Reduce Infection Risk Research Articles

Biomaterials in dentistry: Advances in tissue engineering for dental restoration

Background: In regenerative medicine, advances in biomaterials have significantly impacted various medical fields, including dentistry. The use of implants, both metallic and non-metallic, has raised concerns about bacterial adhesion and biofilm formation, which can lead to complications such as peri-implantitis. Innovations in drug delivery systems and additive manufacturing technologies offer new solutions to these challenges. Methods: The review explores recent developments in biomaterials for dental restoration, focusing on drug-eluting implants, additive manufacturing, nanotechnology, and biocompatible coatings. The study evaluates the effectiveness of various drug delivery systems, including hydrogels, nanoparticles, and polymers, and discusses advancements in 3D printing and surface coatings. Results: Additive manufacturing technologies, such as 3D printing, have enabled the creation of precise models and drug delivery systems. Nanotechnology has introduced new materials with improved antimicrobial properties and targeted drug delivery capabilities. Innovations in coatings, such as hydroxyapatite (HA) and calcium phosphate, have enhanced osseointegration and reduced infection risks. Additionally, nanomaterials like gold and silver nanoparticles have shown promise in improving implant functionality and reducing bacterial colonization. Conclusion: Advances in biomaterials and manufacturing technologies have significantly improved the effectiveness and safety of dental implants.

COVID-19 Pandemisinin Mimari Mekân İhtiyaçları Üzerindeki Etkisi

COVID-19 pandemic, the built environment has faced significant transformations and adaptations to address emerging challenges and public health concerns. This review explores the significant implications of the COVID-19 pandemic on architecture and urban design. Key developments include the rise of home office design to accommodate remote work, increased reliance on digital infrastructure for essential services, the revitalization of public and green spaces, and design adaptations for social distancing. Building designs now prioritize wider corridors and open-air spaces to enable safe circulation, improved ventilation systems to reduce infection risk, and antimicrobial materials for enhanced cleanliness. Moreover, digital technologies, such as smart building systems and AI-driven safety measures, play a central role in post-pandemic designs. These transformations collectively aim to create healthier, adaptable, and resilient built environments ready to face future challenges.

Dexamethasone-Associated Hyperglycemia is Not Associated With Infectious Complications After Total Joint Arthroplasty in Diabetic Patients

BackgroundPostoperative infection is a devastating complication of total joint arthroplasty (TJA). Perioperative use of dexamethasone in patients who have diabetes mellitus (DM) remains controversial due to concern for increased infection risk. This study aimed to evaluate the association between dexamethasone and infection risk among patients who have DM undergoing TJA. MethodsThis was a retrospective cohort study conducted on adult patients who underwent primary, elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) between January 2016 and December 2021 using a large national database. We identified 110,568 TJA patients (TKA: 66.6%; THA: 33.4%), 31.0% (34,298) of which had DM. Patients who received perioperative dexamethasone were compared to those who did not. The primary end points were the 90-day risk of postoperative periprosthetic joint infection, surgical site infection (SSI), and other non-SSI (urinary tract infection, pneumonia, sepsis). ResultsWhen modeling the association between dexamethasone exposure and study outcomes while accounting for the interaction between dexamethasone and morning blood glucose levels, dexamethasone administration conferred no increased odds of postoperative periprosthetic joint infection nor SSI in diabetics. However, dexamethasone significantly lowered the adjusted odds of other postoperative infections in diabetic patients (TKA: adjusted odds ratio = 09, 95% confidence interval = 0.8 to 1.0, P = .030; THA: adjusted odds ratio = 0.7, 95% confidence interval = 0.6 to 0.9, P = .001); specifically in patients with morning blood glucose levels between 110 to 248 mg/dL in TKA and ≤ 172 mg/dL in THA. ConclusionsThis study provides strong evidence against withholding dexamethasone in diabetic patients undergoing TJA based on concern for infection. Instead, short-course perioperative dexamethasone reduced infection risk in select patients. The narrative surrounding dexamethasone should shift away from questions about whether dexamethasone is appropriate for diabetic patients, and instead focus on how best to optimize its use.

