Risk Of New Infections Research Articles

Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Following Prior Infection or Vaccination.

The extent to which infection versus vaccination has conferred similarly durable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity during the Omicron era remains unclear. In a cohort of 4496 adults under continued serological surveillance throughout the first year of Omicron-predominant SARS-CoV-2 transmission, we examined incidence of new infection among individuals whose last known antigenic exposure was either recent (<90 days) or remote (≥90 days) infection or vaccination. We adjudicated 2053 new-onset infections occurring between 15 December 2021 through 22 December 2022. In multivariable-adjusted analyses, compared to individuals whose last known exposure was remote vaccination, those with recent vaccination (odds ratio [OR], 0.82 [95% confidence interval {CI}, .73-.93]; P = .002) or recent infection (OR, 0.14 [95% CI, .05-.45]; P = .001) had lower risk for new infection within the subsequent 90-day period. Given a significant age interaction (P = .004), we found that remote infection compared to remote vaccination was associated with significantly greater new infection risk in persons aged ≥60 years (OR, 1.88 [95% CI, 1.13-3.14]; P = .015) with no difference seen in those <60 years (1.03 [95% CI, .69-1.53]; P = .88). During the initial year of Omicron, prior infection and vaccination both offered protection against new infection. However, remote prior infection was less protective than remote vaccination for individuals aged ≥60 years. In older adults, immunity gained from vaccination appeared more durable than immunity gained from infection.

Predicting COVID-19 cases in Belo Horizonte-Brazil taking into account mobility and vaccination issues.

The pandemic caused millions of deaths around the world and forced governments to take drastic measures to reduce the spread of Coronavirus. Understanding the impact of social distancing measures on urban mobility and the number of COVID-19 cases allows governments to change public policies according to the evolution of the pandemic and plan ahead. Given the increasing rates of vaccination worldwide, immunization data may also represent an important predictor of COVID-19 cases. This study investigates the impact of urban mobility and vaccination upon COVID-19 cases in Belo Horizonte, Brazil using Prophet and ARIMA models to predict future outcomes. The developed models generated projections fairly close to real numbers, and some inferences were drawn through experimentation. Brazil became the epicenter of the COVID-19 epidemic shortly after the first case was officially registered on February 25th, 2020. In response, several municipalities adopted lockdown (total or partial) measures to minimize the risk of new infections. Here, we propose prediction models which take into account mobility and vaccination data to predict new COVID-19 cases.

HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators.

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is one of the pillars of a combination prevention strategy for reducing the risk of new infections caused by HIV. The daily use of antiretroviral drugs by individuals who are not infected with HIV is required to prevent infection. Although its efficacy has been well established in the literature, in recent years, the decreased supply of antiretroviral drugs has been associated with an increase in the incidence of sexually transmitted infections (STI) and changes in the social determinants of health. An ecological study was conducted covering a five-year period (2018-2022), starting from the year of initiation of PrEP administration in Brazilian state capitals. Descriptive analysis was performed, and the spatial distribution of study data was taken into account. Correlation analysis was used to assess the association between PrEP administration, the incidence and detection rate of STI, and socioeconomic data. The southern region showed the highest incidence rates of STI, but the northern and northeastern regions demonstrated the worst socioeconomic indicators, especially those related to illiteracy and basic sanitation. PrEP administration was significantly correlated with illiteracy (ρ = -0.658), per capita income (ρ = 0.622), public garbage collection (ρ = 0.612), syphilis (ρ = 0.628) and viral hepatitis (ρ = 0.419) incidences. Further, all STI were significantly associated with illiteracy and per capita income. Our findings highlight the need to continue exploring PrEP use and rising syphilis rates. In terms of policy, PrEP administration appears to be inversely associated with regions of greater social vulnerability. Further efforts should focus on the social determinants and health needs of this population to improve access to PrEP and reduce social disparities.

