Shorter Duration Of Infection Research Articles

Safety and Efficacy of Bacillus coagulans SNZ 1969® Probiotic Supplementation in Reducing Infections in Malnourished Children: A Randomised, Double-blind, Placebo-controlled Study

Introduction: Malnutrition, a significant global health challenge, increases children’s susceptibility to infections due to compromised immunity and altered gut microbiota. While probiotics have shown potential in improving gut health and immune responses, their efficacy in malnourished children, particularly those using Bacillus coagulans strains, remains understudied. Aim: To investigate the safety and efficacy of Bacillus coagulans SNZ 1969® among malnourished children aged between one and five years. Materials and Methods: A randomised, double-blind, placebocontrolled study was conducted at Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon Hospitals in Pune, Maharashtra, India among paediatric patients in the outpatient setting, after obtaining ethics committee clearance. Malnourished (moderately underweight) children were randomly allocated to either the probiotic group (B. coagulans SNZ 1969®) or the placebo group receiving the respective treatment for a duration of three months. Total days of illness, as well as the incidence of Gastrointestinal Tract (GIT) and Respiratory Tract Infections (RTIs), were assessed. Results: Out of 82 enrolled children, 46 (24 in the probiotic group and 22 in the placebo group) completed the full three-month study. A significant reduction in the total days of illness was observed in the probiotic group (p-value=0.009). Additionally, the probiotic group exhibited a slightly lower frequency of GIT and RTI episodes compared to the placebo group (1.32 vs. 1.48, p-value=0.077). A trend towards fewer days with respiratory symptoms in the probiotic group was noted compared to the placebo group (6.12±2.19 vs. 7.56±3.65; p-value=0.0687), along with a non significant decline in the occurrence of RTIs at the 31-60 and 61-90 day periods. Similar declining trends were observed for the occurrence of GI infections and total days with GI symptoms between the two groups (0.24±0.88 vs. 0.53±1.2; p-value=0.4593). B. coagulans SNZ 1969® treatment was welltolerated, and no severe adverse events were reported. Conclusion: The study demonstrated a significant reduction in the total days of illness with B. coagulans SNZ 1969® treatment compared to placebo. Additionally, B. coagulans SNZ 1969® treatment was found to be associated with a non significant decrease in the occurrence of GI and RTIs, as well as a relatively shorter duration of infection among malnourished children under five years of age.

Isolation may select for earlier and higher peak viral load but shorter duration in SARS-CoV-2 evolution

During the COVID-19 pandemic, human behavior change as a result of nonpharmaceutical interventions such as isolation may have induced directional selection for viral evolution. By combining previously published empirical clinical data analysis and multi-level mathematical modeling, we find that the SARS-CoV-2 variants selected for as the virus evolved from the pre-Alpha to the Delta variant had earlier and higher peak in viral load dynamics but a shorter duration of infection. Selection for increased transmissibility shapes the viral load dynamics, and the isolation measure is likely to be a driver of these evolutionary transitions. In addition, we show that a decreased incubation period and an increased proportion of asymptomatic infection are also positively selected for as SARS-CoV-2 mutated to adapt to human behavior (i.e., Omicron variants). The quantitative information and predictions we present here can guide future responses in the potential arms race between pandemic interventions and viral evolution.

Contact-number-driven virus evolution: A multi-level modeling framework for the evolution of acute or persistent RNA virus infection.

Viruses evolve in infected host populations, and host population dynamics affect viral evolution. RNA viruses with a short duration of infection and a high peak viral load, such as SARS-CoV-2, are maintained in human populations. By contrast, RNA viruses characterized by a long infection duration and a low peak viral load (e.g., borna disease virus) can be maintained in nonhuman populations, and the process of the evolution of persistent viruses has rarely been explored. Here, using a multi-level modeling approach including both individual-level virus infection dynamics and population-scale transmission, we consider virus evolution based on the host environment, specifically, the effect of the contact history of infected hosts. We found that, with a highly dense contact history, viruses with a high virus production rate but low accuracy are likely to be optimal, resulting in a short infectious period with a high peak viral load. In contrast, with a low-density contact history, viral evolution is toward low virus production but high accuracy, resulting in long infection durations with low peak viral load. Our study sheds light on the origin of persistent viruses and why acute viral infections but not persistent virus infection tends to prevail in human society.

