Reported Infection Rates Research Articles

(166) RATES OF INFLATABLE PENILE PROSTHESIS INFECTION WITH INTRAOPERATIVE 0.05% CHLORHEXIDINE GLUCONATE ANTIBIOTIC IRRIGATION COMPARED TO TRADITIONAL ANTIBIOTIC IRRIGATION

Abstract Introduction Primary inflatable penile prosthesis (IPP) surgery carries a 1-3% reported infection rate, but the necessary revision/explant case rises to a 10% risk of infection. Intraoperative antibiotic irrigation is employed throughout surgery by many implanters for this reason. 0.05% Chlorhexidine Glucoronate solution (Irrisept) is an antibacterial, antifungal, and antiviral alternative to traditional antimicrobials. Objective In this study we aim to assess the efficacy of intraoperative Irrisept irrigation in preventing post-operative infection in comparison to the AUA recommended antibiotic guidelines and other regimens. Methods This was a retrospective review of all patients undergoing primary IPP placement or revision, from January 2019-September 2023, at a single institution. Patient demographics, comorbidities, surgery type, operative time, prosthesis type, and 90-day post-operative complications were reviewed. Chi-square analysis was performed to determine statistically significant (p < 0.05) differences in postoperative infections among various groups. Results 415 men had complete data and were included in this study. We found no significant difference in the infection rate between Irrisept and non-Irrisept irrigation (p = 0.523). There was no significant difference in post-operative infections when comparing Irrisept vs vancomycin + gentamicin (p = 0.756), vs. bacitracin (p = 0.785), or other combinations (vancomycin + gentamycin+ fluconazole) (p = 0.304). Additionally, there was no significant difference in infection rates between different prosthesis types using Boston scientific or Coloplast with Irrisept. (p = 0.568). Conclusions The use of intraoperative Irrisept for antibiotic irrigation is effective in preventing post-operative infections in men undergoing IPP surgery. Irrisept is at least equally effective to conventional antibiotic irrigation in preventing infections using both implant devices. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific; Coloplast; BK Ultrasound.

Wastewater-Based Epidemiology for SARS-CoV-2 in Northern Italy: A Spatiotemporal Model.

The study investigated the application of Wastewater-Based Epidemiology (WBE) as a tool for monitoring the SARS-CoV-2 prevalence in a city in northern Italy from October 2021 to May 2023. Based on a previously used deterministic model, this study proposed a variation to account for the population characteristics and virus biodegradation in the sewer network. The model calculated virus loads and corresponding COVID-19 cases over time in different areas of the city and was validated using healthcare data while considering viral mutations, vaccinations, and testing variability. The correlation between the predicted and reported cases was high across the three waves that occurred during the period considered, demonstrating the ability of the model to predict the relevant fluctuations in the number of cases. The population characteristics did not substantially influence the predicted and reported infection rates. Conversely, biodegradation significantly reduced the virus load reaching the wastewater treatment plant, resulting in a 30% reduction in the total virus load produced in the study area. This approach can be applied to compare the virus load values across cities with different population demographics and sewer network structures, improving the comparability of the WBE data for effective surveillance and intervention strategies.

(014) RATES OF INFLATABLE PENILE PROSTHESIS INFECTION WITH INTRAOPERATIVE 0.05% CHLORHEXIDINE GLUCONATE ANTIBIOTIC IRRIGATION COMPARED TO TRADITIONAL ANTIBIOTIC IRRIGATION