P16 COVID-19 and urinary tract infection: the main manifestations and their management

Abstract Background Despite the predominant injury from COVID-19 being to the respiratory system, there are presently several reports of urinary symptoms. The majority of them are due to comorbid urinary tract infection (UTI) but separate clinical signs can be related to the COVID-19 origin. Objectives To investigate the frequency of UTI symptoms among patients recovering from COVID-19. Subjects and Methods A total of 150 patients (males, 49.3%; average age 57 years old) at the average period of recovering after COVID-19 (6–7 months) were asked about quality, frequency and severity of the main UTI symptoms and antibiotics prescription for their treatment. Results Sixty-one (40.7%) of the individuals asked reported anamnestic UTI (nephritis, glomerulonephritis, urolithiasis) prior to COVID-19 infection. One hundred and nine (72.6%) patients mentioned the appearance of UTI symptoms after recovering from COVID-19 (50% of them observed complaints in the period 3–4 months after hospital discharge). The prevalence of urinary symptoms looked as follows: haematuria, 17.43%; nocturia, 27.25%; incomplete emptying, 19.27%; frequent urination, 11.93%; leukocyturia, 24.12%. Forty-four patients (40.36%) visited family doctors for consultation regarding urinary complaints. Thirty-seven patients (33.94%) were recommended antibiotic therapy according to UTI diagnosis. Conclusions Lower urinary tract symptoms are highly prevalent among COVID-19 patients. A possible reason is ACE-2, an essential receptor for the SARS-CoV-2 spike protein. COVID-19 can worsen previous chronic urinary tract pathologies and increase the risk of new infection, thereby creating the need for additional antibiotics.

Polyurethane foams incorporated with different fillers to remove SARS-CoV-2 from water

Recent studies on viral shedding of SARS-CoV-2 have been reporting that this virus is excreted by infected patients. Because of that, high viral loads have been founded in effluents and wastewater from certain locations, where in high numbers of COVID-19 cases were reported. The increase in SARS-CoV-2 virus dispersion in the environment may increase the risk of new infections, therefore removal or inactivation techniques should be encouraged to prevent the spread of this virus. This study evaluated polyurethane foams (PUF) filled with different particulate adsorbents for the removal of SARS-CoV-2 from water. For that, the PUF were characterized in terms of chemical composition, morphology, surface charge, crystallinity, thermal degradation, density and zeta potential. Afterward, the virus removal efficiency of the studied PUF was analyzed using ribonucleic acid (RNA) extraction and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). In this evaluation, the PUF were incubated in an inactivated SARS-CoV-2 viral suspension for 24 h. The results showed high percentages of SARS-CoV-2 removal above 98 % for the neat PU, as well as for the PUF filled with peach stone (PUPS), peach stone-based activated carbon (PUPSAC) and commercial activated carbon (PUCAC). These results indicate that the production of PUF-based adsorbents is a sustainable way for adding value to commercially discredited vegetable matrixes.