Trexit: A “Clean” Withdrawal from Transrectal Prostate Biopsies – Prospective Results of In-office Freehand Transperineal Biopsies Under Local Anaesthesia

Introduction: Prostate biopsy (PB) may be performed by either the transrectal (TR) or transperineal (TP) approach. Cancer detection rates seem to be comparable between the two approaches. However, evidence suggests a reduced infection risk and a higher detection of tumours localised in the anterior zone of the prostate with the TP route. TP-PB is currently recommended as a first-line procedure for the diagnosis of prostate cancer (PCa) whenever available. We sought to report the initial results of in-office freehand TP-PB under local anaesthesia in the outpatient setting. Methods: We conducted a prospective study with consecutive sampling with data from men submitted to TP-PB from Sep/2019 to Sep/2021, in a tertiary care centre. A questionnaire was carried out to appraise the pain related to the procedure on a pain numerical rating scale from 0 to 10. Presenting PSA, biopsy result and characteristics and complications that motivated a visit to the emergency department–ED – until 1 month after the PB were analysed. Antibiotic (AB) prophylaxis was not provided to any of the patients undergoing TP-PB. TP-PB was performed under local anaesthesia by freehand method. Results: A hundred and eight (108) patients underwent TP-PB. The mean age was 66±9 years old. The median presenting PSA was comparable in patients with positive and negative PB results (7.7 ng/mL, p=0.11). Overall, 67/108 (62%) patients had PCa diagnosed. Clinically significant (cs) PCa (ISUP=2) was diagnosed in 42/67 (63%) patients. The TP approach allowed the diagnosis of anterior zone PCa in 61% (41/67) of the patients (anterior zone csPCa in 63% of these), 7% (5/67) had exclusively anterior zone pathological findings. Complications leading to an ED visit were recorded in only one patient. Patients reported only mild levels of discomfort related to the anaesthesia infiltration (3±3) and to the introduction of the US transducer (3±3). Globally, the patients ascribed a pain of 3±3 to the entire procedure. Conclusion: Freehand TP-PB under local anaesthesia, without AB prophylaxis, is a well-tolerated and safe procedure, feasible as an outpatient procedure. TP-PB provides an easy access to the anterior zone of the prostate allowing for the diagnosis of previously missed PCa.

Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease.

People treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article-diabetes mellitus, polycystic kidney disease, and chronic liver disease. Each of these conditions requires an understanding of both its effect on the delivery of the PD and the effect of the PD on the condition itself. In diabetes, glucose absorption from the dialysate complicates metabolic control and affects salt and water management and patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to polycystic kidney disease, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution, and therefore, the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease, key issues include nutritional support because PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites and reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high-however, PD may present a better management option than hemodialysis in many patients-particularly in those where the liver disease is complicated by low BP, clotting abnormalities, or troublesome ascites. Overall, the choice to use PD in patients with these complicating conditions should be based on shared decision making with the patient and their family members informed by high-quality information in which risks, benefits, and management strategies are clearly presented.

Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults

This study used repeat serologic testing to estimate infection rates and risk factors in two overlapping cohorts of SARS-CoV-2 N protein seronegative U.S. adults. One mostly unvaccinated sub-cohort was tracked from April 2020 to March 2021 (pre-vaccine/wild-type era, n = 3421), and the other, mostly vaccinated cohort, from March 2021 to June 2022 (vaccine/variant era, n = 2735). Vaccine uptake was 0.53% and 91.3% in the pre-vaccine and vaccine/variant cohorts, respectively. Corresponding seroconversion rates were 9.6 and 25.7 per 100 person-years. In both cohorts, sociodemographic and epidemiologic risk factors for infection were similar, though new risk factors emerged in the vaccine/variant era, such as having a child in the household. Despite higher incidence rates in the vaccine/variant cohort, vaccine boosters, masking, and social distancing were associated with substantially reduced infection risk, even through major variant surges.