Evaluation of Some Effective Factors in Response to Cryotherapy in Women with Condyloma Acuminata

Background and Objective: Condyloma acuminata is treated in different ways, each of which may have advantages and disadvantages. The present study aimed to evaluate the effective factors in response to cryotherapy treatment in women with condyloma acuminata. Materials and Methods: This case-control study was conducted on 200 women with condyloma acuminata who were candidates for cryotherapy and were referred to Farshchian Hospital (Sinai) in 2021-2022. Before starting cryotherapy, a biopsy sample was taken from the lesions to perform a polymerase chain reaction (PCR) and determine the genotype of the human papillomavirus. Based on the extracted subtype, the lesions were classified into three high-risk, medium- and low-risk groups. Cryotherapy was performed for each lesion once every two weeks and up to six sessions at most. Patients were examined one month after the last cryotherapy session in terms of recovery with no recovery. Non-response to treatment was considered the case group, and response was regarded as the control group. Results: In terms of genotype, 43% were high risk, 24.5% were intermediate, and 32.5% were low risk. The frequency of response to treatment was 37%. A response to cryotherapy of condyloma acuminata in the anogenital area of participating showed a significant correlation with age (P=0.008), lesion size (P=0.001), duration of disease (P=0.001), genotype (P=0.001), and lesion location (P =0.014). Conclusion: Response to cryotherapy treatment in anogenital condyloma acuminata warts is relatively low. Lesions in the vaginal area, younger age, the smaller size of lesions, and shorter duration of infection had a better prognosis after cryotherapy

Long-Term Infection and Pathogenesis in a Novel Mouse Model of Human Respiratory Syncytial Virus

Intensive efforts have been made to develop models of hRSV infection or disease using various animals. However, the limitations such as semi-permissiveness and short duration of infection have impeded their applications in both the pathogenesis of hRSV and therapeutics development. Here, we present a mouse model based on a Rag2 gene knockout using CRISPR/Cas9 technology. Rag2−/− mice sustained high viral loads upon intranasal inoculation with hRSV. The average peak titer rapidly reached 1 × 109.8 copies/g and 1c106 TCID50 in nasal cavity, as well as 1 × 108 copies/g and 1 × 105 TCID50 in the lungs up to 5 weeks. Mild interstitial pneumonia, severe bronchopneumonia, elevated cytokines and NK cells were seen in Rag2−/− mice. A humanized monoclonal antibody showed strong antiviral activity in this animal model, implying that Rag2−/− mice that support long-term stable infection are a useful tool for studying the transmission and pathogenesis of human RSV, as well as evaluating therapeutics.

Pharmacist-led standardization of total parenteral nutrition improves postoperative nutritional status in colorectal cancer patients.

BackgroundTotal parenteral nutrition (TPN) is an essential treatment for patients who undergo abdominal surgery. Due to the gap of knowledge background between clinicians and pharmacists, the participation of the latter may improve TPN standardization. However, the impact on clinical outcome is unknown. In this study, we evaluated the impact of appropriacy and efficacy of TPN prescription, after a pharmacist-led TPN standardization program introduced.MethodsA pharmacist-led TPN standardization program was introduced in the Zhejiang Cancer Hospital and the clinical outcomes were assessed. The TPN standardization program includes a pre-established standard multidisciplinary evaluation standard, a computerized TPN management system and regular evaluations of TPN prescription performed by pharmacists. Any concerns were identified and improved via discussed with doctors. To evaluate the effect of pharmacists’ intervention in nutritional status and postoperative complications, an observational before-and-after cohort study was performed. All patients admitted in hospital with colorectal cancer (CRC) and receiving abdominal surgery in June 2019 (pre-intervention cohort) and June 2020 (post-intervention cohort) were retrospectively analyzed. Nutritional status of patients was evaluated using the levels of postoperative serum albumin, prealbumin, total protein, and their decrease extent. Surgical or TPN-related complications and recovery time were collated as the clinical outcomes.ResultsThere were no significant differences in the basic clinical information of the two cohorts, suggesting that the two groups are comparable. The average postoperative prealbumin levels were elevated in 2020 compared to 2019 (192.3±5.5 mg/L for 2019 and 229.5±4.8 mg/L for 2020, P<0.001). In addition, the post-intervention cohort showed a lower postoperative infection rate (11.6% vs. 18.2%), shorter duration of infection (9.4±1.4 vs. 7.7±1.0 days), lower incidence of postoperative albumin decrease (25.2% vs. 76.7%), prealbumin decrease (71.5% vs. 78.9%), and total protein decrease (25.2% vs. 72.2%), and lower incidence of TPN-related hypoglycemia (5.4% vs. 15.3%).ConclusionsPharmacist-led TPN standardization improved the postoperative clinical outcomes in patients with colorectal cancer (CRC).