Abstract Introduction Primary inflatable penile prosthesis (IPP) surgery carries a 1-3% reported infection rate, but the necessary revision/explant rises to a 10% risk of infection. Intraoperative antibiotic irrigation is employed throughout surgery for this reason. 0.05% Chlorhexidine Glucoronate solution (Irrisept) is an antibacterial, antifungal, and antiviral alternative to traditional antimicrobials. Objective In this study we aim to assess the efficacy of intraoperative Irrisept irrigation in preventing post-operative infection in comparison to vancomycin, gentamicin, fluconazole and bacitracin. Methods This was a retrospective review of all patients undergoing primary IPP placement or revision, from January 2019-September 2023, at a single institution. Patient demographics, comorbidities, surgery type, operative time, prosthesis type, and 90-day post-operative complications were reviewed. Chi-square analysis was performed to determine statistically significant (p < 0.05) differences in postoperative infections among various groups. Results 415 men were included in this study, 27% received Irrisept, 31% received bacitracin, 20% received vancomycin + gentamicin, and 23% received some other antibiotic irrigation combination. We found no significant difference in the infection rate between Irrisept and non-Irrisept irrigation (p = 0.523). There was no significant difference in post-operative infections when comparing Irrisept and vancomycin + gentamicin (p = 0.756), bacitracin (p = 0.785), and other combinations (p = 0.304). Additionally, there was no significant difference in infection rates between different prosthesis types. (p = 0.568). Conclusions The use of intraoperative Irrisept for antibiotic irrigation is effective in preventing post-operative infections in men undergoing IPP surgery. Irrisept is comparable and at least equally effective to conventional antibiotic irrigation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast and BK Ultrasound.

Molecular and haematological investigations on Anaplasma ovis infection in goats in Ahvaz, Iran: Insights into infection rate, haemolytic effect and breed influences.

Anaplasma ovis (A. ovis) is the predominant causative agent of anaplasmosis in goats and sheep in most tropical and subtropical regions of the world. However, there is considerable variation in reported infection rates, breed susceptibility, and controversial findings regarding the haemolytic effects of A. ovis infection in goats. Thus, we investigated the molecular and haematological aspects of A. ovis infection in goats from Ahvaz city. One hundred and fifty apparently healthy goats (74 blacks and 76 Najdi goats) were randomly sampled from six flocks in the Ahvaz suburb during ticks' activity season. Haematological evaluation, smear microscopic (SM) examination and PCR assay were performed to assess A. ovis infection. Additionally, the percentage of parasitemia was determined from blood smears. SM examination revealed that 25.7% of the goats displayed erythrocyte Anaplasma-like inclusion bodies. PCR analysis indicated that 54% of the goats were positive for A. ovis infection (44.6% of blacks and 63.2% of Najdi goats). No significant difference in haematological values was observed between healthy and infected goats based on PCR testing. However, a significant difference in haematological indices was observed between the group with parasitemia level of 0.01-0.02% (SM and PCR positive) compared to the healthy goats (SM and PCR negative), particularly concerning Hb, PCV and RBC count (p < 0.01). When the parasitemia exceeds 0.01%, A. ovis infection may disrupt haematological parameters in infected goats. The high prevalence of A. ovis infection (54%) among the studied goats underscores the importance of giving special attention to implementing necessary measures for disease control in the Ahvaz suburb.

Interrater agreement in classifying infections during extracorporeal membrane oxygenation.

Infectious complications are common during extracorporeal membrane oxygenation (ECMO) and may negatively impact outcomes. However, there is considerable variation in the reported rates of incidence, which hampers the use of infections as a quality benchmark for ECMO centers. To assess the contributing role of poor interrater agreement, three independent raters reviewed medical records from all intensive care unit (ICU) patients who received ECMO for >24 h in our tertiary center between October 2019 and October 2021 for suspected episodes of infection, which were rated based on their date of onset and presumed site/diagnosis. To establish a gold standard, any discrepancies were resolved using an expert panel consisting of two intensivists/infectious disease specialists. During 83 ECMO-runs in 77 patients, we observed a total of 62 adjudicated infectious episodes (incidence rate 62, 95% CI: 48-80, per 1000 days at risk). Among 81 episodes suspected by at least one observer, 66 (81%) were identified by two, and only 44 (54%) by all three raters, resulting in Fleiss' kappa of 0.10 (95% CI: 0.00-0.19; slight agreement). However, if raters concurred regarding infection onset, subsequent agreement on infection site was good (concordance 89%; kappa 0.85, 95% CI: 0.72-0.98; near perfect agreement). In conclusion, adjudication of infectious episodes during ECMO is associated with poor interrater agreement regarding occurrence-but not site-of infection. This finding might partially explain the significant disparities observed in reported infection rates during ECMO, emphasizing the need for caution when interpreting infection data in this particular population due to the potential for inherent measurement error.

Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades.

