Search Results (97)

In this paper we aimed to compare seasonality, clinical characteristics, and outcomes of Influenza A and COVID-19 in the context of influenza reemergence and ongoing Omicron circulation. We performed a retrospective comparative analysis at the Teaching Hospital of Infectious Diseases in Cluj-Napoca, Romania. We included adult patients hospitalized with Influenza A or COVID-19 between 1 November 2022 and 31 March 2024. Data were collected on demographics, clinical presentation, complications, and in-hospital mortality. We included 899 COVID-19 and 423 Influenza A patients. The median age was 74 years for COVID-19 and 65 for Influenza A (p < 0.001). The age-adjusted Charlson comorbidity index was higher in COVID-19 patients (5 vs. 3, p < 0.001). Despite this age gap, acute respiratory failure was more common in Influenza A (62.8% vs. 55.7%, p = 0.014), but ventilation rates did not differ significantly. Multivariate models showed Influenza A was associated with increased risk of intensive-care unit (ICU) admission or ventilation, whereas older COVID-19 patients had higher in-hospital mortality (5.67% vs. 3.3%, p = 0.064). Omicron COVID-19 disproportionately affected older patients with comorbidities, contributing to higher in-hospital mortality. However, Influenza A remained a significant driver of respiratory failure and ICU admission, underscoring the importance of preventive measures in high-risk groups. Full article

Staphylococcus aureus infections are an important cause of morbidity and mortality among patients in intensive care units (ICUs), particularly those with multiple comorbidities and critical conditions. Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains differ in resistance, clinical behavior, and prognoses, making it important to understand their effects on clinical outcomes. Comparing clinical outcomes of MRSA and MSSA infections is important. This retrospective cohort study analyzed ICU patients with confirmed S. aureus infections at a quaternary care hospital. Demographic, clinical, and comorbidity data were collected. Poisson regression was used to analyze 7-day mortality and identify adjusted risk factors. Seven-day mortality was higher in patients with MSSA than MRSA infections, with an adjusted relative risk for MRSA of 0.380 (95% confidence interval: 0.15–0.95; p = 0.039). Independent risk factors for mortality included lack of an infectious disease consultation, vascular comorbidities, such as peripheral vascular disease and cerebrovascular events, chronic kidney disease, and inotropic support requirement. Patients with MRSA infections required significantly longer ventilatory support (mean 43.5 days vs. 13 days for MSSA; p = 0.019). Staphylococcus aureus infections in ICU patients were associated with poor outcomes, particularly in patients without infectious disease consultation and those with vascular comorbidities. Mortality differences between MRSA and MSSA highlight the importance of appropriate empiric therapy and standardized protocols incorporating infectious disease consultation to improve outcomes in critically ill patients. Full article

Background/Objectives: Due to challenges in securing hospital beds, elderly patients may face prolonged emergency department (ED) stays. Recent studies have highlighted an association between ED overnight stays (EDOSs) before admission and increased mortality. This study aimed to evaluate the potential impact of EDOSs on mortality among elderly patients awaiting a regular bed in a standard hospital ward. Methods: This monocentric, retrospective study included subjects ≥ 75 years who required urgent hospitalization between 2017 and 2022. Two groups were compared: patients hospitalized between 00:00 and 08:00 following an ED overnight stay (EDOS group), and those admitted directly to conventional medical units between 08:00 and 00:00 (Ward group). The primary outcome was in-hospital mortality 30 days after ED visit. Results: Among the 20,009 patients included (median age: 85 years [IQR: 80–89]), 3064 (15.3%) belonged to the EDOS group, while 16,945 (84.7%) were in the Ward group. In-hospital mortality occurred in 3020 cases (15.1%), with no significant differences observed between the groups. The variables identified by the logistic model as predictors of mortality included age > 85 years, Charlson Comorbidity Index (CCI) ≥ 5, National Early Warning Score (NEWS) > 6 at arrival, infectious diseases, respiratory diseases, and circulatory system diseases, yielding an accuracy of 0.700 ± 0.007. EDOS while awaiting inpatient beds was not a predictor of mortality. Conclusions: The results of our study did not show an association between mortality and EDOS, even when considering the large sample size collected over 6 years and the varying percentages of patients awaiting hospital beds. Full article

