Rate Of Primary Infection Research Articles

Is it time to adopt routine cytomegalovirus screening in pregnancy? No!

Congenital cytomegalovirus is caused by maternal primary or nonprimary infection during pregnancy and is a major preventable cause of neurodisability. The proposed strategies to reduce congenital cytomegalovirus include primary prevention with maternal hygiene measures and secondary prevention by serologic screening for detecting maternal primary infection. A recent randomized trial found that high-dose valaciclovir treatment resulted in a significant reduction in fetal infection after first-trimester maternal primary infection, leading to calls to start routine serologic screening in pregnancy. Previously, observational studies have found a reduction in fetal infection with after maternal primary cytomegalovirus infection when hyperimmune globulin is administered twice weekly during the first trimester of pregnancy; however, this has not been replicated in randomized trials that have used different regimens. Furthermore, some evidence from a single intervention trial and observational studies do not provide us with the necessary data required for rolling out an appropriate screening program. All screening tests may be associated with harm; in the case of congenital cytomegalovirus, there is the well-recognized potential for increasing terminations of pregnancy without diagnostic confirmation of fetal infection or sequelae. Although valaciclovir and hyperimmune globulin treatments may significantly reduce fetal infection rates, they do not prevent severe cytomegalovirus-related fetal brain damage in all pregnancies. Therefore, it is not clear that the offer of a prenatal intervention will provide sufficient reassurance to screen-positive women. In addition, the effectiveness of a prenatal screening and treatment strategy is predicated on a high rate of maternal primary infection, which is limited to regions with low cytomegalovirus seroprevalence, such as Western Europe. In some countries, such as the United States, Finland, and Brazil, nonprimary maternal infections are responsible for most congenital cytomegalovirus health burdens, limiting the potential impact of pregnancy screening. In this invited clinical perspective, we reviewed the evidence and outlined the steps needed to be taken before determining whether the benefits of routine screening for cytomegalovirus in pregnancy outweigh the harms. Until we have the necessary evidence, we should follow the current advice of multiple national health authorities and focus on promoting primary prevention through maternal hygiene precautions.

823. How to Compare standardized Healthcare-associated Infection (HAI) Rates? Benchmark 2D and 3D

BackgroundExternal benchmarking involves comparing standardized data on HAI rates in one hospital or healthcare facility in relation to others. Here we present two epidemiological graphical tools, 2D and 3D benchmarks, which summarize the efficiency in preventing main infections in a Medical/Surgical Intensive Care Unit (MSICU).MethodsThe 3D benchmark graph considers the incidence density rate of ventilator-associated pneumonias (VAP cases per 1,000 ventilator-days) as the X-Axis, the incidence density rate of central line-associated primary bloodstream infections (CLABSI cases per 1,000 central line-days) as the Y-Axis, and the incidence density rate of urinary catheter-associated urinary tract infections (CAUTI per 1,000 urinary catheter-days) as the Z-Axis. Efficiency in preventing infection (e) considers the zero rate to be 100% efficient (e=100%) and the highest available benchmark rate to be “zero” efficiency (RMax: e=0%). From this definition, the efficiency of any MSICU (0% ≤ e ≤ 100%) is obtained using a linear interpolation function, from the rate observed in the MSICU under evaluation (Rx): e = 100x(RMax – Rx)/RMax. If Rx > RMax, then RMax = Rx. The 3D benchmark is build by calculating the preventing infection (e) for each infection (VAP, CLABSI, and CAUTI) for all benchmarks and for the MSICU under evaluation. In the 3D Benchmark, three control volumes are created: “Infection Control Urgency” volume, “Infection Control Excellence” volume, “Infection Prevention Opportunity” volume. Benchmark 2D considers only the VAP density rate as X-Axis, and the CLABSI density rate as Y-Axis. In this graph, five control regions are created: 1=excellence in the control of VAP+CLABSI; 2=excellence in VAP control and opportunity for CLABSI prevention; 3=excellence in CLABSI control and opportunity to prevent VAP; 4=opportunity to prevent VAP+CLABSI; 5=urgency in infection control.ResultsGraph parameters were based on NHSN data from the device-associated module, NOIS Project, Anahp, CQH, and GVIMS/GGTES/ANVISA (Brazilian benchmarks), and El-Saed et al. benchmarks. We applied the 2D/3D benchmarks to several Brazilian ICUs.2D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019: UCO & UTI 19 =excellence in CLABSI control and opportunity to prevent VAP; UTI 20=excellence in VAP control and opportunity for CLABSI prevention; UTI 18=opportunity to prevent VAP+CLABSI. 3D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019 2D benchmark for the MSICUs from Vera Cruz Hospital, Brazil, Jan-Dez/2019: CTI 3.o Andar =excellence in the control of VAP+CLABSI; CTI 1.o Andar=excellence in VAP control and opportunity for CLABSI prevention. Conclusion2D and 3D benchmarks are easy to understand and summarize the efficiency in prevention the mains infections of MSICU.Disclosures All Authors: No reported disclosures