Lower probability and shorter duration of infections after COVID-19 vaccine correlate with anti-SARS-CoV-2 circulating IgGs.

The correlation between immune responses and protection from SARS-CoV-2 infections and its duration remains unclear. We performed a sanitary surveillance at the European Institute of Oncology (IEO) in Milan over a 17 months period. Pre-vaccination, in 1,493 participants, we scored 266 infections (17.8%) and 8 possible reinfections (3%). Post-vaccination, we identified 30 infections in 2,029 vaccinated individuals (1.5%). We report that the probability of infection post-vaccination is i) significantly lower compared to natural infection, ii) associated with a significantly shorter median duration of infection than that of first infection and reinfection, iii) anticorrelated with circulating antibody levels.

The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection.

The principle strategies of fracture-related infection (FRI) treatment are debridement, antimicrobial therapy, and implant retention (DAIR) or debridement, antimicrobial therapy, and implant removal/exchange. Increasing the period between fracture fixation and FRI revision surgery is believed to be associated with higher failure rates after DAIR. However, a clear time-related cut-off has never been scientifically defined. This systematic review analyzed the influence of the interval between fracture fixation and FRI revision surgery on success rates after DAIR. A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed (including MEDLINE), Embase, and Web of Science Core Collection, investigating the outcome after DAIR procedures of long bone FRIs in clinical studies published until January 2020. Six studies, comprising 276 patients, met the inclusion criteria. Data from this review showed that with a short duration of infection (up to three weeks) and under strict preconditions, retention of the implant is associated with high success rates of 86% to 100%. In delayed infections with a fracture fixation-FRI revision surgery interval of three to ten weeks, absence of recurrent infection was reported in 82% to 89%. Data on late FRIs, with a fracture fixation-FRI revision surgery interval of more than ten weeks, are scarce and a success rate of 67% was reported. Acute/early FRI, with a short duration of infection, can successfully be treated with DAIR up to ten weeks after osteosynthesis. The limited available data suggest that chronic/late onset FRI treated with DAIR may be associated with a higher rate of recurrence. Successful outcome is dependent on managing all aspects of the infection. Thus, time from fracture fixation is not the only factor that should be considered in treatment planning of FRI. Due to the heterogeneity of the available data, these conclusions have to be interpreted with caution. Cite this article: Bone Joint J 2021;103-B(2):213-221.

Treatment history: Factors that affect the outcome of hepatitis c virus treatment with interferon-alpha 2a/b and ribavirin