#4562 OUTBREAK OF RALSTONIA SPP AND BURKHOLDERIA SPP CATHETER-RELATED BLOODSTREAM INFECTION IN A HAEMODIALYSIS UNIT

Abstract Background and Aims Ralstonia (RB) and Burkholderia (BB) species are environmental Gram-negative bacilli responsible for several nosocomial infections in immunocompromised or frail patients. RB and BB may contaminate medical devices because of their ability to survive in a biofilm and with low nutrient requests. Reports of infection outbreaks due to RB and BB are very few and only in sporadic cases, the source of contamination was identified. We describe here: i) how we managed an outbreak of bacteremia caused by RB and BB occurred in our dialysis unit, ii) what we have done to identify the source of infection and iii) the countermeasures we adopted to reduce the risk of new events. Method From 7 to 16 April 2021, 6 out of 39 (15.4%) hemodialyzed (HD) patients with a long-term indwelling central venous catheter (CVC) developed symptoms related to infection. Blood cultures revealed the presence of RB and BB. Thus, a prompt check of the blood cultures of all HD patients with CVC was performed. Blood samples were incubated in an automated microbial detection system (VIRTUO BIOMERIEUX) and subsequently, blood positive samples were inoculated in Chocolate and Columbia blood Agar plates. In addition, a microbiological analysis of disinfectants, drugs used in dialysis unit and samples collected from the reverse osmosis water unit (ROW) and from the ROW delivery line were performed. None of the samples obtained from the ROW and from the ROW delivery line resulted positive. Thus, a microbiological analysis of the biofilm attached on the loading pipes (LP) and on the loading plastic tubes (LPT) that connect the hemodialyzer consoles (HC) to the ROW delivery line were performed. Briefly, LTP were subjected to ultrasound sonication at 30-40 KHz (BactoSonic-Bandelin), to disrupt the bacterial biofilm. The material obtained from sonication was cultured. Bacteria was identified by an automated mass spectrometry (MALDI-TOF VITEK®MS, Biomerieux). Results Bacteremia due to RB and BB was confirmed in 7 out of 39 (17.9%) of the hemodialyzed patients with a long-term indwelling CVC. 1 out of 7 was asymptomatic. Baseline characteristics of the 6 symptomatic patients were: mean age 68±16 years; mean C-reactive protein 4.48±1.3 mg/dl; mean procalcitonin 13.27±11.07 ng/ml; mean body temperature 37.9±1.4°C. The antibiotic therapy was decided according to antibiogram and included meropenem and ciprofloxacin. CVC were removed in all infected patients between 6 to 11 days from the diagnosis. Concomitantly, a new one was placed. None of the HD patients with arterio-venous fistulae developed bacteremia. RB and BB were isolated in the biofilm of 11 out of 37 LPT. Thus, we modified the ROW delivery line in order to set up a scheduled chemical and physical disinfections of the ROW delivery line with the hemodialysis consoles connected avoiding the risk of new contamination of the LPT and loading pipes. Briefly, on alternate months the whole system that include ROW delivery line (PE-Xa Medical Device, Fresenius Medical Care), loading pipes, LPT and hemodialysis consoles are disinfected by hot water (90°C) produced by a water heater (AquaB plus HF, Fresenius Medical Care) and by chemical disinfectant, 5% peracetic acid according to the protocols made by the console fabricant. In addition, we added to the reverse osmosis system a filtration module of 0.01 μm (AquaUF, Fresenius Medical Care) prior to the ROW delivery line, Figure 1. Awaiting for the modification of the ROW delivery line, the patients with CVC were dialyzed using a portable water treatment unit. After more than 14 months from the modification of the whole system for production and delivery of ROW none of the hemodialyzed patients developed infection by RB and BB. Conclusion Our experience suggests that infection outbreak by unusual bacteria such as RB and BB could be successful treated using antibiotic therapy. Nevertheless, in dialysis unit the source of infection should be investigated in order to adopt the countermeasures necessary to reduce the risk of new infections.

Characterizing Twitter Content About HIV Pre-exposure Prophylaxis (PrEP) for Women: Qualitative Content Analysis.

HIV remains a persistent health problem in the United States, especially among women. Approved in 2012, HIV pre-exposure prophylaxis (PrEP) is a daily pill or bimonthly injection that can be taken by individuals at increased risk of contracting HIV to reduce their risk of new infection. Women who are at risk of HIV face numerous barriers to HIV services and information, underscoring the critical need for strategies to increase awareness of evidence-based HIV prevention methods, such as HIV PrEP, among women. We aimed to identify historical trends in the use of Twitter hashtags specific to women and HIV PrEP and explore content about women and PrEP shared through Twitter. This was a qualitative descriptive study using a purposive sample of tweets containing hashtags related to women and HIV PrEP from 2009 to 2022. Tweets were collected via Twitter's API. Each Twitter user profile, tweet, and related links were coded using content analysis, guided by the framework of the Health Belief Model (HBM) to generate results. We used a factor analysis to identify salient clusters of tweets. A total of 1256 tweets from 396 unique users were relevant to our study focus of content about PrEP specifically for women (1256/2908, 43.2% of eligible tweets). We found that this sample of tweets was posted mostly by organizations. The 2 largest groups of individual users were activists and advocates (61/396, 15.4%) and personal users (54/396, 13.6%). Among individual users, most were female (100/166, 60%) and American (256/396, 64.6%). The earliest relevant tweet in our sample was posted in mid-2014 and the number of tweets significantly decreased after 2018. We found that 61% (496/820) of relevant tweets contained links to informational websites intended to provide guidance and resources or promote access to PrEP. Most tweets specifically targeted people of color, including through the use of imagery and symbolism. In addition to inclusive imagery, our factor analysis indicated that more than a third of tweets were intended to share information and promote PrEP to people of color. Less than half of tweets contained any HBM concepts, and only a few contained cues to action. Lastly, while our sample included only tweets relevant to women, we found that the tweets directed to lesbian, gay, bisexual, transgender, queer (LGBTQ) audiences received the highest levels of audience engagement. These findings point to several areas for improvement in future social media campaigns directed at women about PrEP. First, future posts would benefit from including more theoretical constructs, such as self-efficacy and cues to action. Second, organizations posting on Twitter should continue to broaden their audience and followers to reach more people. Lastly, tweets should leverage the momentum and strategies used by the LGBTQ community to reach broader audiences and destigmatize PrEP use across all communities.