Human Immunodeficiency Virus (HIV) Drug Resistance, Phylogenetic Analysis, and Superinfection Among Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: HIV Prevention Trials Network (HPTN) 075 Study

The HIV Prevention Trials Network (HPTN) 075 study evaluated the feasibility of enrolling and retaining men who have sex with men (MSM) and transgender women (TGW) from Kenya, Malawi, and South Africa. During the study follow-up, 21 participants acquired human immunodeficiency virus (HIV) (seroconverters). We analyzed HIV subtype diversity, drug resistance, transmission dynamics, and HIV superinfection data among MSM and TGW enrolled in HPTN 075. HIV genotyping and drug resistance testing were performed for participants living with HIV who had viral loads >400 copies/mL at screening (prevalent cases, n = 124) and seroconverters (n = 21). HIV pol clusters were identified using Cluster Picker. Superinfection was assessed by a longitudinal analysis of env and pol sequences generated by next-generation sequencing. HIV genotyping was successful for 123/124 prevalent cases and all 21 seroconverters. The major HIV subtypes were A1 (Kenya) and C (Malawi and South Africa). Major drug resistance mutations were detected in samples from 21 (14.6%) of 144 participants; the most frequent mutations were K103N and M184V/I. Phylogenetic analyses identified 11 clusters (2-6 individuals). Clusters included seroconverters only (n = 1), prevalent cases and seroconverters (n = 4), and prevalent cases only (n = 6). Superinfections were identified in 1 prevalent case and 2 seroconverters. The annual incidence of superinfection was higher among seroconverters than among prevalent cases, and was higher than the rate of primary HIV infection in the cohort. This report provides important insights into HIV genetic diversity, drug resistance, and superinfection among MSM and TGW in sub-Saharan Africa. These findings may help to inform future HIV prevention interventions in these high-risk groups.

Designing a modelling structure for the grapevine downy mildew pathosystem

A process-based simulation model for the grapevine-downy mildew pathosystem was developed in order to quantitatively synthesize the literature available and to provide a tool to guide strategic decisions for disease management. The model includes: i) the main processes involved in the disease dual epidemics on leaves and clusters, from inoculum mobilisation to disease multiplication on foliage, and to infection of clusters; and ii) host dynamics, i.e. crop development, growth, and physiological and disease-induced senescence. A numerical evaluation was performed to investigate the response of the model to changes of the main epidemiological parameters, i.e. the basic infection rate corrected for the removals (RcOPT), the duration of latency period (LP), the duration of infectious period (IP), and the rate of primary infections (P). Increasing values of RcOPT and IP, and decreasing values of LP resulted in a faster increase of the epidemic on both foliage and clusters, while decreasing values of P delayed epidemics. The simulated dynamics of epidemics on foliage and clusters conformed to patterns of dual epidemics observed for downy mildew. The model can be useful for investigating the effect of strategic disease management tools such as the use of resistant varieties or to investigate the behaviour of the pathosystem under scenarios of climate change.

A comparison between flow-regulated and adjustable valves used in hydrocephalus during infancy.

Ventriculoperitoneal shunt insertion during the neonatal period and early infancy is associated with a high rate of shunt failure when compared to the adult population. Furthermore, the function of flow-regulated valves and differential pressure valves may be different in neonatal hydrocephalus. A retrospective case series of all primary shunt procedures carried out during or immediately following the neonatal period, from August 2011 to February 2018 at Sheffield Children's Hospital. The total sample size was 55. This included 34 patients with adjustable valves (Miethke ProGav) and 21 with flow-regulated valves (Orbis-Sigma); however, only 53 had adequate follow-up. The overall 1year shunt survival was 34% (18/53), and there was no significant difference depending on which shunt valve was implanted. The primary shunt infection rate was 11% (6/53) with S. aureus being the most common causative organism. During the first year of life, clinical signs of shunt overdrainage were seen more frequently in patients with adjustable valves than in those with flow-regulated valves (59% [19/32] versus 24% [5/21], p= 0.02). Furthermore, 2 patients in the adjustable valve group developed sagittal craniosynostosis secondary to shunt overdrainage. Shunt failure is high when inserted during or immediately following the neonatal period. Overdrainage may be less common in patients with flow-regulated valves. However, if overdrainage is observed, adjusting the setting of a differential pressure valve can effectively treat the overdrainage without the need for invasive shunt revision surgery.