Introduction. Until the 1990s, there was no available treatment for chronic hepatitis C, but during this decade the benefits of interferon-alfa therapy were reported. At the end of the 1990s, the pegylated interferon-alfa 2a/b has significantly altered the treatment, whereas direct acting antivirals have significantly affected the treatment. The aim of this study was to show the most significant predictive factors of therapy response among patients with chronic hepatitis C treated with pegylated interferon- alfa 2a/b and ribavirin. Material and Methods. A non-randomized retrospective study included 292 patients with chronic hepatitis C treated at the Clinic for Infectious Diseases, Clinical Center of Vojvodina, from 2008 to 2015. Results. The study showed that therapeutic response was not affected by sex, serum viral load, or if the therapy was applied for the first time or repeated. A sustained virological response was statistically significantly more frequent in younger patients, as well as in patients without extrahepatic manifestations. Cases with higher progression of fibrosis were associated with lower chance for sustained virological response. Genotype 1 showed to be a predictor of adverse response to therapy, and genotype 3 as a predictor of sustained virological response. Steatosis was significantly less frequent in patients with genotype 1 with sustained virological response. Patients with a shorter duration of infection were more prone to sustained virological response. Conclusion. A positive response to pegylated interferon-alfa 2a/b and ribavirin was found in 70.20% of patients with chronic hepatitis C. Elderly age, late detection of the infection, hepatitis C virus 1 genotype, fibrosis progression, presence of hepatic steatosis, and extrahepatic manifestations were risk factors for poor treatment outcome.

Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?

This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution. To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery. SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable. In the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders. The overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis. Prophylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended. 3.

Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: a systematic review.

Background Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic; however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies. English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087). There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114-138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection. Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM; it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months.

Sero-surveillance and risk factors for avian influenza and Newcastle disease virus in backyard poultry in Oman

Avian Influenza (AI) and Newcastle disease (ND) are the most important reportable poultry diseases worldwide. Low pathogenic AI (H9N2) and ND viruses are known to have been circulating in the Middle East, including in Oman, for many decades. However, detailed information on the occurrence of these pathogens is almost completely lacking in Oman. As backyard poultry are not vaccinated against either virus in Oman, this sector is likely to be the most affected poultry production sector for both diseases. Here, in the first survey of AI and ND viruses in backyard poultry in Oman, we report high flock-level seroprevalences of both viruses. Serum and oropharyngeal swabs were taken from 2350 birds in 243 backyard flocks from all regions and governorates of Oman. Information was recorded on location, type of bird and housing type for each sampled farm. Individual bird serum samples were tested using commercial indirect antibody detection ELISA kits. Pooled oropharyngeal samples from each flock were inoculated onto FTA cards and tested by RT-PCR. Samples came from chickens (90.5%), turkeys (2.1%), ducks (6.2%), guinea fowl (0.8%) and geese (0.4%). The bird-level seroprevalence of antibody to AI and ND viruses was 37.5% and 42.1% respectively, and at the flock level it was 84% and 90% respectively. There were statistically significant differences between some different regions of Oman in the seroprevalence of both viruses. Flock-level NDV seropositivity in chickens was significantly associated with AIV seropositivity, and marginally negatively associated with flock size. AIV seropositivity in chickens was marginally negatively associated with altitude. All oropharyngeal samples were negative for both viruses by RT-PCR, consistent with a short duration of infection. This study demonstrates that eight or nine out of ten backyard poultry flocks in Oman are exposed to AI and ND viruses, and may present a risk for infection for the commercial poultry sector in Oman, or wild birds which could carry infection further afield.

Frequent Asymptomatic Respiratory Syncytial Virus Infections During an Epidemic in a Rural Kenyan Household Cohort.

Background. The characteristics, determinants, and potential contribution to transmission of asymptomatic cases of respiratory syncytial virus (RSV) infection have not been well described. Methods. A cohort of 47 households (493 individuals) in coastal Kenya was recruited and followed for a 26-week period spanning a complete RSV season. Nasopharyngeal swab specimens were requested weekly, during the first 4 weeks, and twice weekly thereafter from all household members, regardless of illness status. The samples were screened for a range of respiratory viruses by multiplex real-time polymerase chain reaction. Results. Tests on 16 928 samples yielded 205 RSV infection episodes in 179 individuals (37.1%) from 40 different households. Eighty-six episodes (42.0%) were asymptomatic. Factors independently associated with an increased risk of asymptomatic RSV infection episodes were higher age, shorter duration of infection, bigger household size, lower peak viral load, absence of concurrent RSV infections within the household, infection by RSV group B, and no prior human rhinovirus infections. The propensity of RSV spread in households was dependent on symptom status and amount (duration and load) of virus shed. Conclusions. While asymptomatic RSV was less likely to spread, the high frequency of symptomless RSV infection episodes highlights a potentially important role of asymptomatic infections in the community transmission of RSV.