Probabilistic HIV recency classification-a logistic regression without labeled individual level training data.

Accurate HIV incidence estimation based on individual recent infection status (recent vs long-term infection) is important for monitoring the epidemic, targeting interventions to those at greatest risk of new infection, and evaluating existing programs of prevention and treatment. Starting from 2015, the Population-based HIV Impact Assessment (PHIA) individual-level surveys are implemented in the most-affected countries in sub-Saharan Africa. PHIA is a nationally-representative HIV-focused survey that combines household visits with key questions and cutting-edge technologies such as biomarker tests for HIV antibody and HIV viral load which offer the unique opportunity of distinguishing between recent infection and long-term infection, and providing relevant HIV information by age, gender, and location. In this article, we propose a semi-supervised logistic regression model for estimating individual level HIV recency status. It incorporates information from multiple data sources - the PHIA survey where the true HIV recency status is unknown, and the cohort studies provided in the literature where the relationship between HIV recency status and the covariates are presented in the form of a contingency table. It also utilizes the national level HIV incidence estimates from the epidemiology model. Applying the proposed model to Malawi PHIA data, we demonstrate that our approach is more accurate for the individual level estimation and more appropriate for estimating HIV recency rates at aggregated levels than the current practice - the binary classification tree (BCT).

Prophylactic low-dose, bi-weekly benznidazole treatment fails to prevent Trypanosoma cruzi infection in dogs under intense transmission pressure.

Trypanosoma cruzi naturally infects a wide variety of wild and domesticated mammals, in addition to humans. Depending on the infection dose and other factors, the acute infection can be life-threatening, and in all cases, the risk of chagasic heart disease is high in persistently infected hosts. Domestic, working, and semi-feral dogs in the Americas are at significant risk of T. cruzi infection and in certain settings in the southern United States, the risk of new infections can exceed 30% per year, even with the use of vector control protocols. In this study, we explored whether intermittent low-dose treatment with the trypanocidal compound benznidazole (BNZ) during the transmission season, could alter the number of new infections in dogs in an area of known, intense transmission pressure. Preliminary studies in mice suggested that twice-weekly administration of BNZ could prevent or truncate infections when parasites were delivered at the mid-point between BNZ doses. Pre-transmission season screening of 126 dogs identified 53 dogs (42.1%) as T. cruzi infection positive, based upon blood PCR and Luminex-based serology. Serial monitoring of the 67 uninfected dogs during the high transmission season (May to October) revealed 15 (22.4%) new infections, 6 in the untreated control group and 9 in the group receiving BNZ prophylaxis, indicating no impact of this prophylaxis regimen on the incidence of new infections. Although these studies suggest that rigorously timed and more potent dosing regimen may be needed to achieve an immediate benefit of prophylaxis, additional studies would be needed to determine if drug prophylaxis reduced disease severity despite this failure to prevent new infections.

Increased susceptibility to pneumonia due to tumour necrosis factor inhibition and prospective immune system rescue via immunotherapy.