Autonomous swab robot for naso- and oropharyngeal COVID-19 screening

The COVID-19 outbreak has triggered a global health and economic crisis, necessitating widespread testing to control viral spread amidst rising cases and fatalities. The recommended testing method, a combined naso- and oropharyngeal swab, poses risks and demands limited protective gear. In response to the COVID-19 pandemic, we developed and tested the first autonomous swab robot station for Naso- and Oropharyngeal Coronavirus Screening (SR-NOCS). A force-sensitive robot running under a Cartesian impedance controller is employed to drive the swab to the sampling area. This groundbreaking device underwent two clinical studies-one conducted during the initial pandemic lockdown in Europe (early 2021) and the other, more recently, in a public place after the pandemic had subsided earlier in the year 2023. In total, 52 patients suspected of COVID-19 infection were included in these clinical studies. The results revealed a complete positive correlation between autonomous and manual sampling. The test subjects exhibited a high acceptance rate, all expressing a willingness to undergo future tests with SR-NOCS. Based on our findings, such systems could enhance testing capabilities, potentially conducting up to 300 tests per robot per day with consistent precision. The tests can be carried out with minimal supervision, reducing infection risks and effectively safeguarding patients and healthcare workers.

Neuromuscular implants: Interfacing with skeletal muscle for improved clinical translation of prosthetic limbs.

After an amputation, advanced prosthetic limbs can be used to interface with the nervous system and restore motor function. Despite numerous breakthroughs in the field, many of the recent research advancements have not been widely integrated into clinical practice. This review highlights recent innovations in neuromuscular implants-specifically those that interface with skeletal muscle-which could improve the clinical translation of prosthetic technologies. Skeletal muscle provides a physiologic gateway to harness and amplify signals from the nervous system. Recent surgical advancements in muscle reinnervation surgeries leverage the "bio-amplification" capabilities of muscle, enabling more intuitive control over a greater number of degrees of freedom in prosthetic limbs than previously achieved. We anticipate that state-of-the-art implantable neuromuscular interfaces that integrate well with skeletal muscle and novel surgical interventions will provide a long-term solution for controlling advanced prostheses. Flexible electrodes are expected to play a crucial role in reducing foreign body responses and improving the longevity of the interface. Additionally, innovations in device miniaturization and ongoing exploration of shape memory polymers could simplify surgical procedures for implanting such interfaces. Once implanted, wireless strategies for powering and transferring data from the interface can eliminate bulky external wires, reduce infection risk, and enhance day-to-day usability. By outlining the current limitations of neuromuscular interfaces along with potential future directions, this review aims to guide continued research efforts and future collaborations between engineers and specialists in the field of neuromuscular and musculoskeletal medicine.

Adherent skin barrier drape use is associated with a reduced risk of cardiac implantable device infection: Results from a prospective study of 14,225 procedures

Cardiac implantable electronic device (CIED) infection is a costly and highly morbid complication. Perioperative interventions, including the use of antibiotic pouches and intensified perioperative antibiotic regimens, have demonstrated marginal efficacy at reducing CIED infection. Additional research is needed to identify additional interventions to reduce infection risk. We sought to evaluate whether adherent skin barrier drape use is associated with a reduction in CIED infection. A prospective registry of all CIED implantation procedures was established at our institution in January 2007. The registry was established in collaboration with our hospital infection prevention team with a specific focus on prospectively identifying all potential CIED infections. All potential CIED infections were independently adjudicated by 2 physicians blinded to the use of an adherent skin barrier drape. Over a 13-year period, 14,225 procedures were completed (mean age 72 ± 14 years; female 4,918 (35%); new implants 10,005 (70%); pulse generator changes 2585 (18%); upgrades 1635 (11%). Of those, 2469 procedures (17.4%) were performed using an adherent skin barrier drape. There were 103 adjudicated device infections (0.73%). The infection rate in patients in the barrier use groups was 8 of 2469 (0.32%) as compared with 95 of 11,756 (0.8%) in the nonuse group (P = .0084). In multivariable analysis, the use of an adherent skin barrier drape was independently associated with a reduction in infection (odds ratio 0.32; 95% confidence interval 0.154-0.665; P = .002). The use of an adherent skin barrier drape at the time of cardiac device surgery is associated with a lower risk of subsequent infection.