The Effect of Forest Management Options on Forest Resilience to Pathogens

Invasive pathogens threaten the ability of forests globally to produce a range of valuable ecosystem services over time. However, the ability to detect such pathogen invasions – and thus to produce appropriate and timely management responses – is relatively low. We argue that a promising approach is to plan and manage forests in a way that increases their resilience to invasive pathogens not yet present or ubiquitous in the forest. This paper is based on a systematic search and critical review of empirical evidence of the effect of a wide range of forest management options on the primary and secondary infection rates of forest pathogens, and on subsequent forest recovery. Our goals are to inform forest management decision making to increase forest resilience, and to identify the most important evidence gaps for future research. The management options for which there is the strongest evidence that they increase forest resilience to pathogens are: reduced forest connectivity, removal or treatment of inoculum sources such as cut stumps, reduced tree density, removal of diseased trees and increased tree species diversity. In all cases the effect of these options on infection dynamics differs greatly amongst tree and pathogen species and between forest environments. However, the lack of consistent effects of silvicultural systems or of thinning, pruning or coppicing treatments is notable. There is also a lack of evidence of how the effects of treatments are influenced by the scale at which they are applied, e.g. the mixture of tree species. An overall conclusion is that forest managers often need to trade-off increased resilience to tree pathogens against other benefits obtained from forests.

Management of acute bone loss following high grade open tibia fractures.

Introduction:Optimal treatment for acute post-traumatic bone loss in the tibia remains unclear. Distraction osteogenesis (DO) and induced membrane technique (IM) have been established as the mainstays of treatment. Aim of this article is to review the current evidence regarding the use of these two methods.Methods:A review of the MEDLINE database was performed with strict inclusion and exclusion criteria focusing on treatment of the acute bone loss after open tibia fractures with DO and IM. Bone union rate was taken as the primary outcome and infection rate as secondary outcome.Results:Four studies out of 78 on the use of the DO and three studies out of 18 on the use of the IM technique matched the inclusion criteria. Union rate in the DO group ranged between 92% and 100%, with infection rates between 0 and 4%. In the IM group, union was reached in 42% to 100% of cases, with septic complications occurring in 12% to 43%. Differences in union rate and infection rate reached statistical significance.Discussion:We found a considerable evidence gap regarding treatment of bone loss in high grade open tibia fractures. The limitations of our study prevented us from drawing clear causative conclusions on the results. Although our study points to higher union rates and lower infection rate with the use of the DO technique, the results remain preliminary and further high-level evidence is needed to establish the roles of DO and IM in treatment of acute bone loss in open tibia fractures. (www.actabiomedica.it)

Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis

HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82-8.59) had higher reinfection rates. HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.

2323. Clinical Characteristics and Disease Burden of Epstein–Barr Virus and Four β-Herpes Viruses Infections in Children Visiting Emergency Room

BackgroundIt is well known that most of infants and young children with primary EBV and CMV infection are inapparent, and primary HHV-6B and HHV-7 infection cause exanthema subitum (ES). However, the precise incidence of apparent infection of these viruses remains unclear. Therefore, we sought to elucidate clinical features and disease burdens of these viral infections in febrile children visiting emergency room (ER).MethodsBetween June 2015 and December 2017, febrile children under 5 years old, who visited ER and received hematological examination, were enrolled in this study. Detection of serum viral DNAs using real-time PCR and measurement of antibody titers in acute-phase serum were carried out. Clinical information was collected from the medical records.ResultsIn total of the 905 cases, EBV, CMV, HHV-6B and HHV-7 were detected in 18 cases (2%), 12 cases (1.3%), 104 cases (11.5%) and 23 cases (2.5%), respectively. No HHV-6A DNA was detected. Primary infection rates among EBV, CMV, HHV-6B and HHV-7-infected patients accounted for 44%, 25%, 91% and 57%, respectively. Admission rates of the primary-infected patients were 88% of EBV, 68% of CMV, 66% of HHV-6B and 42% of HHV-7, respectively. Five of the 8 cases (62.5%) of primary EBV-infected patients demonstrated typical clinical course of infectious mononucleosis (IM); however, no IM patient was seen in 9 patients with viral reactivation. No IM case was observed in CMV-infected patients, regardless of primary infection or reactivation. Clinical characteristics were compared between patients with primary HHV-6B and HHV-7 infections because of similarity of clinical features. Average age (1.5 vs. 2.8 years old; P < 0.001), duration of fever (4.5 vs. 2.9 days; P < 0.001), the highest body temperature (40.2 vs. 39.6°C; P < 0.001), and the frequency of typical skin rash (ES) (87% vs. 54%; P < 0.001) were statistically different between the two viral infections. The main reason for admission due to primary HHV-6B and HHV-7 infection was complex-type febrile seizure (58.7 vs. 66.7%; P = 0.705).ConclusionThe clinical features and disease burden of the 5 human herpesviruses infections were elucidated in the febrile children visiting ER.Disclosures All authors: No reported disclosures.