To determine the infection and nonunion rates for open tibia fracture treatment over the past 4 decades since the introduction of the Gustilo-Anderson (GA) open fracture classification. PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018. One hundred sixty-one articles meeting the following inclusion criteria: English language, published between 1977 and 2018, reported infection rates, reported nonunion rates, and fractures classified by the GA open fracture criteria were selected. All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures. Due to variability in the data reviewed, statistical evaluation could not be reliably done. 11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over 4 decades was 18.3%, with 24.3% superficial, 11.2% deep, and 14.7% pin tract. The infection rate by decade was 14% for 1977-1986, 16.2% for 1987-1996, 20.5% for 1997%-2006%, and 18.1% from 2007 to 2017. The overall nonunion rate was 14.1%. The nonunion rate was 13% for 1977-1986, 17% for 1987-1996, 12.8% for 1997%-2006%, and 12.3% for 2007-2017. This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past 40 years. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Predictors of early port infection in adult patients with acute myeloid leukemia.

7041 Background: The most concerning complications following port placement are infection and thrombosis. Early infections in patients with hematological malignancies are reported at 2-5% post-placement. However, data specific to patients with Acute Myeloid Leukemia (AML) is sparse. Here, we report infection rates within 30 days of placement and factors associated with increased risk of infection in patients with AML. Methods: We retrospectively reviewed charts of patients ≥ 18 years with AML who had ports placed between January 2019 to September 2022 at our institution. Baseline and peri-placement characteristics were collected. Port infection was defined as at least one of the following: 1) site infection, 2) gram-positive bacteremia, or 3) bacteremia that was documented by Infectious Disease consultants as a port source. Infections were classified as very early ( &lt; 7 days) and early (7-30 days). Variables were compared in each group by using Pearson’s chi-square test. Results: A total of 101 ports were placed in 98 patients with AML. The median age at placement was 64 years and 58% of patients were female. A total of 14 (13.9%) port infections were identified; 5 (35.7%) were very early and 9 (64.2%) were early infections. The median time to infection was 15 days (range 1-25 days). 5 (35.7%) patients had site-only infections, 6 (42.8%) had isolated bacteremia, and 3 (21.4%) had both. 13 (93%) patients were hospitalized, and 1 patient died from infectious complications. 8 (57%) of infected ports were removed. 57 patients were on regimen-specific prophylactic antibiotics at the time of placement, of whom 12 developed an infection (21%). The infection rate was 10% vs 23% (p = 0.1) in patients with ANC ≥ 500 /µL and ANC &lt; 500/µL respectively at 1 week after port placement, with no difference based on ANC at the time of placement. The infection rate was 21.9% vs. 6.5% in patients with platelets &lt; 100 x103/µL and ≥ 100 x103/µL (p = 0.01) at the time of placement; 28% vs. 8.6% in patients with albumin &lt; 3.5 g/L and ≥ 3.5 g/L (p = 0.02). The infection rate was numerically higher in Venetoclax-based regimens (19%) compared with cytarabine-based regimens (8%) (p = 0.06). Rates of infection were similar among inpatient and outpatient placements (14%). 5/53 patients (9.4%) were in complete remission (CR), 3/29 (10.3%) of newly diagnosed, and 6/19 (31.5%) relapsed/refractory (R/R) AML patients developed an infection (p = 0.02). Conclusions: In our single-institution study, a higher-than-expected port infection rate of 14% was seen in patients with AML. Platelets ≤100 x103/µL and albumin &lt; 3.5 g/L at the time of placement, Venetoclax-based regimens, and R/R state were associated with significantly higher rates of infection. Interestingly ANC at the time of placement was not associated with an increased infection rate. Strategies to prevent early infections in these high-risk patients are much needed.

COVID-19 Vaccine Coverage in India: A District-Level Analysis.

