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Novel ST398 methicillin susceptible Staphylococcus aureus (MSSA) in the United States was first observed in New York City (2004–2007); its diffusion across the country resulted in changing treatment options. Utilizing outpatient antimicrobial susceptibility data from the Veterans Health Administration from 2010 to 2019, the spatiotemporal prevalence of potential ST398 MSSA is documented.
In this systematic literature review and meta-analysis, we did not find a statistically significant difference in readmission and treatment failure rates between home-based and facility-based OPAT. Optimal patient selection for appropriate OPAT location appears to be more important than the location itself for the best OPAT outcome.
We performed a systematic literature review and meta-analysis on the effectiveness of coronavirus disease 2019 (COVID-19) vaccination against post-COVID conditions (long COVID) among fully vaccinated individuals.
Systematic literature review/meta-analysis.
We searched PubMed, Cumulative Index to Nursing and Allied Health, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to June 2, 2023, for studies evaluating the COVID-19 vaccine effectiveness (VE) against post-COVID conditions among fully vaccinated individuals who received two doses of COVID-19 vaccine. A post-COVID condition was defined as any symptom that was present four or more weeks after COVID-19 infection. We calculated the pooled diagnostic odds ratio (DOR) (95% confidence interval) for post-COVID conditions between fully vaccinated and unvaccinated individuals. Vaccine effectiveness was estimated as 100% x (1-DOR).
Thirty-two studies with 775,931 individuals evaluated the effect of vaccination on post-COVID conditions, of which, twenty-four studies were included in the meta-analysis. The pooled DOR for post-COVID conditions among fully vaccinated individuals was 0.680 (95% CI: 0.523–0.885) with an estimated VE of 32.0% (11.5%–47.7%). Vaccine effectiveness was 36.9% (23.1%–48.2%) among those who received two doses of COVID-19 vaccine before COVID-19 infection and 68.7% (64.7%–72.2%) among those who received three doses before COVID-19 infection. The stratified analysis demonstrated no protection against post-COVID conditions among those who received COVID-19 vaccination after COVID-19 infection.
Receiving a complete COVID-19 vaccination prior to contracting the virus resulted in a significant reduction in post-COVID conditions throughout the study period, including during the Omicron era. Vaccine effectiveness demonstrated an increase when supplementary doses were administered.
Background: Many clinical guidelines recommend that clinicians should use antibiograms to decide on empiric antimicrobial therapy. However, antibiograms aggregate epidemiologic data without consideration for any other factors that may affect the risk of antimicrobial resistance (AMR), and little is known about an antibiogram’s reliability in predicting antimicrobial susceptibility. We assessed the diagnostic accuracy of antibiograms as a prediction tool for E. coli clinical isolates in predicting the risk of AMR for individual patients. Methods: We extracted microbiologic and patient-level data from the nationwide clinical data warehouse of the Veterans Health Administration (VHA). We assessed the diagnostic accuracy of the antibiogram for 3 commonly used antimicrobial classes for E. coli: ceftriaxone, fluoroquinolones, and trimethoprim-sulfamethoxazole. First, we retrospectively generated facility-level antibiograms for all VHA facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli, according to the latest Clinical & Laboratory Standards Institute guideline. Second, we created a patient-level data set by including only patients who did not have a positive culture for E. coli in the preceding 12 months. Then we assessed the diagnostic accuracy of an antibiogram for E. coli to predict resistance for the isolates in the following calendar year, using logistic regression models with percentages in the antibiogram as dependent variables. We also set 5 stepwise thresholds at 80%, 85%, 90%, 95%, and 98%, and we calculated sensitivity, specificity, and accuracy for each antimicrobial. Results: Among 127 VHA hospitals, 1,484,038 isolates from 704,779 patients were available for analysis. The area under the ROC curve (AU-ROC) was 0.686 for ceftriaxone, 0.637 for fluoroquinolones, and 0.578 for trimethoprim-sulfamethoxazole, suggesting their relatively poor prediction performances (Fig. 1). The sensitivity and specificity of the antibiogram widely varied by antimicrobial groups and thresholds, with substantial trade-offs. Along with AU-ROC, these metrics suggest poor prediction performances when antibiograms are used as the sole prediction tool (Fig. 2). Conclusions: Antibiograms for E. coli have poor performances in predicting the risk of AMR for individual patients when they are used as a sole tool, and their contribution to the clinical decision making may be limited. Clinicians should also consider other clinical and epidemiologic data when interpreting antibiograms, and guideline statements that suggest antibiogram as a valuable tool for decision making in empiric therapy may need to be reconsidered. Further studies are needed to evaluate the contribution of antibiograms when combined with other patient-level factors.