Background/Objectives: This study mapped antibody dynamics across three COVID-19 vaccination rounds (primary course, first, and second booster with BNT162b2) in Belgian nursing home residents (NHRs). Methods: Within a national SARS-CoV-2 serosurveillance study (February 2021–September 2022) across Belgian nursing homes, dried blood spots were collected, on which anti-spike SARS-CoV-2 IgG antibodies were quantified by ELISA in international units/mL (IU/mL). Sociodemographic data were collected at the study start and infection history and vaccination data at each sampling round. Results: Infection-naïve NHRs had low antibody levels after primary course vaccination (geometric mean concentration (GMC) 292 IU/mL, 95% confidence interval (95% CI): 197–432), but increased tenfold after first booster (GMC 2168 IU/mL, 95% CI: 1554–3027). While antibodies among NHRs significantly declined within six months after primary vaccination (p < 0.0001), they remained stable for nine months post-booster (p > 0.05). Among primary vaccine non-responders, 92% (95% CI: 82–97%) developed antibodies after the first booster (GMC 594 IU/mL, 95% CI: 416–849), though tenfold lower than initial responders (GMC 4642 IU/mL, 95% CI: 3577–6022). Conclusions: These findings demonstrate that NHRs require tailored vaccination, prioritizing repeated immunization to improve serological outcomes in poor responders such as infection-naive NHRs. Regular immune monitoring could aid in implementing evidence-based vaccine strategies, ensuring optimal protection for vulnerable populations against SARS-CoV-2 and other infectious threats. Full article

Highly Urbanized Cities (HUCs) in the Philippines were at the forefront of public health surveillance and response during the COVID-19 pandemic. With the rapid spread of COVID-19 to Philippine cities, local government units continuously assessed, adapted, and implemented public health interventions (PHIs) and depended on available open-source government data (OSGD). This study consolidated PHIs in selected HUCs in the Philippines using high-quality OSGD to create a timeline of interventions and document good practices in local COVID-19 control. OSGD resources were collected from February 2020 to January 2023, and the data quality of OSGD was evaluated using the Journal of the American Medical Association (JAMA) benchmarks. A total of 180 metadata sources that met at least two core standards (Authorship and Currency) were included in the analysis. COVID-19 control strategies were analyzed vis-à-vis the rise of COVID-19 cases and types of PHIs, including the control of imported cases, case management, contact management, behavioral modification, and pharmaceutical intervention. Travel bans and hard lockdowns in Luzon early in the pandemic delayed the introduction of COVID-19 to other parts of the country. Good practices of LGUs for local COVID-19 control, such as quarantine passes, curfews and liquor bans, using QR-based contact tracing, massive community testing in high-risk communities, and free public swabbing centers, were implemented to slow down the local spread of COVID-19. With the evolving scenarios in city-level COVID-19 epidemics, local risk assessments based on available OSGD drove the adoption of relevant and innovative control strategies in HUCs in the Philippines. Lessons learned must be integrated into epidemic preparedness and response programs against future emerging or re-emerging infectious diseases. Full article

Background/Objectives: Antimicrobial stewardship programs improve antimicrobial use and help combat antimicrobial resistance. The Infectious Disease Society of America’s (IDSA) recommended core interventions include prospective audit and feedback along with formulary restriction and preauthorization. IDSA recommends any one of these interventions be implemented in acute care hospitals to improve antimicrobial stewardship. The objective of this project was to implement a prospective audit and feedback system using selected antimicrobials at a tertiary care hospital in the United Arab Emirates as the foundation to build an antimicrobial stewardship program. Results: A total of 497 patients met the inclusion and exclusion criteria during the study period; the post-intervention group had 260 patients, and the control group had 237 patients. After the implementation of the program, a total of 186 interventions were recommended, and 76% were accepted. The length of stay, length of therapy, and days of therapy were lower in the intervention group compared to the control group (p < 0.05). There was no statistically significant difference in clinical outcome measures (e.g., 30-day readmission, 30-day all-cause mortality, 30-day emergency visit with the same infection, and 60-day readmission). Methods: This single-center quasi-experimental research was conducted from August 2023 to July 2024. A pharmacist-led prospective audit and feedback system was initiated in February 2024 after review and approval of the medical staff, in addition to formulary restrictions. Data from patients receiving the selected antimicrobial before February 2024 were collected from their charts and related medical records without any intervention; this was used by our control group. After implementation, the hospital pharmacy’s records were evaluated during the night shift to determine whether they met the inclusion criteria. The records of the eligible patients were then evaluated by the clinical pharmacist. In case of antimicrobial inappropriateness, feedback was provided to the prescriber. If the recommendation was not accepted, succeeding reviews and feedback were provided on subsequent days. The effectiveness of the intervention was measured using clinical and antibiotic use measures. Conclusions: Implementation of a pilot pharmacist-led antimicrobial stewardship program resulted in modification in antimicrobial use measures (i.e., defined daily doses of targeted antimicrobials and days of antimicrobial therapy) without an increase in length of stay or readmissions or mortality. Full article