India implemented the largest COVID-19 vaccination drive in the world, through which it vaccinated the majority of its population. Lessons from the Indian COVID-19 vaccination experience can be invaluable for other LMICs as well as for preparedness for future outbreaks. Our study is designed to explore the factors associated with COVID-19 vaccination coverage in India at the district level. We used data from COVID-19 vaccination in India combined with several other administrative data to create a unique data set that facilitated a spatio-temporal exploratory analysis by uncovering the factors associated with vaccination rates across different vaccination phases and districts. We found evidence that past reported infection rates were positively correlated with COVID-19 vaccination outcomes. Past cumulative COVID-19 deaths as a proportion of district populations were associated with lower COVID-19 vaccination, but the percentage of past reported infection was positively correlated with first-dose COVID-19 vaccination, which might indicate a positive role of higher awareness created by a higher reported infection rate. Districts that on average had a higher population burden per health centre were likely to have lower COVID-19 vaccination rates. Vaccination rates were lower in rural areas relative to urban areas, whereas the association with literacy rate was positive. Districts with a higher percentage of children with complete immunisation were associated with higher COVID-19 vaccination, whereas low vaccination was observed in districts that had higher percentages of wasted children. COVID-19 vaccination was lower among pregnant and lactating women. Higher vaccination was observed among populations with higher blood pressure and hypertension (which were a few of the co-morbidities associated with COVID-19 infection).

The Incidence of and Risk Factors for Breast Infections After Tissue Expander Placement

Abstract Goals/Purpose Breast tissue expansion has a reported infection rate ranging from 2.4-25% in the literature when used for post mastectomy breast reconstruction. Expander infections may prolong the reconstructive timeframe, increase costs, portend poorer aesthetic outcomes, and decrease patient satisfaction. Medical treatments are often attempted to salvage implants prior to surgical treatment including irrigation, implant replacement, or explantation. The purposes of this study include 1) to ascertain the incidence of breast infections in patients with breast tissue expanders at our institution, 2) explore the success of medical treatments in precluding explantation, 3) identify modifiable risk factors associated with any post-expander breast infection, and 4) identify modifiable risk factors associated with post-expander breast infections requiring subsequent explantation. Methods/Technique A single-center, single-surgeon, 4-year retrospective review was performed. Patient demographics, medical comorbidities, and surgical techniques were extracted. Clinical infection was defined by clinical evidence of cellulitis or abscess in a breast with a tissue expander present, regardless of the presence or absence of systemic symptoms. Preservation of the tissue expander following treatment of clinical infection with either antibiotics or surgical intervention was considered salvage, whereas removal of the expander with pocket closure was considered explantation. The incidence of infection and explantation were calculated separately. Chi-squared analysis was used to identify risk factors for both infection and explantation separately. A generalized estimated equations model was used to account for patients who had one infected breast and how that might affect the risk of infection in the other breast or in either breast following future implant or expander placement. It was also used to identify odds ratios for infection and explantation related to the risk factors identified previously. Results/Complications A total of 349 breasts with tissue expanders in 163 patients were included in the study cohort. There was a 17.1% incidence of infection in the cohort and a 12.9% incidence of explantation secondary to infection. Of the infected breasts, 24.6% were managed with antibiotics alone. Significant risk factors for infection were prior chest radiation (p=0.021; OR 3.73, CI95% 1.22-11.34) and use of immune modulating drugs (p=0.012; 2.81, CI95% 1.25-6.30). Significant risk factors for explantation were age (p=0.030), tissue expander volume (p=0.038), and subpectoral placement (p=0.012). For each 5-year increase in age, odds ratio for explantation was 1.44 (CI95% 1.04-2.01). For every 50-cc increase in tissue expander volume, odds ratio for explantation was 1.28 (CI95% 1.02–1.55). Subpectoral placement carried an odds ratio of 11.5 (CI95% 1.7-77.3) compared to prepectoral placement or placement of a tissue expander under autologous tissue transfer (latissimus or free tissue transfer). Conclusion The incidence of breast tissue expander related infections at our institution was within the ranges previously published. A quarter of the breasts with infections were able to successfully avoid explantation with prompt initiation of antibiotic therapy. A history of chest radiation prior to mastectomy and the use of immune modulating drugs were noted to be significant risk factors for developing infections in breasts with tissue expanders. Explantation was more common with increases in age and tissue expander volumes. Surprisingly, subpectoral placement portended a significantly higher risk of explantation as compared to prepectoral tissue expander placement or when placed under a flap. BMI, a history of smoking, intent of mastectomy (prophylactic vs curative), adjuvant radiation, and use of acellular dermal matrix were not significantly related to either infection or explantation in this cohort.