Although multiple studies have revealed that coronavirus disease 2019 (COVID-19) vaccines can reduce COVID-19–related outcomes, little is known about their impact on post–COVID-19 conditions. We performed a systematic literature review and meta-analysis on the effectiveness of COVID-19 vaccination against post–COVID-19 conditions (ie, long COVID).
We searched PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to April 27, 2022, for studies evaluating COVID-19 vaccine effectiveness against post–COVID-19 conditions among individuals who received at least 1 dose of Pfizer/BioNTech, Moderna, AstraZeneca, or Janssen vaccine. A post–COVID-19 condition was defined as any symptom that was present 3 or more weeks after having COVID-19. Editorials, commentaries, reviews, study protocols, and studies in the pediatric population were excluded. We calculated the pooled diagnostic odds ratios (DORs) for post–COVID-19 conditions between vaccinated and unvaccinated individuals. Vaccine effectiveness was estimated as 100% × (1 − DOR).
In total, 10 studies with 1,600,830 individuals evaluated the effect of vaccination on post–COVID-19 conditions, of which 6 studies were included in the meta-analysis. The pooled DOR for post–COVID-19 conditions among individuals vaccinated with at least 1 dose was 0.708 (95% confidence interval (CI), 0.692–0.725) with an estimated vaccine effectiveness of 29.2% (95% CI, 27.5%–30.8%). The vaccine effectiveness was 35.3% (95% CI, 32.3%–38.1%) among those who received the COVID-19 vaccine before having COVID-19, and 27.4% (95% CI, 25.4%–29.3%) among those who received it after having COVID-19.
COVID-19 vaccination both before and after having COVID-19 significantly decreased post–COVID-19 conditions for the circulating variants during the study period although vaccine effectiveness was low.
Background: Avoiding unnecessary antipseudomonal coverage is 1 of the most common targets for antibiotic stewardship programs (ASPs), but little is known about the magnitude of facility-level variation in antipseudomonal agent utilization. We aimed to describe the variability in the use of antipseudomonal agents across inpatient settings within a nationwide integrated healthcare system. Method: We analyzed the data from a retrospective cohort of patients who were admitted to acute-care hospitals within the VHA system in 2019. We defined antipseudomonal agents as systemic antibiotics with activity against wild-type Pseudomonas aeruginosa, and we evaluated overall and antipseudomonal antibiotic use among 129 hospitals, according to the agents described in the NHSN Antimicrobial Usage and Resistance Module. We calculated each hospital’s overall and antipseudomonal days of therapy (DOT) per 1,000 days present and the proportion of antipseudomonal agent usage among all antibiotics based on DOT at each hospital. Hospital-level variation was assessed by comparing the proportion of total antibiotic consumption accounted for by antipseudomonal agents. Associations between antipseudomonal proportions and overall antibiotic consumption were also assessed. Results: Among 129 VHA hospitals, the median DOT per 1,000 days present for all antibiotics was 434.4 (IQR, 371.9–487.1), and the median antipseudomonal DOT per 1,000 days present was 127.7 (IQR, 99.8–159.6). The median proportion of total antibiotic consumption accounted for by antipseudomonal agents was 30.0% (range, 14.9%–40.7%; IQR, 26.4%–34.4%) (Fig. 1). We detected only a weak correlation between overall antibiotic consumption and antipseudomonal proportion (Pearson correlation coefficient, 0.396), which suggests that hospitals with higher total antibiotic consumption were not necessarily using more antipseudomonal agents. In a stratified analysis, there was more prominent hospital-level variability in surgical specialties than medical specialties (Fig. 2). Conclusions: We detected high hospital-level variability in the consumption and proportion of antipseudomonal antibiotics among an integrated healthcare system. Although it is plausible that these variabilities originated from case-mix differences among hospitals, including differing rates of P. aeruginosa infections, it may also highlight opportunities for reducing antipseudomonal antibiotic utilization, especially among surgical specialties. Further studies are needed to evaluate the contribution of modifiable patient- and facility-level factors to this variability.
To evaluate the frequency of antibiotic prescribing for common infections via telemedicine compared to face-to-face visits.
Systematic literature review and meta-analysis.
We searched PubMed, CINAHL, Embase (Elsevier platform) and Cochrane CENTRAL to identify studies comparing frequency of antibiotic prescribing via telemedicine and face-to-face visits without restrictions by publish dates or language used. We conducted meta-analyses of 5 infections: sinusitis, pharyngitis, otitis media, upper respiratory infection (URI) and urinary tract infection (UTI). Random-effect models were used to obtain pooled odds ratios (ORs). Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic test.