Role of Dermabrasion Assisted Tangential Excision in Burns

Burn injury of second degree deep dermal and full thickness delays in healing and heals by scarring. Deep dermal burns need early treatment by tangential excision and skin grafting to promote healing. While wound irrigation, debridement, and local wound care may be sufficient for managing superficial burns (involving the epidermis and superficial dermal layer), deep burns (involving the deep dermal layer and other structures deeper to it) require tangential excision and skin grafting. If performed early it is associated with better outcomes in terms of reduced infection risk and hastened wound healing.

Effect of unequal vaccination coverage and migration on long-term pathogen evolution in a metapopulation.

Worldwide inequalities in vaccine availability are expected to affect the spread and spatial distribution of infectious diseases. It is unclear, however, how spatial variation in vaccination coverage can affect the long-term evolution of pathogens. Here we use an analytical model and numerical simulations to analyse the influence of different imperfect vaccines on the potential evolution of pathogen virulence in a two-population model where vaccination coverage varies between populations. We focus on four vaccines, with different modes of action on the life cycle of a pathogen infecting two host populations coupled by migration. We show that, for vaccines that reduce infection risk or transmissibility, spatial heterogeneity has little effect on pathogen prevalence and host mortality, and no effect on the evolution of pathogen virulence. In contrast, vaccines that reduce pathogen virulence can select for more virulent pathogens and may lead to the coexistence of different pathogen strains, depending on the degree of spatial heterogeneity in the metapopulation. This heterogeneity is driven by two parameters: pathogen migration and the difference in the vaccination rate between the two populations. We show that vaccines that only reduce pathogen virulence select mainly for a single pathogen strategy in the long term, while vaccines that reduce both transmission and virulence can favor the coexistence of two pathogen genotypes. We discuss the implications and potential extensions of our analysis.

Waterless bathing for inpatients with neurological issues and complex needs

Waterless bathing techniques can enhance the care of patients with neurological difficulties. Traditional methods can be uncomfortable and time consuming. Hospital-acquired infections in the NHS are a significant concern because of both financial burdens and antibiotic resistance, and preventing them is paramount. ContiTM waterless bathing products help reduce infection risks, save time and improve the patient experience. Four case studies illustrate the application of these techniques in a specialist hospital for people with complex and serious neurological conditions, demonstrating their practicality and efficacy as well as improvements in patient care and infection control within healthcare facilities.

Development and application of a nomogram model for the prediction of carbapenem-resistant Klebsiella pneumoniae infection in neuro-ICU patients.

Patients in neuro-ICU are at a high risk of developing nosocomial CRKP infection owing to complex conditions, critical illness, and frequent invasive procedures. However, studies focused on constructing prediction models for assessing the risk of CRKP infection in neurocritically ill patients are lacking at present. Therefore, this study aims to establish a simple-to-use nomogram for predicting the risk of CRKP infection in patients admitted to the neuro-ICU. Three easily accessed variables were included in the model, including the number of antibiotics used, surgery, and the length of neuro-ICU stay. This nomogram might serve as a useful tool to facilitate early detection and reduction of the CRKP infection risk of neurocritically ill patients.