Impact of Concomitant Corticosteroids on Tofacitinib Induction Efficacy and Infection Rates in Ulcerative Colitis

BackgroundTofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis.AimTo report efficacy and infection rates in patients receiving tofacitinib induction treatment, by baseline corticosteroid status.MethodsWe evaluated efficacy and safety data from OCTAVE Induction 1&2 in patients with moderately-to-severely active ulcerative colitis who received tofacitinib 10 mg twice daily or placebo for 8 weeks, based on induction baseline oral corticosteroid use (Corticosteroid-Yes/No) and dose (< 20/ ≥ 20 mg/day). Infections of interest included serious infections, herpes zoster (HZ), and adjudicated opportunistic infections (OIs).ResultsAt OCTAVE Induction 1&2 baseline, 478/1092 (43.8%) patients were receiving corticosteroids. Tofacitinib demonstrated significant induction efficacy versus placebo for both Corticosteroid-Yes and Corticosteroid-No. With adjustment for prior tumor necrosis factor inhibitor and immunosuppressant failure, there were no statistically significant differences in remission and clinical response rates for Corticosteroid-Yes versus Corticosteroid-No. Among tofacitinib-treated patients, HZ and OIs occurred more frequently in Corticosteroid-Yes versus Corticosteroid-No, regardless of dose (< 20 mg vs. ≥ 20 mg). Infection incidence rates (regardless of severity/seriousness) during tofacitinib induction were generally similar regardless of baseline corticosteroid use. The proportion of tofacitinib-treated patients with HZ was 0.2% for Corticosteroid-No versus 1.1% for Corticosteroid-Yes < 20 mg and 1.0% for Corticosteroid-Yes ≥ 20 mg. Two out of three patients had HZ OIs.ConclusionsTofacitinib induction efficacy (clinical response and remission) was similar in baseline corticosteroid subgroups. Infections of interest were rare; HZ and OIs occurred more frequently among those receiving tofacitinib and corticosteroids versus those receiving tofacitinib without corticosteroids.Trial Registrationhttp://www.clinicaltrials.gov (NCT01465763[21/10/2011]; NCT01458951[21/10/2011]).

Internal Ventricular Cerebrospinal Fluid Shunt for Adult Hydrocephalus: A Systematic Review and Meta-Analysis of the Infection Rate.

Hydrocephalus is a common neurological condition that usually requires internal ventricular cerebrospinal fluid shunt (IVCSFS). The reported infection rate (IR) varies greatly from below 1% up to over 50%, but no meta-analysis to assess the overall IR has ever been performed. To determine the IVCSFS overall IR in the adult population and search for associated factors. Six databases were searched from January 1990 to July 2022. Only original articles reporting on adult IVCSFS IR were included. Random-effects meta-analysis with generalized linear mixed model method and logit transformation was used to assess the overall IR. Of 1703 identified articles, 44 were selected, reporting on 57 259 patients who had IVCSFS implantation and 2546 infections. The pooled IR value and its 95% CI were 4.75%, 95% CI (3.8 to 5.92). Ninety-five percent prediction interval ranged from 1.19% to 17.1%. The patients who had IVCSFS after intracranial hemorrhage showed a higher IR (7.65%, 95% CI [5.82 to 10], P -value = .002). A meta-regression by year of publication found a decreasing IR (-0.031, 95% CI [-0.06 to 0.003], P -value = .032) over the past 32 years. IVCSF is a procedure that every neurosurgeon should be well trained to perform. However, the complication rate remains high, with an estimated overall IR of 4.75%. The IR is especially elevated for hydrocephalic patients who require IVCSFS after intracranial hemorrhage. However, decades of surgical advances may have succeeded in reducing IR over the past 32 years.

