Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America最新文献_第9页

The duration, dynamics and determinants of SARS-CoV-2 antibody responses in individual healthcare workers 个体医护人员SARS-CoV-2抗体反应的持续时间、动态和决定因素

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-11-04 DOI: 10.1101/2020.11.02.20224824

S. Lumley, Jia Wei, D. O’Donnell, N. Stoesser, P. Matthews, A. Howarth, S. Hatch, B. Marsden, S. Cox, T. James, Liam J. Peck, Thomas G Ritter, Z. de Toledo, R. Cornall, E. Jones, D. Stuart, G. Screaton, Daniela Ebner, S. Hoosdally, D. Crook, C. Conlon, K. Pouwels, A. Walker, T. Peto, T. Walker, K. Jeffery, D. Eyre

{"title":"The duration, dynamics and determinants of SARS-CoV-2 antibody responses in individual healthcare workers","authors":"S. Lumley, Jia Wei, D. O’Donnell, N. Stoesser, P. Matthews, A. Howarth, S. Hatch, B. Marsden, S. Cox, T. James, Liam J. Peck, Thomas G Ritter, Z. de Toledo, R. Cornall, E. Jones, D. Stuart, G. Screaton, Daniela Ebner, S. Hoosdally, D. Crook, C. Conlon, K. Pouwels, A. Walker, T. Peto, T. Walker, K. Jeffery, D. Eyre","doi":"10.1101/2020.11.02.20224824","DOIUrl":"https://doi.org/10.1101/2020.11.02.20224824","url":null,"abstract":"Background SARS-CoV-2 IgG antibody measurements can be used to estimate the proportion of a population exposed or infected and may be informative about the risk of future infection. Previous estimates of the duration of antibody responses vary. Methods We present 6 months of data from a longitudinal seroprevalence study of 3217 UK healthcare workers (HCWs). Serial measurements of IgG antibodies to SARS-CoV-2 nucleocapsid were obtained. Bayesian mixed linear models were used to investigate antibody waning and associations with age, gender, ethnicity, previous symptoms and PCR results. Results In this cohort of working age HCWs, antibody levels rose to a peak at 24 (95% credibility interval, CrI 19-31) days post-first positive PCR test, before beginning to fall. Considering 452 IgG seropositive HCWs over a median of 121 days (maximum 171 days) from their maximum positive IgG titre, the mean estimated antibody half-life was 85 (95%CrI, 81-90) days. The estimated mean time to loss of a positive antibody result was 137 (95%CrI 127-148) days. We observed variation between individuals; higher maximum observed IgG titres were associated with longer estimated antibody half-lives. Increasing age, Asian ethnicity and prior self-reported symptoms were independently associated with higher maximum antibody levels, and increasing age and a positive PCR test undertaken for symptoms with longer antibody half-lives. Conclusion IgG antibody levels to SARS-CoV-2 nucleocapsid wane within months, and faster in younger adults and those without symptoms. Ongoing longitudinal studies are required to track the long-term duration of antibody levels and their association with immunity to SARS-CoV-2 reinfection.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81547785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 110

Discharge Delays and Costs Associated with Outpatient Parenteral Antimicrobial Therapy for High priced Antibiotics. 出院延误和费用与门诊肠外抗菌治疗有关的高价抗生素。

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1076

Monica L. Bianchini, Rachel M. Kenney, Robyn Lentz, M. Zervos, Manu Malhotra, S. Davis