Performance of all-air wall induction unit for displacement ventilation in a four-bed hospital ward during the cooling period

The existing induction air-conditioning system faces ventilation shortcomings and condensation risks. We developed an all-air wall induction air terminal unit (wall IU) that doesn't require reheating and eliminates water pipes to address condensation. Moreover, with modifications to its supply method, it can achieve displacement ventilation (DV) in an adiabatic environment. However, the real-world performance of this system needs to be further confirmed. This study examines wall IU performance during the cooling period. A full-scale experiment was conducted in a room furnished as a four-bed hospital ward with an outdoor climate chamber (OCC) to simulate summer conditions. IU's cooling and ventilation performance was evaluated by examining steady-state temperatures and tracer gas distributions. Moreover, CFD simulations to reproduce the experiment were performed to supplement the results. Patients' thermal comfort and infection risk while cohabiting with an infected individual were estimated using detailed temperature, airflow, and concentration data from an experiment-based CFD analysis. Furthermore, the DV stratification height under various perimeter heat loads and performance comparison between wall and ceiling-mounted induction units were also studied. In conclusion, the wall IU improved ventilation efficiency by achieving DV under cooling supply conditions. Satisfied thermal comfort is ensured based on ADPI and DR evaluation. DV's stratification height can be kept high enough under a 20 °C equivalent temperature difference when using a single glass window or more after thermal insulation enhancement. Compared with ceiling-mounted induction units, wall-mounted units can reduce infection risk by more than double while making cold drafts less noticeable.

A privacy preserving four-factor authentication protocol for internet of medical things

Medical applications of the Internet of Things (IoT) have gained significant attention, especially in the context of monitoring health-related information for elderly individuals living alone and patients receiving home-based care, especially during the COVID-19 pandemic. These applications offer immense convenience and contribute to the reduction of infection risk. Consequently, safeguarding the privacy of patient data has become increasingly vital. However, the resource limitations inherent to IoT present challenges in implementing complex algorithms. Numerous researchers have proposed authentication schemes based on three factors: passwords, biometric features, and smart cards. While three-factor authentication protocols are generally more secure than two-factor ones, recent studies have unveiled vulnerabilities in existing protocols designed for IoT environments, particularly concerning sensor node capture attack and smart card stolen attack. Only a few protocols provide reliable solutions to address these issues. To tackle this challenge, we propose a lightweight authentication protocol that introduces the Physical Unclonable Function (PUF) as the fourth factor, enhancing the security and privacy of the system. By integrating PUF technology into servers and embedding it into the integrated circuit chips of sensors, our protocol is specifically designed to thwart attacks like sensor node capture and smart card stolen. We validate the security of our proposed protocol using formal BAN logic and ProVerif simulator tool, demonstrating its capability to provide secure mutual authentication. Moreover, through informal analysis, we illustrate that our scheme can withstand multiple attacks. Furthermore, our proposed protocol outperforms existing protocols in terms of computational cost, storage cost, communication cost, and security requirements.

52 Bolus vitamin D supplementation did not reduce infection risk, re-occurrence, or symptom duration in young male adults undergoing arduous military physical training: D_SAF, randomised controlled trial

52 Bolus vitamin D supplementation did not reduce infection risk, re-occurrence, or symptom duration in young male adults undergoing arduous military physical training: D_SAF, randomised controlled trial

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Developing an AI-predictive model for predicting the likelihood of post-operative infection in surgical patients