Immunomodulators such as tumour necrosis factor (TNF) inhibitors are used to treat autoimmune conditions by reducing the magnitude of the innate immune response. Dampened innate responses pose an increased risk of new infections by opportunistic pathogens and reactivation of pre-existing latent infections. The alteration in immune response predisposes to increased severity of infections. TNF inhibitors are used to treat autoimmune conditions such as rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, transplant recipients, and inflammatory bowel disease. The efficacies of immunomodulators are shown to be varied, even among those that target the same pathways. Monoclonal antibody-based TNF inhibitors have been shown to induce stronger immunosuppression when compared to their receptor-based counterparts. The variability in activity also translates to differences in risk for infection, moreover, parallel, or sequential use of immunosuppressive drugs and corticosteroids makes it difficult to accurately attribute the risk of infection to a single immunomodulatory drug. Among recipients of TNF inhibitors, Mycobacterium tuberculosis has been shown to be responsible for 12.5-59% of all infections; Pneumocystis jirovecii has been responsible for 20% of all non-viral infections; and Legionella pneumophila infections occur at 13-21 times the rate of the general population. This review will outline the mechanism of immune modulation caused by TNF inhibitors and how they predispose to infection with a focus on Mycobacterium tuberculosis, Legionella pneumophila, and Pneumocystis jirovecii. This review will then explore and evaluate how other immunomodulators and host-directed treatments influence these infections and the severity of the resulting infection to mitigate or treat TNF inhibitor-associated infections alongside antibiotics.

Abrupt and gradual drying-off procedure and intramammary dry treatment: Impact on udder health status of Chios breed dairy sheep

In order to evaluate the impact of drying-off procedure on udder health status and the effect of intramammary dry treatment on prevention of new intramammary infections and improving cure rate of mammary abnormalities, a randomized single blinded controlled trial was performed in which 80 Chios breed dairy ewes were randomly allocated into 2 groups. Ewes of Group A (n=40) dried off gradually during a 15-day period, whereas in ewes of Group B (n=40), udder drying-off took place abruptly. Half of the ewes of each group received intramammary infusion (1 syringe/teat) of benzathine cloxacilline (IDT subgroup, n=20). The rest of the ewes of each group received no treatment at all (control subgroup, n=20). Representative samples of teat duct material and milk were aseptically collected from each mammary half for cytological and microbiological examination. Samples were collected using both conventional and aseptic techniques at the time of enrollment until the final milking before dry off (7 to 14 days before the expected dry period), at dry period (approximately 65 days) and continued at lambing until the end of the ongoing milking period. 61.8% of bacterial isolates obtained from teat duct and milk were identified as coagulase-negative staphylococci (CNS). No significant differences were noticed between the two groups in the frequency of mammary gland infection peri-partum (p=0.466), in the risk of new mammary infections during dry period (p=0.750) and in the cure rate of any subsequent mammary infection (p=0.131). Drying-off procedure had no significant impact on somatic cell counts (p=0.760) or milk leucocyte subpopulations (p&gt;0.05) but had a significant effect on milk production of the next lactation period (p&lt;0.001). Ewes treated with antibiotic agent presented a significantly higher cure rate of subsequent mammary infections (p=0.036) and a significantly lower risk of new mammary infections (p=0.039) during dry period, compared to the control group. No statistically significant differences were noticed concerning the impact of treatment on cytological profiles (p&gt;0.5), somatic cell counts (p=0.581) and milk production (p=0.705). The results strengthen the hypothesis that drying off procedure does not affect cure rate neither reduce the risk of new infections during dry period and has no effect on development of mastitis around dry period whereas the use of intramammary dry treatment provides a better bacteriological cure rate of the mammary gland and decreases the possibility of new intramammary infections during dry period.

From the Editor’s Desk...

From the Editor’s Desk...

Endoparasitism of Golden Retrievers: Prevalence, risk factors, and associated clinicopathologic changes.