The success of treatment of chronic hepatitis C in opiate addicts in Clinical center of Vojvodina

Chronic hepatitis C is a disease with a high prevalence in the population of intravenous drug users. Serious clinical course of the disease, which can lead to cirrhosis of the liver with all its complications, has a large epidemiological and clinical significance. This study was aimed at assessing the success of antiviral treatment of chronic hepatitis C in intravenous drug users and defining indicators of successful treatment in this population. This retrospective study included 316 patients treated with standard therapy for chronic hepatitis C, pegylated interferon and ribavirin, at the Department of Infectious Diseases, Clinical Center of Vojvodina in Novi Sad in the period from January 2007 to December 2012. The patients were divided into a group of intravenous drug users (n = 163) and a group of other modes of transmission of hepatitis C virus (n = 153). The indicators of successful treatment were measured in both groups. A total 51.57% of the subjects belonged to the group of intravenous drug users. The therapy was successful in 87.15% of cases, while the success was achieved in only 53.47% of cases in the group of patients infected otherwise. The positive effect of therapy was associated with younger age, shorter duration of infection, low levels of fibrosis and a higher percentage of infected with hepatitis C virus genotypes 2 and 3. The population of intravenous drug users can be effectively treated with the standard therapy for chronic hepatitis C, even more successfully than the population infected in some other way.

The role of the RNA chaperone Hfq in Haemophilus influenzae pathogenesis

BackgroundThe RNA binding protein Hfq of Haemophilus influenzae is highly homologous to Hfq from other bacterial species. In many of these other bacteria, Hfq affects the expression of a broad range of genes and enhances the ability to respond to stressful environments. However, the role of Hfq in H. influenzae is unknown.ResultsDeletion mutants of hfq were generated in the nontypeable H. influenzae strains R2866 and 86-028NP to assess the role of Hfq in these well characterized but genotypically and phenotypically divergent clinical isolates. A deletion mutation of hfq had no effect on growth of H. influenzae in nutrient rich media and had no effect on survival in several stressful conditions in vitro. However, the mutation resulted in a reduced ability to utilize heme from hemoglobin. The mutant and wild type strains were assessed for virulence and competitive fitness in models of invasive disease and otitis media. In the chinchilla model of otitis media, the hfq mutant of 86-028NP exhibited impaired competitive fitness when compared to its wild type progenitor but exhibited no apparent defect in virulence. In the infant rat model, deletion of hfq in R2866 resulted in reduced bacterial titers in blood and a shorter duration of infection when compared to the wild type strain in the competitive fitness study.ConclusionWe conclude that Hfq is involved in the utilization of essential nutrients and facilitates infection by H. influenzae.

Assessment of disease progression in patients with transfusion-associated chronic hepatitis C using transient elastography.

To evaluate the relationship between liver stiffness and duration of infection in blood transfusion-associated hepatitis C virus (HCV) patients with or without hepatocellular carcinoma (HCC). Between December 2006 and June 2008, a total of 524 transfusion-associated HCV-RNA positive patients with or without HCC were enrolled. Liver stiffness was obtained noninvasively by using Fibroscan (Echosens, Paris, France). The date of blood transfusion was obtained by interview. Duration of infection was derived from the interval between the date of blood transfusion and the date of liver stiffness measurement (LSM). Patients were stratified into four groups based on the duration of infection (17-29 years; 30-39 years; 40-49 years; and 50-70 years). The difference in liver stiffness between patients with and without HCC was assessed in each group. Multiple linear regression analysis was used to determine the factors associated with liver stiffness. A total of 524 patients underwent LSM. Eight patients were excluded because of unsuccessful measurements. Thus 516 patients were included in the current analysis (225 with HCC and 291 without). The patients were 244 men and 272 women, with a mean age of 67.8 ± 9.5 years. The median liver stiffness was 14.3 kPa (25.8 in HCC group and 7.6 in non-HCC group). The patients who developed HCC in short duration of infection were male dominant, having lower platelet count, with a history of heavier alcohol consumption, showing higher liver stiffness, and receiving blood transfusion at an old age. Liver stiffness was positively correlated with duration of infection in patients without HCC (r = 0.132, P = 0.024) but not in patients with HCC (r = -0.103, P = 0.123). Liver stiffness was significantly higher in patients with HCC than in those without in each duration group (P < 0.0001). The factors significantly associated with high liver stiffness in multiple regression were age at blood transfusion (P < 0.0001), duration of infection (P = 0.0015), and heavy alcohol consumption (P = 0.043). Although liver stiffness gradually increases over time, HCC develops in patients with high stiffness value regardless of the duration of infection.