Inapparent dengue virus infection among students in Mandalay, Myanmar.

A school- and laboratory-based cross-sectional descriptive study was conducted to find out the burden of inapparent dengue virus (DENV) infection in Mandalay where DENV is endemic and there is circulation of all four DENV serotypes. A total of 420 students who had no history of fever and visited the hospital within 6months were recruited from three monastic schools. Serum samples were collected and the DENV genome was checked by conventional one-step RT-PCR and anti-DENV IgM and IgG antibodies were determined. Inapparent dengue (DEN) infection is defined as individuals who were either RT-PCR-positive or anti-DENV IgM-positive with no clinical manifestations or mild symptoms, and which are not linked to a visit to a healthcare provider. Among 420 students, 38 students (9.0%, 95% CI, 6.4 to 12.2) were confirmed as recent inapparent DEN infection. The DENV serotype-1 was detected in six students. Thirty-one out of 38 (81.6%) laboratory-confirmed inapparent DEN-infected students had primary infections and seven (18.4%) had secondary infections. This study explored the prevalence of inapparent DEN infection rate in urban monastic schools in Mandalay and showed that the rate of primary infection among inapparent DENV-infected children was high.

Exact solution of generalized cooperative susceptible-infected-removed (SIR) dynamics.

In this paper, we introduce a general framework for coinfection as cooperative susceptible-infected-removed (SIR) dynamics. We first solve the SIR model analytically for two symmetric cooperative contagions [L. Chen et al., Europhys. Lett. 104, 50001 (2013)10.1209/0295-5075/104/50001] and then generalize and solve the model exactly in the symmetric scenarios for three and more cooperative contagions. We calculate the transition points and order parameters, i.e., the total number of infected hosts. We show that the behavior of the system does not change qualitatively with the inclusion of more diseases. We also show analytically that there is a saddle-node-like bifurcation for two cooperative SIR dynamics and that the transition is hybrid. Moreover, we investigate where the symmetric solution is stable for initial fluctuations. We finally explore sets of parameters which give rise to asymmetric cases, namely, the asymmetric cases of primary and secondary infection rates of one pathogen with respect to another. This setting can lead to fewer infected hosts, a higher epidemic threshold, and also continuous transitions. These results open the road to a better understanding of disease ecology.

Modelling the key drivers of an aerial Phytophthora foliar disease epidemic, from the needles to the whole plant.

Understanding the epidemiology of infectious diseases in a host population is a major challenge in forestry. Radiata pine plantations in New Zealand are impacted by a foliar disease, red needle cast (RNC), caused by Phytophthora pluvialis. This pathogen is dispersed by water splash with polycyclic infection affecting the lower part of the tree canopy. In this study, we extended an SI (Susceptible-Infectious) model presented for RNC to analyse the key epidemiological drivers. We conducted two experiments to empirically fit the extended model: a detached-needle assay and an in vivo inoculation. We used the detached-needle assay data to compare resistant and susceptible genotypes, and the in vivo inoculation data was used to inform sustained infection of the whole plant. We also compared isolations and real-time quantitative PCR (qPCR) to assess P. pluvialis infection. The primary infection rate and the incubation time were similar for susceptible and resistant genotypes. The pathogen death rate was 2.5 times higher for resistant than susceptible genotypes. Further, external proliferation of mycelium and sporangia were only observed on 28% of the resistant ramets compared to 90% of the susceptible ones. Detection methods were the single most important factor influencing parameter estimates of the model, giving qualitatively different epidemic outputs. In the early stages of infection, qPCR proved to be more efficient than isolations but the reverse was true at later points in time. Isolations were not influenced by the presence of lesions in the needles, while 19% of lesioned needle maximized qPCR detection. A primary infection peak identified via qPCR occurred at 4 days after inoculation (dai) with a secondary peak observed 22 dai. Our results have important implications to the management of RNC, by highlighting the main differences in the response of susceptible and resistant genotypes, and comparing the most common assessment methods to detect RNC epidemics.

