JAMMI最新文献

{"title":"Community and Hospital HIV Follow-Up Clinics Achieve Similar Lumbar Puncture and Syphilis Treatment Success in Patients with HIV-Syphilis Coinfection: Saskatoon, SK, Canada.","authors":"Samuel Seshadri, Cara Spence, Tanna Lauriente, Stephen Sanche, Beverly Wudel","doi":"10.3138/jammi-2024-0038","DOIUrl":"10.3138/jammi-2024-0038","url":null,"abstract":"<p><strong>Background: </strong>The rates of HIV and syphilis in Saskatchewan (SK) have been rising rapidly in recent years. The syndemic has raised concern for neurosyphilis, a complication that can occur at any stage of syphilis and is more common in people living with HIV (PLWH). Criteria published by the Public Health Agency of Canada recommends considering a lumbar puncture (LP) in patients with concomitant HIV and syphilis infection whose rapid plasma reagin (RPR) titre is ≥1:32 or whose CD4+ count is ≤350. We assessed whether this recommendation was met at 2 comparable clinical sites.</p><p><strong>Methods: </strong>In this retrospective analysis, we compare rates of LP and corresponding syphilis treatment success at two clinics in Saskatoon, SK: a community-based primary care clinic and a tertiary care hospital-based infectious disease clinic.</p><p><strong>Results: </strong>Of 193 syphilis cases across both sites, 128 cases met laboratory criteria for lumbar puncture. Rates of LP (9% primary care clinic and 19% infectious disease clinic) and syphilis treatment success (87% primary care clinic and 89% infectious disease clinic) were comparable between groups. When RPR titre was controlled for, clinic type did not statistically significantly affect the rates of lumbar puncture (<i>p</i> = 0.104) or syphilis treatment success (<i>p</i> = 0.068). A RPR titre ≥1:32 was positively associated with both treatment success (OR 2.596) and lumbar puncture (OR 4.495).</p><p><strong>Conclusion: </strong>Results suggest that there is no difference in either the community or hospital-based clinic type for syphilis treatment success and that rates of lumbar puncture of patients meeting serologic criteria are low across diverse HIV patient groups and clinical settings.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 2","pages":"171-178"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12253935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-SARS-CoV-2 Antibody Levels in a Cohort of Health Care Workers Before and After the Omicron Wave in Canada.","authors":"Jorge L Martinez-Cajas, Santiago Perez-Patrigeon, Gerald A Evans, Bradley Stoner, Ann Jolly, Beatriz Alvarado, Hugh Guan, Yanping Gong","doi":"10.3138/jammi-2024-0029","DOIUrl":"10.3138/jammi-2024-0029","url":null,"abstract":"<p><strong>Introduction: </strong>We measured anti-S immunoglobulin G (IgG) levels in a cohort of health care workers (HCWs) to explore factors affecting the levels of vaccine-induced IgG antibodies and their relationship with risk of incident SARS-CoV-2 infection throughout the first seven epidemic waves.</p><p><strong>Methods: </strong>A convenience sample of HCWs from one acute care hospital and four long-term care homes had anti-S SARS-CoV-2 IgG antibody levels at the beginning of the pandemic (T1) and during Omicron waves 5-7 (T2). Poisson analysis was conducted to assess predicted levels of antibodies by covariates (health and social conditions), number, timing and type of vaccines, as well as history of previous SARS-CoV-2 infection. Antibody levels assessed between October 2021 and August 2022 were also analyzed in relation to incident cases of Omicron infections.</p><p><strong>Results: </strong>Of the HCWs who provided one (n = 128) or two blood samples (n = 146), 53% were vaccine naïve at T1 and 1.4% were so at T2. The mean SARS-CoV-2 IgG concentration was 648 binding antibody units/mL at T1 and 1,913 binding antibody units/mL at T2. Income insufficiency and the presence of more than one chronic condition were associated with lower antibody levels at T2. Antibody levels were higher in HCWs with prior SARS-CoV-2 infection and increased with more vaccine doses received. Hybrid immunity elicited higher levels of antibodies in HCWs at T1 and T2. Waning of antibody levels over time was seen after vaccination with a third dose at T2. A correlation between antibody levels and subsequent risk of Omicron infection was not found.</p><p><strong>Conclusions: </strong>Our results suggest that timing and prioritization of anti-SARS-CoV-2 vaccination needs to consider the health and socioeconomic factors of HCWs, and the waning effects of vaccines.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 2","pages":"127-145"},"PeriodicalIF":1.