Endoparasitism is a common disease in dogs throughout their lifetime despite the widespread availability of inexpensive diagnostic tests and effective treatments. The consequences of host parasite interactions in otherwise apparently healthy dogs remains largely unknown. This cross-sectional study used complete blood count, serum biochemistry, and fecal flotation data collected from 3,018 young dogs (<3 years of age) enrolled within the Morris Animal Foundation Golden Retriever Lifetime Study (GRLS) to determine the prevalence of endoparasitism and compare bloodwork values of parasite positive and negative participants using logistic regression. Variables including age, gender, reproductive status, and geographic region at the time of evaluation were assessed to identify potential associations. To the authors' knowledge, a comprehensive assessment of clinicopathological changes associated with endoparasite infection in a large cohort has not been completed in the recent decade. The overall prevalence of endoparasitism was 6.99% (211/3018). Dogs who were parasite positive had statistically lower albumin (P = 0.004), lower RBC count (P = 0.01), higher neutrophil count (P = 0.002), and higher platelet count (P <0.001) as compared to parasite negative dogs. It was also concluded that dogs living in rural areas were more likely to have endoparasites than those living in suburban areas. Epidemiological data is crucial for the design and monitoring of prevention and control strategies. Identification of endoparasites by fecal testing is an essential tool to identify susceptible and resistant animals that can act as spreaders and reservoirs of intestinal parasites thereby enabling appropriate therapy and reducing the risk of new infection to animals and humans. Further epidemiological studies are needed to prevent, monitor, and develop new strategies to control endoparasites.

Multi‐country outbreak of Salmonella Enteritidis sequence type (ST)11 infections linked to eggs and egg products – 8 February 2022

On 2 September 2021, France reported an increase in Salmonella Enteritidis ST11 infections. By 11 January 2022, 272 confirmed cases had been reported in five European Union/European Economic Area (EU/EEA) countries and the United Kingdom (UK): Denmark (n=3), France (n=216), the Netherlands (n=12), Norway (n=7), Spain (n=22), and the UK (n=12) in 2021. Two deaths were recorded in adult men. Twenty-five cases were hospitalised. Sixty cases reported consumption of eggs/egg products. Some cases reported in France in 2021 had visited restaurants serving eggs distributed by a common supplier, Spanish Packing Centre A. The eggs originated from three Spanish farms, one testing positive for the outbreak strain. Fresh table eggs from the farms linked to the outbreak were withdrawn and redirected for use in heat-treated egg products. No other countries received eggs from the same farms via Packing Centre A during summer 2021. Therefore, the source of infection for cases in late 2021 and in countries other than Spain and France could not be established. This 2021 outbreak is linked microbiologically to a historical cross-border outbreak reported by the Netherlands in 2019. Eggs consumed by cases in the Dutch outbreak were traced back to a Spanish farm, but it was not possible to identify an epidemiological link with the 2021 outbreak. This suggests a wide distribution of the outbreak strain that could affect the food supply chain and/or earlier steps in the production chain. There may be multiple heterogeneous sources of S. Enteritidis ST11, and the outbreak strain could also be circulating at other farms, inside or outside Spain. The risk of new infections caused by the outbreak strain and contaminated eggs remains high in the EU/EEA. It is therefore important to foster cross-sectoral investigations of contaminations in the egg supply chain in countries where S. Enteritidis ST11 has been detected.

Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis

It remains unclear whether rectal colonization with multidrug-resistant organisms (MDROs) is prevalent and predisposes to infections by the same pathogens in patients with cirrhosis. Two series of critically ill patients were evaluated. In the Barcelona cohort, 486 consecutive patients were prospectively evaluated, 129 with and 357 without cirrhosis (2015-2016). Rectal swabs were performed at admission and weekly thereafter (until intensive care unit [ICU] discharge) to detect MDRO colonization. Risk factors for colonization and infection by MDROs were evaluated. A retrospective cohort from Frankfurt (421 patients with cirrhosis; 2010-2018) was investigated to evaluate MDRO rectal colonization in another epidemiological scenario. In the Barcelona cohort, 159 patients were colonized by MDROs (32.7%), 102 (64.2%) at admission and 57 (35.8%) during follow-up. Patients with cirrhosis showed higher rates of rectal colonization at admission than those without cirrhosis (28.7% vs. 18.2%, p= 0.01) but similar colonization rates during ICU stay. Extended-spectrum beta-lactamase-Enterobacterales were the most frequent MDROs isolated in both groups. Colonization by MDROs independently increased the risk of infection by MDROs at admission and during follow-up. Risk of new infection by the colonizing strain was also significantly increased in patients with (hazard ratio [HR] 7.41) and without (HR 5.65) cirrhosis. Rectal colonization by MDROs was also highly prevalent in Frankfurt (n= 198; 47%; 131at admission [66.2%] and 67 [33.8%] during follow-up), with vancomycin-resistant enterococci being the most frequent colonizing organism. Rectal colonization by MDROs was also associated with an increased risk of infection by MDROs in this cohort. Infections occurring in MDR carriers were mainly caused by the colonizing strain. Rectal colonization by MDROs is extremely frequent in critically ill patients with cirrhosis. Colonization increases the risk of infection by the colonizing resistant strain. Rectal colonization by multidrug-resistant organisms (MDROs) is a prevalent problem in patients with cirrhosis requiring critical care. The pattern of colonizing bacteria is heterogeneous with relevant differences between centers. Colonization by MDROs is associated with increased risk of infection by the colonizing bacteria in the short term. This finding suggests that colonization data could be used to guide empirical antibiotic therapy and de-escalation policies in patients with cirrhosis.

The immune system through the ages

&lt;abstract&gt; &lt;p&gt;The components of the immune system develop in utero and like a computer, some components are immediately functional (the innate components) but other components must learn the programs and details necessary to function (antigen adaptive components). Like other systems, including military and municipal, the innate and antigen specific components develop into an immune system that helps maintain and surveil the other body processes and systems for aberrations, provide surveillance and protection of the mucoepithelial borders and protection from microbial invasion. Inability, excesses, or errors in these processes cause disease. Aging of the immune system brings immunosenescence, inflammaging, more errors, and decreased surveillance which increases risk for new infections (e.g. COVID-19, influenza), recurrence of latent infections, cancer and autoimmune and inflammatory diseases. With greater understanding of the surveillance, effector and regulatory deficits upon aging, better therapies can be developed.&lt;/p&gt; &lt;/abstract&gt;

Comparative efficacy and safety of antipseudomonal β-lactams for pediatric febrile neutropenia: A systematic review and Bayesian network meta-analysis.

Background:Antipseudomonal β-lactams have been used for the treatment of febrile neutropenia (FN); however, the efficacy and safety of antipseudomonal β-lactams in pediatric patients remain unclear. The aim of this study was to comprehensively compare the efficacy and side effects of optional antipseudomonal β-lactams for pediatric FN.Methods:PubMed, Embase, Medline, and Cochrane Library were systematically searched from their inception to December 18, 2020. Eligible randomized controlled trials in which pediatric FN patients were treated with an empiric monotherapy of antipseudomonal β-lactams were selected. Data synthesis was performed using WinBUGS 14.0 software and meta packages implemented in R 3.6.2. Random-effects network meta-analysis was performed, and dichotomous data were pooled as odds ratios with 95% confidence intervals. The primary outcome was treatment success without modification; the secondary outcomes were adverse events (AEs), all-cause mortality, and new infections. The GRADE tool was used to assess the quality of the evidence. The protocol was registered with PROSPERO ID CRD42021226763.Results:Eighteen studies with 2517 patients were included. The results showed no statistically significant difference between the optional antipseudomonal β-lactams in the outcomes of treatment success without modification, all AEs, all-cause mortality, and new infections for pediatric FN. Based on the results of Bayesian rank probability, meropenem was ranked highest among all the treatment options with regard to treatment success without modification benefit; ceftazidime and meropenem were associated with a lower risk of AEs; cefoperazone/sulbactam and piperacillin/tazobactam were associated with a lower risk of mortality, and piperacillin/tazobactam and meropenem were associated with a lower risk of new infections. The quality of evidence was moderate.Conclusions:Meropenem and piperacillin/tazobactam were found to be better with regard to treatment success without modification, with a comparable safety profile. Therefore, our findings support the use of meropenem and piperacillin/tazobactam as a treatment option for pediatric FN patients.