Management of Port Occlusions in Adults: Different-Site Replacement versus Same-Site Salvage

PurposeTo compare the safety and effectiveness of different-site port placement versus same-site port salvage in adult patients with occluded ports. Materials and MethodsNinety-five occluded subcutaneous infusion ports (ports) in 95 patients presenting between July 1, 2002, and June 30, 2017, were retrospectively reviewed: 48 (51%) different-site placements (replacements; same-day indwelling port removal and different-site new port placement) and 47 (49%) same-site salvages (salvages; 35 fibrin sheath strippings, 12 over-the-wire exchanges). Demographic information, indication for initial placement and replacement or salvage, procedural details, post-intervention primary catheter patency, and post-intervention port sequelae were recorded. Post-intervention primary catheter patency, and malfunction and infection rates were compared with Kaplan-Meier estimation and the log-rank test, and Fisher exact test, respectively. The association of patient risk factors and port patency was assessed with Cox regression. ResultsMedian primary catheter patency after replacement was 254 days (interquartile range [IQR], 297) and after salvage was 391 days (IQR, 906) (P = .25). Within the salvage group, median primary catheter patency after stripping was 391 days (IQR, 658) and after exchange was 666 days (IQR, 1412) (P = .08). There was no statistical difference in malfunction (P = .12) and infection (P = .74) rates between the replaced and salvaged groups or in malfunction (P = .09) and infection (P = .1) rates between the exchanged and stripped subgroups. None of the patient or catheter characteristics assessed were significantly associated with primary catheter patency. ConclusionsThere was no statistical difference between patency, malfunctions, or infections after replacement and salvage, or after stripping and exchange, so technique selection should be based on the patient’s estimated lifetime venous access requirements, cost, and physician preference.

Financial incentives to perform stump treatment against Heterobasidion root rot in Norway spruce dominated forests, the case of Finland

The financial incentives to perform stump treatment against root and butt rot caused by fungal agent Heterobasidion annosum were analyzed by simulating multiple scenarios of primary and secondary infection rates in southern and central Finland. Forest dynamics of two Norway spruce (Picea abies) dominated stands were simulated with MOTTI and Hmodel models. The results suggest stump treatment to be profitable in relatively healthy stands with high spore pressure for primary infections throughout the current risk zone for Heterobasidion in Finland. In addition, stump treatment quality has a significant effect on the profitability together with the price paid for decayed timber. For example, good quality treatment with lowest prices created a better economic outcome in many scenarios compared to inadequate quality treatment with the highest prices. To achieve the best economic outcome from stump treatment measures, monitoring systems are needed to predict spatiotemporal infection risks and the highest quality stump treatment should be applied.

Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate.

Total joint arthroplasty (TJA) episodic payment models shift risk and cost of periprosthetic joint infection (PJI) to surgeons and hospitals, causing some to avoid treating high-risk patients. Furthermore, there are little data to support optimization of host factors preoperatively to decrease PJI, and recent literature supports using extended antibiotic prophylaxis following reimplantation TJA. The purpose of this study was to evaluate whether extended oral antibiotic prophylaxis minimized PJI after primary TJA in high-risk patients. A retrospective cohort study was performed of 2,181 primary total knee arthroplasties (TKAs) and primary total hip arthroplasties (THAs) carried out from 2011 through 2016 at a suburban academic hospital with modern perioperative and infection-prevention protocols. Beginning in January 2015, extended oral antibiotic prophylaxis for 7 days after discharge was implemented for patients at high risk for PJI. The percentages of patients diagnosed with PJI within 90 days were identified and compared between groups that did and did not receive extended oral antibiotic prophylaxis, with p ≤ 0.05 indicating significance. The 90-day infection rates were 1.0% and 2.2% after the TKAs and THAs, respectively. High-risk patients without extended antibiotic prophylaxis were 4.9 (p = 0.009) and 4.0 (p = 0.037) times more likely to develop PJI after TKA and THA, respectively, than high-risk patients with extended antibiotic prophylaxis. Extended postoperative antibiotic prophylaxis led to a statistically significant and clinically meaningful reduction in the 90-day infection rate of selected patients at high risk for infection. We encourage further study and deliberation prior to adoption of a protocol involving extended oral antibiotic prophylaxis after high-risk TJA, with the benefits weighed appropriately against potential adverse consequences such as increasing the development of antimicrobial resistance. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study

IntroductionMillions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%–50% of...