Objective: This study investigated the impact of maternal subclinical hypothyroidism on fetal thymus size and development and explored how inadequate thyroid hormone production in pregnant women affects the fetal thymus. Methods: Conducted at the Giresun Obstetrics, Gynecology, and Pediatrics Training and Research Hospital, this case–control study involved 86 pregnant women, 43 with hypothyroidism and 43 without. Maternal thyroid function was assessed using TSH and free T4 levels, and fetal thymus size and thymus–thorax ratio were measured using ultrasound. Exclusion criteria were chronic hypertension, gestational hypertension or eclampsia, multiple pregnancies, infectious diseases, renovascular diseases, diagnosed with hypothyroidism prior to pregnancy and other endocrine disorders, fetal cardiac diseases, and morbid obesity. Data collected included maternal age, gestational week, number of pregnancies, parity, number of living children, thyroid-stimulating hormone (TSH) and Free thyroxine 4 (T4) levels, and fetal thymus measurements (transverse diameter and thymus/thorax ratio). Statistical analyses were performed using the Mann–Whitney U test and logistic regression analysis. The relationships between TSH, thymus diameters, thorax diameters, and the thymus–thorax ratio were evaluated using Spearman’s correlation coefficient. Results: The thymus–thorax ratio was significantly reduced in the hypothyroid group (p = 0.003). Logistic regression analysis identified TSH as an independent risk factor for a low thymus–thorax ratio, with each unit increase in TSH associated with a 1.345-fold higher likelihood of having a low thymus–thorax ratio. A significant negative correlation was found between TSH levels and the TTR ratio (Spearman’s correlation coefficient r = −0.338, p = 0.001). Conclusions: An association was identified between maternal TSH levels and the thymus–thorax ratio, with increasing TSH levels correlating with a decrease in the thymus–thorax ratio. Regular monitoring of thyroid hormone levels during pregnancy and appropriate replacement treatment in cases of deficiency are crucial for optimal fetal thymus development. Further multicenter studies are needed to confirm these findings and investigate the long-term implications of altered fetal thymus development. Full article

Background: The emergence of more than 40 new infectious diseases since the 1980s has emerged as a serious global health concern, many of which are zoonotic. In response, many international organizations, including the US Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the European Center for Disease Prevention and Control (ECDC), have developed strategies to combat these health threats. The need for rapid vaccine development has been highlighted by Coronavirus disease 2019 (COVID-19), and mRNA technology has shown promise as a platform. While the acceleration of vaccine development has been successful, concerns have been raised about the technical limits, safety, supply, and distribution of vaccines. Objective: This study analyzes the status of vaccine platform development in global pandemics and explores ways to respond to future pandemic crises through an overview of the roles of international organizations and their support programs. It examines the key roles and partnerships of international organizations such as the World Health Organization (WHO), vaccine research and development expertise of the Coalition for Epidemic Preparedness Innovations (CEPI), control of the vaccine supply chain and distribution by the Global Alliance for Vaccines and Immunization (GAVI), and technology transfer capabilities of the International Vaccine Institute (IVI) in supporting the development, production, and supply of vaccine platform technologies for pandemic priority diseases announced by WHO and CEPI and analyzes their vaccine support programs and policies to identify effective ways to rapidly respond to future pandemics caused by emerging infectious diseases. Methods: This study focused on vaccine platform technology and the key roles of international organizations in the pandemic crisis. Literature data on vaccine platform development was collected, compared, and analyzed through national and international literature data search sites, referring to articles, journals, research reports, publications, books, guidelines, clinical trial data, and related reports. In addition, the websites of international vaccine support organizations, such as WHO, CEPI, GAVI, and IVI, were used to examine vaccine support projects, initiatives, and collaborations through literature reviews and case study methods. Results: The COVID-19 pandemic brought focus on the necessity for developing innovative vaccine platforms. Despite initial concerns, the swift integration of cutting-edge development technologies, mass production capabilities, and global collaboration have made messenger RNA (mRNA) vaccines a game-changing technology. As a result of the successful application of novel vaccine platforms, it is important to address the remaining challenges, including technical limits, safety concerns, and equitable global distribution. To achieve this, it is essential to review the regulatory, policy, and support initiatives that have been implemented in response to the COVID-19 pandemic, with particular emphasis on the key stages of vaccine development, production, and distribution, to prepare for future pandemics. An analysis of the status of vaccine development for priority pandemic diseases implies the need for balanced vaccine platform development. Also, international organizations such as WHO, CEPI, GAVI, and IVI play key roles in pandemic preparedness and the development and distribution of preventive vaccines. These organizations collaborated to improve accessibility to vaccines, strengthen the global response to infectious diseases, and address global health issues. The COVID-19 pandemic response demonstrates how the synergistic collaboration of WHO’s standardized guidelines, CEPI’s vaccine research and development expertise, GAVI’s control of the vaccine supply chain and distribution, and IVI’s technology transfer capabilities can be united to create a successful process for vaccine development and distribution. Conclusions: In preparation for future pandemics, a balanced vaccine platform development is essential. It should include a balanced investment in both novel technologies such as mRNA and viral vector-based vaccines and traditional platforms. The goal is to develop vaccine platform technologies that can be applied to emerging infectious diseases efficiently and increase manufacturing and distribution capabilities for future pandemics. Moreover, international vaccine support organizations should play key roles in setting the direction of global networking and preparing for international vaccine support programs to address the limitations of previous pandemic responses. As a result, by transforming future pandemic threats from unpredictable crises to surmountable challenges, it is expected to strengthen global health systems and reduce the social and economic burden of emerging infectious diseases in the long term. Full article