Intravenous Drug Users Can Achieve a High Sustained Virological Response Rate: experience From Croatian Reference Center for Viral Hepatitis

Hepatitis C virus (HCV) is one of the major infectious disease agents among injecting drug users (IVDUs). However, most of the IVDUs are not still treated. To examine the treatment course, adherence, tolerability and safety profiles and SVR rates in IVDUs compared to non-IVDUs. Demographic and clinical data were collected from medical records of 345 adult patients diagnosed with chronic hepatitis C (CHC) who were treated with a PEG-IFN-α and ribavirin in Croatian Reference Center for Viral Hepatitis in Zagreb between January 2003 and January 2010. Efficacy, safety and tolerability treatment profiles were analyzed in IVDUs vs. non-IVDUs. Positive predictors for treatment outcome were evaluated by univariate and multivariate logistic regression. A total of 106 (30.46%) IVDUs were identified. The IVDUs were mainly male (81.13% vs. 52.30%, P = 0.0001), young (mean ± SD age: 32.46 ± 5.33 y vs. 46.12 ± 11.48 y, P = 0.0001), had lower fibrosis and HAI score (measured by ISHAK) and shorter duration of infection (mean ± SD: 8.98 ± 5.87 vs. 16.79 ± 8.99 y, P = 0.0001) compared to non-IVDU group. In IVDUs, genotype 1a (24.52%) and 3a (38.68%) were predominant. There were no differences in completion rate between the two studied groups. IVDUs achieved a significantly higher rate of overall SVR (70.75% vs. 51.04%, P < 0.0009) and in genotypes 1 and 4 (65.08% vs. 48.73%, P = 0.0294) vs. non-IVDUs. Treatment discontinuation rates due to side-effects were not significantly different in IVDUs and non-IVDUs (2.83% vs. 7.11%, P = 0.1390). IVDU group had a higher rate of lost to follow-up (13.21% vs. 4.60%, P = 0.0071). There were no statistically significant differences in SVR rate between IVDUs with, or without substitution therapy (55.55% vs. 74.62%, P = 0.0866). Independent predictors of SVR were age < 40 years and genotypes 2 and 3. Type of PEG-IFN-α used was not associated with SVR. Treatment of CHC in IVDUs should strongly be encouraged as they have positive predictors for achieving SVR such as younger age, shorter duration of infection, and consequently favorable histological stage of the disease, and good adherence to treatment. There is no difference in safety and tolerability profiles of treatment in IVDUs compared to patients with no history of drug abuse.

Gentamicin Improves the Activities of Daptomycin and Vancomycin against Enterococcus faecalis In Vitro and in an Experimental Foreign-Body Infection Model

For enterococcal implant-associated infections, the optimal treatment regimen has not been defined. We investigated the activity of daptomycin, vancomycin, and gentamicin (and their combinations) against Enterococcus faecalis in vitro and in a foreign-body infection model. Antimicrobial activity was investigated by time-kill and growth-related heat production studies (microcalorimetry) as well as with a guinea pig model using subcutaneously implanted cages. Infection was established by percutaneous injection of E. faecalis in the cage. Antibiotic treatment for 4 days was started 3 h after infection. Cages were removed 5 days after end of treatment to determine the cure rate. The MIC, the minimal bactericidal concentration (MBC) in the logarithmic phase, and the MBC in the stationary phase were 1.25, 5, and >20 μg/ml for daptomycin, 1, >64, and >64 μg/ml for vancomycin, and 16, 32, and 4 μg/ml for gentamicin, respectively. In vitro, gentamicin at subinhibitory concentrations improved the activity against E. faecalis when combined with daptomycin or vancomycin in the logarithmic and stationary phases. In the animal model, daptomycin cured 25%, vancomycin 17%, and gentamicin 50% of infected cages. In combination with gentamicin, the cure rate for daptomycin increased to 55% and that of vancomycin increased to 33%. In conclusion, daptomycin was more active than vancomycin against adherent E. faecalis, and its activity was further improved by the addition of gentamicin. Despite a short duration of infection (3 h), the cure rates did not exceed 55%, highlighting the difficulty of eradicating E. faecalis from implants already in the early stage of implant-associated infection.