Bistability and Resurgent Epidemics in Reinfection Models

Spreading processes that propagate through local interactions have been studied in multiple fields (e.g., epidemiology, complex networks, social sciences) using the susceptible-infected-recovered (SIR) and susceptible-infected-susceptible (SIS) frameworks. SIR assumes individuals acquire full immunity to the infection after recovery, while SIS assumes individuals acquire no immunity after recovery. However, in many spreading processes individuals may acquire only partial immunity to the infection or may become more susceptible to reinfection after recovery. We study a model for reinfection called Susceptible-Infected-Recovered-Infected (SIRI). The SIRI model generalizes the SIS and SIR models and allows for study of systems in which the susceptibility of agents changes irreversibly after first exposure to the infection. We show that when the rate of reinfection is higher than the rate of primary infection, the SIRI model exhibits bistability with a small difference in the initial fraction of infected individuals determining whether the infection dies out or spreads through the population. We find this critical value and show that when the infection does not die out there is a resurgent epidemic in which the number of infected individuals decays initially and remains at a low level for an arbitrarily long period of time before rapidly increasing toward an endemic equilibrium in which the fraction of infected individuals is non-zero.

A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters

BackgroundPeripheral intravenous catheters (PIVs) have been considered as having lower risk of infection than central lines. However, research is limited regarding numbers of primary bloodstream infections related to peripheral lines and prevention of peripheral line-associated bloodstream infections (PLABSI). MethodsOur aim was to create and monitor compliance with a new PIV maintenance bundle using disinfecting caps and tips and to assess whether this bundle would lead to a decrease in PLABSI rates. Weekly audits were conducted to measure compliance with both the new PIV bundle and our existing central line-associated bloodstream infection (CLABSI) bundle. We also audited the disconnection method used for intravenous line tubing (peripheral and central lines) before and during the study intervention period. ResultsA compliance rate of close to 90% with the use of the disinfecting caps and tips was attained. Using a PLABSI bundle successfully decreased primary bloodstream infections due to PIVs (from 0.57 infections per 1000 patient-days preintervention to 0.11 infections per 1000 patient-days; p < 0.001). We confirmed that improving care for PIVs would decrease primary bloodstream infections associated with these devices. ConclusionsUsing a PIV maintenance bundle including disinfecting caps and tips can effectively lower the rate of primary bloodstream infections attributable to PIV lines.

Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention

Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection.

Urinary Cytomegalovirus Shedding in the United States: The National Health and Nutrition Examination Surveys, 1999-2004.

There are no data on the prevalence of cytomegalovirus (CMV) shedding from a representative sample of the US population. This information is critical for understanding and preventing CMV. We tested urine specimens from CMV immunoglobulin (Ig) G-positive participants aged 6-49 years in 3 racial/ethnic groups from the National Health and Nutrition Examination Surveys 1999-2004 for the presence of CMV DNA using real-time polymerase chain reaction assay. We examined the association of sociodemographic characteristics with shedding prevalence and viral loads. Among 6828 CMV IgG-positive participants tested, 537 had CMV DNA detected in urine-a shedding prevalence of 9.70%. Among persons aged 6-49 years, shedding prevalence was 3.83%. The prevalence of urinary shedding was inversely associated with increasing age (26.60%, 6.50%, and 3.45% in CMV IgG-positive participants aged 6-11, 12-19, and 20-49 years, respectively; P < .001 for trend test and pairwise comparisons). Urinary viral load also decreased significantly with age (mean, 2.97, 2.69, and 2.43 log10 copies/mL in those age groups, respectively; P < .001 for trend test and pairwise comparisons). Urinary CMV shedding and viral loads decreased dramatically with age, likely reflecting higher rates of primary CMV infection and longer duration of shedding in younger individuals. The findings demonstrate that children aged 6-11 years continue to shed CMV at higher rates and viral loads than adolescents and adults and thus may still be an important source for CMV transmission.