From doctors to ancillary staff: Regional and metropolitan cancer workforce perceptions and distress resulting from COVID-19 pandemic adaptations

The declaration of the COVID-19 pandemic has resulted in necessary and rapid changes to health service delivery. In the Australian context, it has been broadly identified that these impacts have been felt by health care workers (HCW) providing care. We aimed to capture oncology HCW perceptions of support, stress, personal ability to meet needs and institutional preparedness across longitudinal periods of COVID-19 response in the early stages of the pandemic. An electronic survey was developed to measure the weekly impacts and distress experienced by HCW during the early phases of the pandemic. Hospital email communications relating to pandemic directives were noted. HCW included nursing, medical, ancillary staff and allied health team members at 2 study sites, 1 metropolitan and 1 regional center in Queensland, Australia. Descriptive statistics were applied to quantitative data, and a framework analysis for qualitative data. Key themes were synthesized using mixed methods approaches. A total of 176 HCW consented to participate. Four key themes were identified. Key theme 1 was strategies for protection, and included the subthemes of self-isolation, using personal protective equipment (PPE), protecting patients and families and each other. Key theme 2 was navigating rules and keeping up, and included the subthemes of compliance, exceptions, conflict and complex decision fatigue. Key theme 3 was tempered optimism, with subthemes including this is grief, pride in one's place and strategies for coping. Key theme 4 was framing the new normal, with subthemes including using technology, second wave and uncertainty. Staff groups reported the emotional impacts of rapid change across clinical areas and centers. Distress corresponded to rapid change amid uncertainty, rather than reported infection rates. These findings give insight into the experiences of patient facing oncology HCW during periods of uncertainty, potentially informing policy in the future.

High anti-SARS-CoV-2 seroprevalence among unvaccinated mother–child pairs from a rural setting in north-eastern Tanzania during the second wave of COVID-19

The reported infection rates, and the burden of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in low- and middle-income countries, including sub-Saharan Africa, are relatively low compared to Europe and America, partly due to limited testing capabilities. Unlike many countries, in Tanzania, neither mass screening nor restrictive measures such as lockdowns have been implemented to date. The prevalence of SARS-CoV-2 infection in rural mainland Tanzania is largely unknown. Between April and October 2021, we conducted a cross-sectional study to assess anti-SARS-CoV-2 seroprevalence among mother-child pairs (n=634 children, n=518 mothers) in a rural setting of north-eastern Tanzania. We found a very high prevalence of anti-SARS-CoV-2 antibody titres with seroprevalence rates ranging from 29% among mothers and 40% among children, with a dynamic peak in seropositivity incidence at the end of July/early in August being revealed. Significant differences in age, socioeconomic status and body composition were associated with seropositivity in mothers and children. No significant associations were observed between seropositivity and comorbidities, including anaemia, diabetes, malaria, and HIV. The SARS-CoV-2 transmission in a rural region of Tanzania during 2021 was high, indicating a much higher infection rate in rural Tanzania compared to that reported in the UK and USA during the same period. Ongoing immune surveillance may be vital to monitoring the burden of viral infection in rural settings without access to molecular genotyping where a load of communicable diseases may mask COVID-19. Surveillance could be implemented in tandem with the intensification of vaccination strategies.

Determining the Antibiofilm Efficacy of Oregano Gel in an Ex Vivo Model of Percutaneous Osseointegrated Implants

Biofilm contamination is common in patients with percutaneous osseointegrated (OI) implants, leading to frequent infections, irritation, and discomfort. Reported infection rates soar up to 65% as the recalcitrant nature of biofilms complicates treatment. There is persistent need for therapies to manage biofilm burden. In response, we formulated and tested oregano essential oil in a topical gel as a potential biofilm management therapy. We developed an ex vivo system based on an established ovine OI implant model with Staphylococcus aureus ATCC 6538 biofilms as initial inocula. Gel was administered to the samples across a period of five days. Samples were quantified and colony forming unit (CFU) counts were compared against a positive control (initial bacterial inocula without treatment). Significant biofilm reduction was observed in samples treated with oregano gel compared to controls, demonstrating the potential of an oregano oil-based gel as a biofilm management therapy at the skin-implant interface of percutaneous OI implants.

Determining Gaps in Publicly Shared SARS-CoV-2 Genomic Surveillance Data by Analysis of Global Submissions.