Combining Geospatial Analysis with HIV Care Continuum to Identify Differential HIV/AIDS Treatment Indicators in Uganda

To control the HIV epidemic at the population level, a 90–90–90 target has been proposed for sub-Saharan Africa, whereby 90 percent of people living with HIV (PLH) should know their HIV status, 90 percent of those diagnosed should be receiving antiretroviral therapy (ART), and 90 percent of those on ART should achieve viral suppression (VS). VS occurs when ART reduces the viral load of PLH to an undetectable level with minimal risk of new infections. We present a two-pronged interdisciplinary analysis, combining geospatial and HIV care continuum techniques, to guide treatment interventions toward achieving the 90–90–90 target in Uganda. We conducted spatiotemporal analysis of VS and constructed HIV care continuums for districts using publicly available data from a centralized laboratory of the Ministry of Health, Uganda. Spatial patterns of VS revealed a distinct east–west pattern of low rates and a north–south pattern of high rates with statistically significant clusters of districts with high and low rates in southwestern and eastern Uganda, respectively. VS rates, calculated in a sequential care continuum framework, revealed local variability as well as a significant gap from the 90–90–90 target by districts. Such evident local variability of VS might indicate the importance of regionally targeted interventions for bringing the HIV epidemic to an end.

Development of Heterobasidion spp. fruit bodies on decayed Piecea abies

Because intensive forestry favors the spread of Heterobasidion spp., increasing amounts of decayed Norway spruce (Picea abies) wood in forest stands should be taken into account in the management of commercial forests. Spruce wood colonized by Heterobasidion spp. ensures fruit body formation, which increases the risk of new infections by basidiospores and, subsequently, the spread of Heterobasidion root rot. To date, very little is known about the prevalence of Heterobasidion fruit bodies on decayed spruce wood in different environments. To assess Heterobasidion fruit body production on various soil types and on different parts of trees, more than 36,000 fruit bodies on 425 decayed logs, 321 decayed trees, and 262 stumps of Norway spruce located on mineral and peat soils were surveyed. The most abundant fruit body formation occurred on infected spruce logs left on peat soil. Significantly more fruit bodies (average total fruit body area cm2 m−3) were found on logs on drained peat soil compared to drained mineral soil (4960 and 2674 cm2, respectively). On stems of windthrown, uprooted trees, approximately three times more actively sporulating fruit bodies were formed compared to roots. Further, approximately two times more Heterobasidion fruit bodies occurred on the roots of partly uplifted stumps than on stumps with roots remaining in the soil. H. parviporum was identified in 88% and H. annosum in 12% of analyzed spruce individuals. In cases where the tree was infected by H. annosum s.s., fruit bodies of this fungus were also commonly produced on spruce wood. Abundant development of fruit bodies was also observed in abandoned agricultural and pasture lands. Moreover, rich vegetation in fertile forest types favored fruit body development on both mineral and peat soils. On such sites, infected logs and windthrown trees, as well as partly uplifted spruce stumps, should be removed to limit the spread of Heterobasidion spp. by basidiospores.

Monitoring Plasmodium vivax resistance to antimalarials: Persisting challenges and future directions

Emerging antimalarial drug resistance may undermine current efforts to control and eliminate Plasmodium vivax, the most geographically widespread yet neglected human malaria parasite. Endemic countries are expected to assess regularly the therapeutic efficacy of antimalarial drugs in use in order to adjust their malaria treatment policies, but proper funding and trained human resources are often lacking to execute relatively complex and expensive clinical studies, ideally complemented by ex vivo assays of drug resistance. Here we review the challenges for assessing in vivo P. vivax responses to commonly used antimalarials, especially chloroquine and primaquine, in the presence of confounding factors such as variable drug absorption, metabolism and interaction, and the risk of new infections following successful radical cure. We introduce a simple modeling approach to quantify the relative contribution of relapses and new infections to recurring parasitemias in clinical studies of hypnozoitocides. Finally, we examine recent methodological advances that may render ex vivo assays more practical and widely used to confirm P. vivax drug resistance phenotypes in endemic settings and review current approaches to the development of robust genetic markers for monitoring chloroquine resistance in P. vivax populations.