Background: Infections caused by S. aureus strains encoding Panton–Valentine leukocidin (PVL-SA) have become increasingly relevant in community settings and can cause severe conditions in pediatric populations. We present the pediatric case of an invasive disease caused by PVL-SA and provide a literature review of severe manifestations caused by these strains in children. Methods: A PubMed search (February 2024) found studies that included relevant clinical outcomes, diagnostics, and treatments, excluding cases of asymptomatic infection or in adult populations. A logistical multivariate analysis was used to find predictors of the need for intensive care. Results: A 10-year-old boy came to the attention of our Pediatric Infectious Diseases Unit with fever, chest pain, and tachypnea. A rapid worsening of his clinical conditions was observed, with the development of necrotizing pneumonia, osteomyelitis, deep vein thrombosis (DVT), and multiple abscesses. Blood cultures confirmed the presence of PVL-producing methicillin-resistant S. aureus (MRSA). The initial treatment included linezolid and ceftaroline and was later adjusted to clindamycin, daptomycin, and fosfomycin, with clinical improvement. Discussion: Our review collected 36 articles, including 156 pediatric cases of severe PVL-SA infection. Bacteremia was present in 49% of cases, lung infection in 47%, and osteomyelitis in 37%. The presence of pulmonary localization was predictive of the need for intensive care, O.R. 25.35 (7.46–86.09; p < 0.001). Anti-toxin molecules were used in about half the cases where information on treatment was reported. Our report highlights the capacity of PVL-SA to cause life-threatening complications in children, while also discussing the full range of its clinical spectrum and the most effective therapeutic approaches. Full article

Genital herpes simplex virus (HSV) is associated with a reduction in quality of life and adverse outcomes. The aim of this study is to assess the interest and expectations for a therapeutic HSV vaccine among individuals diagnosed with genital herpes in Italy. A retrospective survey was conducted at the Infectious Diseases Unit of the IRCCS San Raffaele Scientific Institute, Milan, Italy. The study collected data on demographics, clinical history and interest in HSV vaccination. The results showed that 87.5% of participants were interested in a therapeutic vaccine, with interest higher among younger people and those with frequent genital herpes recurrences. Participants most expected the vaccine to reduce the pain associated with outbreaks, followed by a reduction in the frequency and duration of recurrences. These findings underscore the strong demand for a therapeutic HSV vaccine, especially among those who experience recurrent outbreaks, and highlight the importance of considering patient expectations when developing preventive and therapeutic strategies for genital herpes. Full article

Background: Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years. Methods: We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014–September 2015), post-implementation (October 2015–March 2020), and COVID-19 (April 2020–August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed. Results: The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time. Conclusions: The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance. Full article