{"title":"Discharge Delays and Costs Associated with Outpatient Parenteral Antimicrobial Therapy for High priced Antibiotics.","authors":"Monica L. Bianchini, Rachel M. Kenney, Robyn Lentz, M. Zervos, Manu Malhotra, S. Davis","doi":"10.1093/cid/ciz1076","DOIUrl":"https://doi.org/10.1093/cid/ciz1076","url":null,"abstract":"BACKGROUND\u0000Outpatient parenteral antimicrobial therapy (OPAT) is a widely-used safe and cost-effective treatment strategies. Most public and private insurance providers require prior authorization (PA) for OPAT, yet impact of the inpatient PA process is not known. This study aimed to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics.\u0000\u0000\u0000METHODS\u0000IRB-approved study of adult patients discharged with high-priced OPAT antibiotics from January to December 2017. Antibiotics included: daptomycin, ceftaroline, ertapenem, and the novel beta-lactam beta-lactam inhibitor combinations. Patients with an OPAT PA delay were compared to patients without. Primary endpoint: total direct hospital costs from the start of treatment. Secondary outcomes: discharge delay and 30-day readmission or mortality.\u0000\u0000\u0000RESULTS\u0000Two-hundred patients included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a sub-acute care facility compared to an outpatient setting: 37 (63%) vs 52 (37%), p=0.001. Discharge delays and median total direct hospital costs were higher in patients with OPAT delays: 31 (53%) vs 21 (15%), p<0.001; and $19,576 vs (IQR 10,056-37,038) vs $7,770 (IQR 3,031-13,974), p<0.001. In a multiple variable regression, discharge to a sub-acute care facility was associated with an increased odds of discharge delay while age over 64 years was associated with a decreased odds of discharge delay.\u0000\u0000\u0000CONCLUSIONS\u0000OPAT with high-priced antibiotics requires significant care coordination. PA delays for these antibiotics are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient are and address access barriers.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79271504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Hospitalization Rates and Outcomes among Persons Living with HIV in the Southeastern United States, 1996-2016. 1996-2016年美国东南部艾滋病毒感染者的住院率和结果

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1043

Thibaut Davy-Mendez, S. Napravnik, D. Wohl, A. Durr, Oksana Zakharova, Claire E Farel, J. Eron

{"title":"Hospitalization Rates and Outcomes among Persons Living with HIV in the Southeastern United States, 1996-2016.","authors":"Thibaut Davy-Mendez, S. Napravnik, D. Wohl, A. Durr, Oksana Zakharova, Claire E Farel, J. Eron","doi":"10.1093/cid/ciz1043","DOIUrl":"https://doi.org/10.1093/cid/ciz1043","url":null,"abstract":"BACKGROUND\u0000Advances in antiretroviral therapy, aging, and comorbidities impact hospitalization rates in HIV-infected populations. We examined temporal trends and patient characteristics associated with hospitalization rates and outcomes.\u0000\u0000\u0000METHODS\u0000Study population included patients in the University of North Carolina Center for AIDS Research HIV Clinical Cohort receiving clinical care 1996-2016. We estimated annual hospitalization rates, time to inpatient mortality or live discharge, and 30-day readmission risk using bivariable Poisson, Fine and Gray, and log-binomial regression models.\u0000\u0000\u0000RESULTS\u00004323 patients (29% women, 60% African-American) contributed 30 007 person-years. Overall, the hospitalization rate per 100 person-years was 34.3 (95% confidence interval [CI] 32.4, 36.4) with a mean change of -3% per year (95% CI -4%, -2%). Thirty-day readmission risk was 18.9% (95% CI 17.7%, 20.2%) and stable over time (P=0.21 and P=0.44 for 2010-2016 and 2003-2009, respectively, compared to 1996-2002). Patients who were Black (compared to White), older, had HIV RNA >400 copies/mL, or had CD4 count <200 cells/µL had higher hospitalization rates (all P<0.05). Higher inpatient mortality was associated with older age and lower CD4 (both P<0.05). Thirty-day readmission risk was higher among Black patients, those with detectable HIV RNA, and with lower CD4 cell counts (all P<0.05).\u0000\u0000\u0000CONCLUSIONS\u0000Hospitalization rates decreased from 1996 to 2016, but readmissions remained unchanged and high. Older patients, of minority race/ethnicity, and with uncontrolled HIV experienced higher rates and worse hospitalization outcomes. These findings underscore the importance of early diagnosis and treatment, linkage and retention in care, and care engagement at the time of hospital discharge.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85963990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 16