Abstract Introduction Antimicrobial resistance was listed among the top ten global health issues by the World Health Organization in 2019.1 By 2050, it is projected to have caused 10 million deaths, surpassing cancer, diabetes, and road traffic accidents.2 The rise in resistant bacterial strains and reduced availability of novel antibiotics makes tackling antimicrobial resistance even more challenging. Preventing infections is the most effective approach, and Artificial Intelligence (AI) has the potential to help predict the likelihood of a patient experiencing a post-operative infection.3 This can help clinicians identify those who might be at higher risk and implement clinical interventions to potentially reduce this risk, during the pre-operative stage. Aim To develop and internally validate an AI-predictive model for predicting the likelihood of post-operative infection in surgical patients. Methods A secondary care dataset from the Pioneer Research Hub was used to develop the predictive model, which included a range of data such as demographic information, vital signs, microbiological culture results, lab investigations, comorbidities, surgical details, and infection diagnoses. Machine learning techniques and clinician input were used to select predictors, both modifiable (e.g. blood glucose) and non-modifiable (e.g. age). Recursive feature elimination with cross-validation was performed, and the dataset was split into training (80%) and internal validation (20%) sets. Missing data was managed through complete case analysis and multiple imputation. Various supervised machine learning classifier algorithms were trained, and an ensemble model was created. Ethical approval was obtained (20/EM/0183, IRAS 280077). Results Data on 2,716 patients who underwent elective abdominal surgery were included in the model training and validation. The infection incidence in this cohort was 38%. Out of 74 initial predictors, 19 were selected. These predictors included demographic data (gender), comorbidities (diabetes, COPD, cardiac conditions, obesity, anaemia), microbiology data (positive cultures within 90 days before surgery, multi-drug resistance), and laboratory investigations within 90 days before surgery: WBCs, lymphocytes, blood glucose, platelets, haematocrit, mean cell haemoglobin, haemoglobin, total bilirubin, aspartate aminotransferase, alanine transaminase, and C-reactive protein. The gradient boosting classifier performed the best among the supervised machine learning algorithms. The ensemble model showed high performance in training (sensitivity: 85.3%, specificity: 74.6%, AUROC: 88.6%) and internal validation (sensitivity: 96.9%, specificity: 74.1%, AUROC: 85.5%). The PROBAST checklist was used to address bias before predictor selection. Discussion/Conclusion The developed AI-predictive model has the potential to predict the likelihood of an elective abdominal surgery patient experiencing a post-operative infection. Identifying patients at high risk of post-surgical infections can guide clinical decision making and help implement interventions during the pre-operative stage, (i.e. as part of nutritional prehabilitation screening), to reduce infection risk. However, it is important to acknowledge the limitations of this model. One limitation is the presence of missing data in the training dataset, which may introduce biases and affect the accuracy of the model. Additionally, potential inaccuracies in data entry could impact the reliability of the model's predictions. Furthermore, it is crucial to consider any historical biases that might have influenced data collection, as these biases could have adverse effects on the developed model.

Prescription of antibiotic prophylaxis in implant placement among Portuguese dentists: A web survey.

This study aims to assess whether antibiotic prophylaxis for dental implant placement is commonly used by dentists in Portugal. This cross-sectional survey study was based on a web survey with 22 questions divided into 5 parts. The 1st part focused on demographic details, work experience, and academic expertise, whereas the 2nd and 3rd parts were about the pre- and postoperative antibiotic prescriptions. The 4th and 5th parts focused on dentists' motivation for using/avoiding antibiotic prophylaxis and the use of a protocol, respectively. Data interpretation included descriptive analysis and statistical inference via cross-tabling with chi-square adjusted standardised for residual effects. Of the 204 valid surveys, at least one was received from every large Portuguese city which ensured the national coverage of the survey. Most respondents are not specialist dentists (72%). Sixty-four percent of the respondents always use antibiotic prophylaxis, while 29% adopt it only when grafting materials are employed. Most respondents use both pre- and postoperative regimens (55%). Amoxicillin 875 mg + clavulanic acid 125 mg is the most prescribed antibiotic (57%). Finally, the risk reduction of postoperative infection is the most frequent justification for the use of antibiotic prophylaxis (60%). The results highlight that most of the respondents do not follow the consensual international guidelines for prophylactic antibiotherapy in dental implant placement surgeries. This finding should serve as a rationale to increase the dissemination of those guidelines.