Air sanitization is an important non-pharmaceutical intervention for mitigating the risk of indoor pathogen spreading. A dipropylene glycol-containing air sanitizer was tested against aerosolized Staphylococcus aureus and Klebsiella pneumoniae. The bacteria, suspended in a soil load, were aerosolized using a six-jet Collison nebulizer with pressurized air. The 25-m³ (~900 ft³) aerobiology chamber was maintained at 22 ± 2 °C and 50 ± 5% relative humidity per the U.S. Environmental Protection Agency’s 2012 Guidelines on air sanitizers. An initial 2-min air sample was collected from the chamber using a slit-to-agar sampler containing 150-mm Petri plates, with Trypticase soy agar (TSA) containing neutralizers to quench the microbicidal activity of the air sanitizer, to determine the initial bacterial challenge in the air. The air sanitizer was sprayed into the chamber from pressurized cans. Additional air samples were collected from the chamber over 10 min to detect surviving bacteria. The TSA plates were then incubated aerobically at 36 ± 1 °C for 90 ± 4 h and scored for bacterial colony-forming units. A 30-s spray of the air sanitizer reduced infectious S. aureus and K. pneumoniae titers by 3.0 log₁₀ (99.9%) in 3.2 ± 0.3 min and 1.2 ± 0.0 min, respectively. Based on these findings, the EPA granted registration of the air sanitizer as the first product of its kind for indoor air sanitization. Full article

Background/Objectives: Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but severe post-infectious complication of COVID-19 that often requires admission to the Pediatric Intensive Care Unit (PICU). The present study aimed to compare the demographic, clinical, and laboratory characteristics of children diagnosed with MIS-C who were admitted to the PICU and those who did not require PICU admission. Methods: Children diagnosed with MIS-C from September 2020 to April 2023 were included in this case-control study. Demographic, clinical, and laboratory data were collected from medical records. Results: Fifty children with MIS-C were included in the study [median (IQR) age: 7.5 (4.3, 11.4) years, 28/50 (56%) males]. Twenty-two (22/50, 44%) children required admission to the PICU. In the multivariate regression analysis, hepatic (OR: 12.89, 95%CI: 1.35–123.41, p-value = 0.03) and cardiological involvement (OR: 34.55, 95%CI: 2.2–541.91, p-value = 0.01) were significantly associated with hospitalization at the PICU. Regarding the laboratory and imaging parameters during the first 48 h from admission, D-dimer levels higher than 4 μg/mL and decreased Left Ventricular Ejection Fraction (LVEF) were associated with an increased risk of PICU admission (OR: 7.95, 95%CI: 1.48–42.78, p-value = 0.02 and OR = 1.28, 95%CI: 1.07–1.53, p-value = 0.01). Children who were admitted to the PICU were more likely to develop complications during their hospitalization (10/22, 45.5% vs. 3/28, 10.7%, p-value = 0.005) and were hospitalized for more days than children in the pediatric ward (median length of stay (IQR): 20 (15, 28) days vs. 8.5 (6, 14) days, p-value < 0.001). Conclusions: The findings of this study indicate that cardiovascular and hepatic involvement and increased D-dimer levels in children with MIS-C might be associated with admission to the PICU. Full article

This study investigates the prevalence and patterns of transmitted drug resistance mutations (TDRMs) and HIV-1 subtypes among antiretroviral therapy (ART) naïve individuals in Veneto, Italy, from 2017 to 2024. This research aims to understand the dynamic landscape of TDRMs and HIV-1 genetic diversity to inform treatment strategies effectively. We included all adult ART-naïve people with HIV (PWH) from seven infectious disease units in Veneto, Italy. We collected the genotypic resistance testing conducted to predict drug susceptibility and subtype distribution using the Stanford HIVdb algorithm. We included 762 PWH, showing a slight but statistically significant decline in the B subtype among Italian PWH (p = 0.045) and an increase in non-B subtypes among foreigners, though it was not statistically significant (p = 0.333). The most frequent mutations were in Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs), especially in non-B subtypes, with a notable rise from 10.7% in 2017–2019 to 15.5% in 2020–2024. Notably, TDRMs were consistently detected, highlighting an ongoing challenge despite the stable prevalence observed over the years. In addition, the data revealed a concerning rise in mutations against newer drug classes, such as integrase inhibitors. Conclusively, the study underscores the necessity of continuous surveillance of HIV subtypes and resistance patterns to adapt ART regimens optimally. Despite the stable levels of drug resistance, the emergence of resistance against newer drugs necessitates ongoing vigilance and possible adjustment in treatment protocols to enhance clinical outcomes and manage HIV drug resistance effectively. Full article

Background: One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology–hematology ward. Methods: a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology–hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. Results: fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259–0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious’ relapses (15%). Conclusions: ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects. Full article