Viral genomic surveillance has been a critical source of information during the COVID-19 pandemic, but publicly available data can be sparse, concentrated in wealthy countries, and often made public weeks or months after collection. We used publicly available viral genomic surveillance data submitted to GISAID and GenBank to examine sequencing coverage and lag time to submission during 2020-2021. We compared publicly submitted sequences by country with reported infection rates and population and also examined data based on country-level World Bank income status and World Health Organization region. We found that as global capacity for viral genomic surveillance increased, international disparities in sequencing capacity and timeliness persisted along economic lines. Our analysis suggests that increasing viral genomic surveillance coverage worldwide and decreasing turnaround times could improve timely availability of sequencing data to inform public health action.

Outcomes of systemic screening for syphilis, gonorrhoea and Chlamydia trachomatis among immigrant visa applicants migrating from Japan to the US in 2016-2019.

Identifying sexually transmitted infections is a public health task. Screening at the time of migration detected asymptomatic infections over a range of ages. Reporting infection rates may serve to establish a benchmark for risk assessments. All sexually active people who have never had sexually transmitted infection tests should be offered sexually transmitted infection tests.

Preoperative hemoglobin A1c and perioperative blood glucose in patients with diabetes mellitus undergoing spinal cord stimulation surgery: A literature review of surgical site infection risk.

The aim of our study was to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative surgical site infection (SSI). A librarian-assisted literature search was performed with two goals: (1) identify surgical publications related to SSI and HbA1c values, and (2) identify publications reporting infection risk with DM in spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cardiovascular implantable electronic device (CIED) implantation surgeries. Published guidelines on perioperative management of DM are reviewed. We identified 30 studies reporting SSI and HbA1c values. The literature review indicated that for many surgical procedures, elevated HbA1c is not correlated to rate of SSI. We identified 16 studies reporting infection rates within DM cohorts following SCS, IDDS, and CIED implantation surgeries. The data reviewed did not indicate DM as an independent risk factor for SSI. Preoperative HbA1c levels in patients with a history of DM is not a singularly sufficient tool to estimate risk of perioperative infection in SCS implantation surgery. Published guidelines on perioperative management of DM do not suggest a specific HbA1c above which surgery should be delayed; intentional perioperative glycemic control is recommended.

Spatial Modelling of Key Regional- Level Factors of Covid-19 Mortality In Russia

Intensive socio-economic interactions are a prerequisite for the innovative development of the economy, but at the same time, they may lead to increased epidemiological risks. Persistent migration patterns, the socio-demographic composition of the population, income level, and employment structure by type of economic activity determine the intensity of socio-economic interactions and, therefore, the spread of COVID-19.We used the excess mortality (mortality from April 2020 to February 2021 compared to the five-year mean) as an indicator of deaths caused directly and indirectly by COVID-19. Similar to some other countries, due to irregularities and discrepancies in the reported infection rates, excess mortality is currently the only available and reliable indicator of the impact of the COVID-19 pandemic in Russia.We used the regional level data and fit regression models to identify the socio-economic factors that determined the impact of the pandemic. We used ordinary least squares as a baseline model and a selection of spatial models to account for spatial autocorrelation of dependent and independent variables as well as the error terms.Based on the comparison of AICc (corrected Akaike information criterion) and standard error values, it was found that SEM (spatial error model) is the best option with reliably significant coefficients. Our results show that the most critical factors that increase the excess mortality are the share of the elderly population and the employment structure represented by the share of employees in manufacturing (C economic activity according to European Skills, Competences, and Occupations (ESCO) v1 classification). High humidity as a proxy for temperature and a high number of retail locations per capita reduce the excess mortality. Except for the share of the elderly, most identified factors influence the opportunities and necessities of human interaction and the associated excess mortality.

Clinical Outcome of Coccygectomy Using a Paramedian Curvilinear Skin Incision in Adults and Children With Meta-Analysis of the Literature Focusing on Postoperative Wound Infection.