The effectiveness of Contact Precautions on methicillin-resistant Staphylococcus aureus (MRSA) in long-term care across the United States. 美国长期护理中耐甲氧西林金黄色葡萄球菌(MRSA)接触预防措施的有效性

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1045

D. Morgan, M. Zhan, Michihiko Goto, C. Franciscus, Bruce H. Alexander, M. Vaughan-Sarrazin, M. Roghmann, Lisa Pineles

{"title":"The effectiveness of Contact Precautions on methicillin-resistant Staphylococcus aureus (MRSA) in long-term care across the United States.","authors":"D. Morgan, M. Zhan, Michihiko Goto, C. Franciscus, Bruce H. Alexander, M. Vaughan-Sarrazin, M. Roghmann, Lisa Pineles","doi":"10.1093/cid/ciz1045","DOIUrl":"https://doi.org/10.1093/cid/ciz1045","url":null,"abstract":"BACKGROUND\u0000Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections in long-term care facilities (LTCF). The Centers for Disease Control and Prevention (CDC) recommends Contact Precautions for prevention of MRSA within acute care facilities and are being used within the United States Department of Veterans Affairs (VA) for LTCF in a modified fashion. The impact of Contact Precautions in long-term care is unknown.\u0000\u0000\u0000METHODS\u0000To evaluate if Contact Precautions decreased MRSA acquisition in LTCF compared to Standard Precautions we performed a retrospective effectiveness study (pre-post with concurrent controls) using data from the VA healthcare system from 1/1/2011 until 12/31/2015, two years before and after a 2013 policy recommending a more aggressive form of Contact Precautions.\u0000\u0000\u0000RESULTS\u0000Across 75,414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using Standard Precautions vs. Contact Precautions in multivariable discrete-time survival analysis, controlling for patient demographics, risk factors, and year of admission (Odds Ratio (OR) 0.97, 95% confidence interval (CI), 0.85-1.12, p=0.71).\u0000\u0000\u0000CONCLUSIONS\u0000MRSA acquisition and infections were not impacted by use of active surveillance and Contact Precautions in LTCF in the VA.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85125737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Carved in Stone with Consequences: Antibiotic Allergy Labels in Transplant Patients. 刻在石头上的后果:移植患者的抗生素过敏标签。

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1028

E. Shenoy, A. Ramsey

引用次数: 0

Transferrable Market Exclusivity Extensions to Promote Antibiotic Development: An Economic Analysis. 可转让市场专有权扩展促进抗生素发展:一项经济分析。

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1039

B. Rome, A. Kesselheim

{"title":"Transferrable Market Exclusivity Extensions to Promote Antibiotic Development: An Economic Analysis.","authors":"B. Rome, A. Kesselheim","doi":"10.1093/cid/ciz1039","DOIUrl":"https://doi.org/10.1093/cid/ciz1039","url":null,"abstract":"BACKGROUND\u0000To address the growing threat of multidrug resistant organisms, policymakers are seeking ideas to promote development of novel antibiotics. In 2018, the REVAMP Act was proposed in Congress to reward manufacturers of certain novel antibiotics with transferrable market exclusivity vouchers.\u0000\u0000\u0000METHODS\u0000We estimated the economic impact of this proposal by identifying antimicrobial drugs approved by the FDA from 2007 - 2016 that would likely have qualified for an exclusivity voucher and matching each drug to the highest-revenue fast-track drug facing generic entry within 4 years after the antibiotic was approved. Assuming a spending decrease of 75% after generic entry, we calculated the per-drug and total societal costs of these transferrable market exclusivity extensions over a decade.\u0000\u0000\u0000RESULTS\u0000We identified 10 antimicrobials that would have qualified for an exclusivity voucher, each of which was matched with one of 17 fast-track drugs facing generic entry through July 2019. These 10 drugs had a median annual revenue prior to generic entry of $249 million (range: $26 million - $2.7 billion). Accounting for a 75% spending reduction after generic entry, the median excess spending associated with 12 months of extended exclusivity was $187 million, for a total of $4.5 billion over 10 years.\u0000\u0000\u0000CONCLUSIONS\u0000While market exclusivity extensions are a politically appealing mechanism to encourage novel antibiotic development, this approach would cost public and private payers billions of dollars over the next decade.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90828763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Impact of a Multiplexed PCR Panel on Identifying Diarrheal Pathogens in Hematopoietic Cell Transplant Recipients. 多重PCR对造血细胞移植受者腹泻病原体鉴定的影响。

