome is possible in real clinical practice are considered.The second part of the review is devoted to a promising active method in gastroenterological practice-enterosorption. The main requirements for modern enterosorbents are met by the domestic enterosorbent based on silica (colloidal silicon dioxide) Polysorb® MP. Its properties are considered, data of comparative studies with other enterosorbents are given. The studies demonstrating the efficacy and safety of the use of enterosorbent Polysorb® MP in the complex therapy of infectious diarrhea in adult patients and in pediatric practice are presented. Diarrhea is one of the most common gastrointestinal symptoms in the new coronavirus infection COVID-19. A number of studies have noted the effectiveness of the use of colloidal silicon dioxide (Polysorb® MP) in the complex treatment of adults and children with COVID-19 and as part of the post-COVID syndrome. The use of Polysorb® MP helps to reduce the viral load in the intestine, reduce diarrhea and other clinical symptoms of gastrointestinal lesions in COVID-19.Availability of modern effective and safe enterosorbent Polysorb® MP in the arsenal of a doctor at the stage of providing primary health care will optimize drug therapy in patients with diarrhea syndrome and other comorbid somatic pathologies.

Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities

BackgroundMigrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients. MethodsTwo-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis. ResultsIn phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions included patient/staff infectious disease champions, targeted training and specialist support, simplified care pathways for screening and management of positive results, and financial incentivisation. Participants responded positively to Health Catch-UP!, stating it would systematically integrate data and support clinical decision-making, increase knowledge, reduce missed screening opportunities, and normalisation of primary care-based infectious disease screening for migrants. ConclusionsOur results suggest that implementation of infectious disease screening in migrant populations is not comprehensively done in UK primary care. Primary health care professionals support the concept of innovative digital tools like Health Catch-UP! and that they could significantly improve disease detection and effective implementation of screening guidance but that they require robust testing and resourcing.

Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis.

Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system's resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors' experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients' management and clinical outcomes.

Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

BackgroundPeople with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists). MethodsA committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only). ResultsIDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation. ConclusionOur findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.

Antibiotic prescribing practices and perceptions on antimicrobial resistance among healthcare practitioners in Russia

ObjectivesAntimicrobial resistance (AMR) is a growing global health threat. The misuse of antibiotics is the main factor contributing to the development of AMR. Healthcare practitioners (HCPs) play a crucial role in the use of antibiotics. There are limited data available on antibiotic prescribing patterns among physicians in Russia. The aim of this study was to explore antibiotic prescribing practices and perceptions of AMR among HCPs in the Russian Federation. Study designA cross-sectional, multi-centre study was used. MethodsA survey using an online questionnaire was conducted among HCPs. A qualitative study was conducted before the questionnaire was developed. The online questionnaire was distributed via email addresses obtained from the Consilium Medicum database, a specialised educational resource for healthcare professionals in Russia. ResultsIn total, 746 HCPs from 74 regions of the Russian Federation were included in the study. Physicians who participated in this study did not frequently prescribe antibiotic drugs: 40.6% of participants recommended antibiotics less than five times per week. Gynaecologists, paediatricians, family doctors, and surgeons were the least likely study participants to prescribe antibiotics, whereas clinical pharmacologists, otolaryngologists, urologists, and infectious disease specialists prescribed antibiotics more often. Amoxicillin and amoxicillin/clavulanic acid were the most frequently prescribed antimicrobials. The majority of HCPs in Russia who took part in this survey reported relying on national guidelines for information on antibiotic prescribing. Only 67.8% of study participants perceived AMR as a challenge for their practice. ConclusionsHealth authorities should regularly provide up-to-date reliable information on AMR in the region. Antimicrobial stewardship programmes are important for specialised medical professionals, such as urologists, gynaecologists, and otolaryngologists, since they are responsible for prescribing second-line antibiotics, which carries with it a greater responsibility.

Hospital Pharmacy in the multidisciplinary team of COVID inpatient units

Since the implementation of the Antimicrobial Stewardship Programs, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain. Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in hospitals.The COVID-19 pandemic forced hospital pharmacists to abruptly suspend all their structured activities and concentrate on the health crisis. Real-time information sharing between different medicine specialties is an effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear.Hospital pharmacies had to reorganize their activities to respond to the pandemic. On the one side were patients with COVID-19, and on the other were routine hospital pharmacy tasks, with the added difficulty of adapting to individual protection measures. New communication and collaboration strategies were adopted. Protocols were established for the management of COVID-19 patients, with continuous changes; special medications had to be prepared and distributed; circuits were designed for the home- or institution-based care of patients; internal circuits were created to minimize the movements of hospital staff and professionals caring for COVID-19 patients.The most effective antiviral drug and anti inflammatory therapy remains elusive. In this scenario, hospital pharmacists emerge as a key player, as they have a deep understanding of the mechanisms of action of drugs and potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary teams has become essential for the optimization of clinical outcomes.