P1-S4.22 Impact of a hypothetical chlamydia vaccine on population prevalence: a mathematical Modelling Study

BackgroundIt has not yet been possible to develop a Chlamydia trachomatis (chlamydia) vaccine but research to achieve this continues. It is therefore important to evaluate the potential impact of different...

Hepatitis C, liver transplantation, and why we should consider children separately

According to 2005 data from the Organ Procurement and Transplantation Network, hepatitis C is the leading indication for liver transplantation, accounting for more than 40% of cases. Among adults, 95% of transplanted livers are reinfected after surgery. Reinfection and progression of fibrosis in the new liver are associated with genotype, viral load, immune state, and age of the donor. In teasing out the factors that lead to reinfection, rarely is the age of the recipientmentioned. Yet as we have come to know hepatitis C, we have found that it is clearly an immune-mediated disease, with many disease features influenced by age, and thus facts stated for adults do not necessarily hold for children. Whereas transplantation for hepatitis C has been the center of many adult-focused studies, there is a paucity of equivalent information in the pediatric population. The NHANES III study estimates that 250,000 children in the United States are suspected of having hepatitis C. Because the disease often goes undetected, the number may be larger. The majority of children with hepatitis C have a relatively benign course before reaching adulthood. Liver enzymes are often normal, and rarely is there progression to cirrhosis. Autoimmune features such as cryoglobulinemia, vasculitis, and porphyria cutanea tarda are exceedingly rare. However, sometimes the disease is more aggressive, as in the case of the children presented by Barshes et al. in this issue. Certain aspects of hepatitis C are distinctly different in children compared with adults; for that reason, it is important to present and analyze pediatric data separately. The mode of acquisition, the ability to spontaneously clear the virus, and the response to antiviral therapy all differ. The most common modes of acquisition for children are maternal-fetal transfer or exposure to blood products, usually related to a comorbid process such as hemoglobinopathy or cancer. Maternal-fetal transfer depends on maternal immune state and the mother’s viral titers at the time of delivery. Transfer in healthy women ranges 1-7%, but it increases to 20% in the presence of coinfection with human immunodeficiency virus. However, unlike adults, and unlike children with hepatitis B, children who acquire this disease early in life have a good chance of clearing this virus. Ceci et al. report that up to 75% clear the virus by 2 years. Furthermore, the course in neonatal-acquired hepatitis C virus is slowly progressive, with little, if any, marked liver damage. Despite this optimistic data, hepatitis C is such a common disease that many children in the United States become chronically infected. As such, a number of patients will present with a more virulent course before adulthood. Children who acquire the disease through blood products have a different course. For these children, progression of fibrosis is tied to the underlying comorbidity. We suspect this by comparing data published regarding transfusion-acquired hepatitis C among different diseases. Transfusion-acquired hepatitis C after cardiac repair in infants tends to have a benign course, as shown by both Vogt et al. and Matsuoka et al., whereas transfusion-acquired hepatitis C for thalassemia and childhood cancers can have a much more aggressive course. Among the hemoglobinopathies, the accelerated rate of fibrosis parallels the degree of iron overload. In cancer, it is probably related to chemotherapy, radiation, and immune state. Response to treatment in children is surprisingly different than in adults. A meta-analysis of pediatric studies published between 1990 and 2000, before any multicenter large studies had been conducted, showed a sustained viral response (SVR) of 36% for monotherapy with interferon. Adults treated comparably only have 7-15% SVR. A more recent study in children aged