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1068

Wesley S Rogers, L. Westblade, R. Soave, S. Jenkins, K. van Besien, H. Singh, T. Walsh, C. Small, T. Shore, C. Crawford, M. Satlin

{"title":"Impact of a Multiplexed PCR Panel on Identifying Diarrheal Pathogens in Hematopoietic Cell Transplant Recipients.","authors":"Wesley S Rogers, L. Westblade, R. Soave, S. Jenkins, K. van Besien, H. Singh, T. Walsh, C. Small, T. Shore, C. Crawford, M. Satlin","doi":"10.1093/cid/ciz1068","DOIUrl":"https://doi.org/10.1093/cid/ciz1068","url":null,"abstract":"BACKGROUND\u0000Diarrhea is common and associated with substantial morbidity among hematopoietic cell transplant (HCT) recipients, but the etiology is often not identified. Multiplexed PCR assays increase the detection of diarrheal pathogens, but the impact of this technology in this population has not been evaluated.\u0000\u0000\u0000METHODS\u0000Our center replaced stool cultures and other conventional microbiological methods with the FilmArray® Gastrointestinal Panel (GI PCR) in June 2016. We reviewed all adult patients who received a HCT from June 2014-May 2015 (pre-GI PCR, n=163) and from June 2016-May 2017 (post-GI PCR, n=182) and followed them for one year after transplantation. Clostridioides difficile infection was diagnosed by an independent PCR test in both cohorts.\u0000\u0000\u0000RESULTS\u0000The proportion of patients with ≥1 identified infectious diarrheal pathogen increased from 25% to 37% after implementation of GI PCR (p=0.01). Eight patients (5%) in the pre-GI PCR cohort tested positive for a pathogen other than C. difficile, vs. 49 patients (27%) in the post-GI PCR cohort (p<0.001). The most common non-C. difficile diarrheal pathogens in the post-GI PCR cohort were enteropathogenic Escherichia coli (n=14, 8%), norovirus (n=14, 8%), and Yersinia enterocolitica (n=7, 4%). The percentage of diarrheal episodes with an identified infectious etiology increased from 14% to 23% (p=0.001). Median total costs of stool testing per patient did not increase (pre: $473; post: $425; p=0.25).\u0000\u0000\u0000CONCLUSIONS\u0000Infectious etiologies of diarrhea were identified in a higher proportion of HCT recipients after replacing conventional stool testing with a multiplexed PCR assay, without an increase in testing costs.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74464591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Antimicrobial stewardship and implementation of rapid multiplex respiratory diagnostics: Is there method in the madness? 抗菌药物管理和快速多重呼吸道诊断的实施:疯狂中有方法吗?

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1046

T. Timbrook

引用次数: 2

Declining Hospitalizations among Persons With HIV; Time to Leave no One Behind. 艾滋病毒感染者住院率下降;是时候不让任何人掉队了。

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1047

J. Colasanti, C. del Rio

引用次数: 1

Candidemia in the Growing Opioid Epidemic: A Distinct and Emerging Entity. 念珠菌在不断增长的阿片类药物流行:一个独特的和新兴的实体。

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America Pub Date : 2020-10-23 DOI: 10.1093/cid/ciz1065

D. Andes

引用次数: 1