A single surgeon case series and meta-analysis of literature. To evaluate the clinical outcome and patient satisfaction following coccygectomy for coccygodynia in adults and children using a curvilinear paramedian skin incision and to conduct a meta-analysis of the literature to determine the associated infection rate with different surgical factors. 45 consecutive patients (40 adults and 5 children) underwent surgical coccygectomy for persistent coccygodynia symptoms using a paramedian curvilinear incision. Postoperative clinical outcome scores, patients' satisfaction and wound complications were assessed. A systematic literature search using specific MesH terms was then conducted covering the period from 1980 to 2020. Only those studies reporting infection rates post coccygectomy were included in a meta-analysis. The average age of patients was 39years with a mean duration of symptoms prior to surgery of 7.4years. The mean Oswestry Disability Index improved from 29 to 7.7 (P < .001). The mean pain Visual analogue scale improved from 8 to 2 (P < .001) and the median patient satisfaction score was 8 (out of 10) suggesting good to excellent outcome. The clinical improvement was the same in children and adults. There was a total of 5 (11%) wound infections, 2 of which needed surgical debridement. Meta-analysis of the included studies showed that the use of prophylactic antibiotics for 24hours, nonabsorbable skin sutures and glue were associated with low infection rate. Coccygectomy using curvilinear paramedian skin incision for chronic coccygodynia is an effective procedure with similar or lower complication rates as reported in the literature.

COVID-19: ESSENTIAL WORKERS AND THE RISKS WE FACE

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The COVID-19 pandemic has affected the Unites States of America more than any other country.1 However, West Virginia ranks in the lower quartile with 4,950 cases per 100,000 as of December 31, 2020.2,3 Serological testing for antibodies identifies prior viral exposure and, potentially, immunity, although recent studies have indicated that SARS-CoV-2 antibodies can decline over time.4,5Our hypothesis was that healthcare workers in Charleston, WV would have a higher prevalence of COVID 19 antibodies compared to other community essential workers. We also hypothesized that working in a unit providing care directly to COVID positive patients would be the highest risk factor. Our study investigates prevalence of SARS-CoV-2 antibodies in West Virginia essential workers and demographics associated with positive rates. METHODS: Between September and December 2020, blood samples were tested for SARS-CoV-2 IgG antibodies from 1081 essential workers in Charleston, WV in a variety of occupations. Equivocal results were included in the positive tests. In addition, a questionnaire was obtained describing history of symptoms, contact exposures, prior testing, and employment information. Healthcare workers (HCW) was defined as those working in the medical profession including Emergency Medical Services (EMS) personnel with direct patient care with COVID-19 patients. Community Essential Workers (CEW) included law enforcement, firefighters, restaurant workers, teachers, and grocery workers. Descriptive statistics, Fisher’s exact test, and Chi square were performed with SAS 9.4. RESULTS: A total of 458 HCW and 623 CEW were enrolled (n=1081). Of those that responded, 20.5% thought they had contracted COVID-19 with only 4.7% of our study population reporting testing positive for COVID on a PCR test. The overall positive antibody rate in our study population was 7.8% while the cumulative reported infection rate for West Virginia at the same time was 4.9%. Of 84 (7.8%) positive results, 25.0% were previously tested for COVID-19 infection and were negative, 50.0% tested positive, and 25.0% were not previously tested.We found no statistically significant difference (p>0.05) in risk for developing COVID antibodies based on gender, living situation (single or roommate) or between HCW on COVID units vs non-COVID units. However, HCW were found to have almost twice the positive antibody rate compared to CEW (10% vs 5.8%). Just being previously tested for COVID, regardless of the result, increased your chance of having antibody from 4.4% to 11.9%. Interestingly, only 26% of participants that believed they have previously been infected were found to have reactive antibodies. CONCLUSIONS: In the fall of 2020, essential workers had a nearly 50% higher incidence of SARS-CoV-2 antibodies than what the incidence was reported at that time in WV, with HCW having a statistically significant higher risk than CEW. However, working in a COVID unit was not the driving factor of this difference suggesting intra-hospital spread. We hope to further characterize these groups with reported behaviors in hygiene as well as following antibody rates over time. CLINICAL IMPLICATIONS: Essential workers in late 2020 had an increased risk of COVID 19 compared to the general public with healthcare workers having a significantly higher risk than other community essential workers. DISCLOSURES: No relevant relationships by Rayan Ihle, source=Web Response No relevant relationships by Syed Mahmood, source=Web Response