The Role of Intravenous Immunoglobulin (IVIG) in Reducing Infection Risk in Multiple Myeloma (MM) Patients Receiving Immune-Based Therapies: A Single Center Experience

Introduction Immune-based therapies, including the anti-CD38 antibody daratumumab (Dara), and most recently bispecific antibodies (BsAb) targeting CD3 and BCMA, GPRC5D or FCRH5 are increasingly important strategies used to treat Multiple Myeloma. However, there are concerns that the prolonged use of these therapies predisposes patients (pts) to increased rates of infection, partly due to hypogammaglobulinaemia. To this date, most clinical trials on Dara and BsAb do not consistently capture rates of hypogammaglobulinaemia and leaves the use of intravenous immunoglobulin (IVIg) as prophylaxis to individual investigator discretion. There are currently a paucity of studies documenting IVIg as a means to reduce infection risk in these pts. Patient and Methods All patients with MM who started Dara or BsAb therapy at St Vincent's Hospital Melbourne from Jan 2021 to Dec 2022 were included in this retrospective chart review. Patients who received more than 2 months of treatment were included. The evaluation period for each patient began at the time of first Dara or BsAb dose and ended at the cut-off date of 28 th June 2023. The two time periods were “ON IVIg” defined as any time within 30 days of last IVIg administration and “OFF IVIg” defined as any time >30 days from last IVIg administration. The primary outcome was the incidence rate of all grade infections (expressed in events/person-year) during periods of ON IVIg vs OFF IVIg. Secondary outcomes included incidence rate of severe infection (CTCAE Grade 3-5). Incidence rate ratios (IRR) and the corresponding 95% confidence intervals were calculated using the Exact Poisson method. Results A total of 52 Dara or BsAb treated pts were identified of which 7 were excluded due to treatment cessation from progressive disease within 2 months. The remaining 45 pts were included in the study of which 16 were on Dara, 16 on a BCMA BsAb and 13 on a non-BCMA BsAb. All 16 of the patients on Dara received Dara as a triplet combination. Median age was 65 (IQR 59-70), 25 (56%) were male and median prior lines of therapy received was 1 (IQR 1-3). At the start of treatment, 34 pts (76%) had documented hypogammaglobinaemia of which 12 (27%) had severe hypogammaglobinaemia (defined uninvolved IgG <4.0 g/L). Median functional IgG was 5.0 g/L (IQR 3.9-6.5). Eleven pts (24%) were already on IVIG prior to Dara or BsAb therapy and a further 18 (40%) were commenced on IVIG during the course of treatment. At the cut-off date, 30 (67%) pts were still receiving Dara or BsAb therapy. Median time on treatment was of 8.94 months (IQR 5.06-14.30). The proportion of time ON IVIg for the cohort was 53%. Patient receiving BsAb spent a greater proportion of time ON IVG than patients receiving Dara-based therapy (56% vs 42%, p <0.002). There were 95 all grade infections during the evaluated period, most commonly in the respiratory tract; upper respiratory tract infections (36%), lower respiratory tract infections (31%) and COVID-19 (12%). There were 15 documented severe infections of which 10 occurred during the OFF IVIG period. There were no infection related deaths. The median time to first infection from commencement of Dara or BsAb was 3.12 (IQR 1.25-5.61) months. The rate of all grade infections ON IVIG was 1.54 (95% CI 1.07-2.15) per person years and lower compared to 2.56 (1.95-3.29) per person years OFF IVIG with IRR of 0.60 (95% CI 0.39-0.93; p=0.016) (figure 1). Rate of severe infections was 0.22 (0.07-0.51) and 0.43 (0.20-0.78) per person years respectively with IRR of 0.52 (0.14-1.66; p=0.234). BsAb therapy had a higher all grade infection rate vs Dara-based therapy; 2.86 (2.23-3.62) vs 1.39 (0.91-2.03) per person years respectively; IRR 2.06 (1.30-3.38; p=0.001) Conclusion There are high rates of pre-existing hypogammaglobinaemia in MM patients even during early lines of treatment. The use of IVIG during immune-based therapies appears to significantly reduce the yearly rate of all grade infections by 40% in our cohort. Differences between the rates of severe infection ON IVIg and OFF IVIg are not significant due to small number of events. Further prospective studies are needed to confirm these findings, towards an evidence-based approach in IVIg support for patients with myeloma on novel immunotherapies.