Among 3,106 studies screened, 23 studies (1 randomized control study, 22 observational studies) were included in the systematic literature review. Most of the studies (21 of 23) were conducted in the United States. Studies were substantially heterogenous, but stratified analyses revealed that providers prescribed antibiotics more frequently via telemedicine for otitis media (pooled odds ratio [OR], 1.26; 95% confidence interval [CI], 1.04–1.52; I2 = 31%) and pharyngitis (pooled OR, 1.16; 95% CI, 1.01–1.33; I2 = 0%). We detected no significant difference in the frequencies of antibiotic prescribing for sinusitis (pooled OR, 0.86; 95% CI, 0.70–1.06; I2 = 91%), URI (pooled OR, 1.18; 95% CI, 0.59–2.39; I2 = 100%), or UTI (pooled OR, 2.57; 95% CI, 0.88–7.46; I2 = 91%).
Telemedicine visits for otitis media and pharyngitis were associated with higher rates of antibiotic prescribing. The interpretation of these findings requires caution due to substantial heterogeneity among available studies. Large-scale, well-designed studies with comprehensive assessment of antibiotic prescribing for common outpatient infections comparing telemedicine and face-to-face visits are needed to validate our findings.
A questionnaire was distributed to hospitals in Tokyo (N = 38) regarding their preparedness against and in-facility transmission of coronavirus disease 2019 (COVID-19). As of May 31, 2020, 284 HCP had contracted COVID-19, and in-facility COVID-19 transmission occurred at 13 hospitals, negatively impacting hospital functions and patient care.
Background: Shortages of essential medicines, a long-standing issue in healthcare, apply equally to antimicrobial agents, a group of essential drugs necessary for sustainable healthcare. The WHO categorized essential medicines into the access, watch, and reserve groups. Older antimicrobials, in particular, were categorized into the access group, meaning that these drugs are in theory widely available at an affordable cost. The shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, which often has the undesirable consequence of defeating antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. In Japan, cefazolin has been in critically short supply since March 2019. Cefazolin is a first-line agent against common infectious diseases and in surgical antimicrobial prophylaxis, and its shortage has substantially impacted inpatient care. The aim of the present study was to investigate changes in antimicrobial practice at a tertiary-care center in Japan following the emergence of the national cefazolin shortage in March 2019. Methods: Data on each antimicrobial use are logged as days of therapy (DOT) per 1,000 patient days (PD) for antimicrobial stewardship purposes at the study institution. We extracted weekly data from September 2018 to September 2019 to evaluate the impact of the national cefazolin shortage on antimicrobial use at our tertiary-care center. Changes in weekly antimicrobial use and the weekly incidence of Clostridium difficile infections were analyzed by interrupted time series analysis. We also investigated changes in antimicrobial practice at selected situations. Results: As weekly cefazolin use significantly declined after the emergence of the national shortage, use of third-generation cephalosporin (+18.9 DOT per 1,000 PD for intercept [P < .001] and +0.65 DOT per 1,000 PD per week for trend [P = .037]) and clindamycin (18 DOT per 1,000 PD for intercept [P = .008] and 0.12 DOT per 1,000 PD per week for trend [P = .003]) significantly increased. Significant changes in antimicrobial practice were also observed in surgical antimicrobial prophylaxis: third-generation cephalosporin use increased from 1.0% (31 of 3,032) to 62.9% (2,237 of 3,554) (P < .001). However, no significant change in the incidence of Clostridium difficile infection was observed during the study period: +1.72 per 10,000 PD for intercept (P = .12) and 0.12 per 10,000 PD per week for the trend (P = .09). Conclusions: The national cefazolin shortage had a significantly negative impact on patient care and led to increased use of alternative, broader-spectrum antimicrobials, which are not ideal choices either for prophylaxis or treatment.
Four patients presented with hemiballism-hemichorea as a clinical manifestation of white matter ischemia. These patients illustrate “positive” motor phenomena rather than limb weakness as a consequence of cerebral ischemia. In each patient, the involuntary movements disappeared following worsening of paresis. Subcortical white matter infarction in three patients and hemodynamic hypo-perfusion in the cerebral hemisphere contralateral to dyskinetic movements were possible causes. Neuroradiologically, none had pathological changes in the vicinity of the subthalamic nucleus. We presume from these observations that ischemia of the subcortical white matter, without involvement of the basal ganglia or the subthalamic nucleus, may cause hemiballism-hemichorea
A magnetically enhanced capacitively coupled plasma source was developed for sputter deposition of Cu seed layers on sub 0.25µm via or contact holes. The plasma source is of planer parallel plate configuration where the Cu target plate is one of the electrodes. For the generation of plasma, 60 MHz rf power is selected in order to increase the plasma density. Additionally, a line cusp magnetic field is used to further increase the plasma density. The film deposition rate and uniformity obtained with this plasma source is∼200 nm/min and ∼±5%, respectively. The Cu film resistivity lies around 2 µωcm. This sputtering system yields good film coverage on bottom and sidewalls of via holes with an aspect ratio > 5; therefore, a perfect Cu filling could be realized by electroplating process.
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