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Drug-Resistant Tuberculosis with Bedaquiline, Pretomanid, Linezolid with or Without Moxifloxacin (BPaL/M): Feasibility and Implementation Challenges in Western Canada.","authors":"Paige Muir, Victoria J Cook, Inna Sekirov, James Johnston, William J Connors","doi":"10.3138/jammi-2024-0034","DOIUrl":"10.3138/jammi-2024-0034","url":null,"abstract":"<p><strong>Background: </strong>Rifampin-resistant (RR) and multidrug-resistant (MDR) tuberculosis (TB) previously required treatment with a protracted course of toxic second-line TB drugs with suboptimal efficacy. Novel 6-month regimens of bedaquiline, pretomanid, linezolid with or without moxifloxacin (BPaL/M) are now recommended, but implementation in Canada is not well described.</p><p><strong>Methods: </strong>We analyzed eight people with MDR or pre-extensively drug-resistant (pre-XDR) TB or rifamycin intolerance treated with BPaL/M in western Canada to inform expanded use.</p><p><strong>Results: </strong>The mean times to confirm first- and second-line phenotypic TB susceptibility profiles were 5 and 11 weeks, respectively. Time to start an effective treatment regimen took on average 5 weeks from date of diagnosis, and time to start BPaL/M took 11 weeks due to medication approval, access, and delivery delays. The mean time to culture and smear conversion was 3 and 5 weeks, respectively, from the start of effective therapy. Individuals were isolated for a mean of 15 weeks with an average duration of hospitalization of 13 weeks. BPaL/M medications were associated with minor toxicity, including mild non-progressive peripheral neuropathy (3 cases, CTCAE grade 2) and blood transfusion for anemia (3 cases, CTCAE grade 3), all managed by linezolid dose adjustments. The mean total treatment duration was 8 months, and all individuals completed 6-month BPaL/M treatment with microbiological and clinical cure as of last follow-up (mean 8 months).</p><p><strong>Conclusions: </strong>Six-month all-oral BPaL/M regimens appeared effective in these individuals, but delays in drug susceptibility testing and poor medication access led to prolonged isolation, hospitalizations, and overall treatment duration. To fully realize the patient and health system benefits of BPaL/M treatment in Canada, streamlining laboratory testing and medication access must be prioritized.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 2","pages":"192-202"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12253940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Public Health Laboratory Network National Syphilis In-Laboratory Serological Testing Recommendations.","authors":"Muhammad Morshed, Maud Vallée, Hong Yuan Zhou, Maan Hasso, Derek Stein, Vanessa Tran, Ayushi Regmi, Ameeta E Singh, Kristy Hayden, Sapan Jindal, Todd F Hatchette","doi":"10.3138/jammi-2024-0027","DOIUrl":"10.3138/jammi-2024-0027","url":null,"abstract":"<p><p>Syphilis, caused by the bacterium <i>Treponema pallidum</i>, is a centuries-old sexually transmitted disease that continues to be a significant global health concern. Despite the efficacy of penicillin the disease has seen a resurgence worldwide, including in Canada. In 2022, Canada reported 13,953 cases of infectious syphilis, representing a 109% increase since 2018, and 117 cases of congenital syphilis, a staggering 599% increase. Historically, gay and bisexual men who have sex with men have been predominantly affected; however, recent years have seen a significant rise in female cases, contributing to the increase in congenital syphilis. Syphilis diagnosis is complex, requiring specialized expertise. The Canadian Public Health Laboratory Network last updated its laboratory diagnosis guidelines in 2015. Given the advancements in diagnostic techniques and the pressing need for updated guidance, this document provides an overview of the syphilis-causing pathogen <i>T. pallidum</i>, its transmission, pathogenesis, and clinical manifestations. It also reviews the epidemiology of syphilis, highlighting recent trends in Canada, and discusses current and emerging serological laboratory diagnostic techniques. This updated guidance aims to equip health care professionals with the latest knowledge and recommended testing algorithms to accurately diagnose and manage syphilis, ultimately helping to address the rising rates of this disease and improve public health outcomes in Canada.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 2","pages":"112-126"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12253939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Update on Prevention of Paediatric Respiratory Syncytial Virus Hospitalizations in Canada.","authors":"Joan L Robinson, Jesse Papenburg","doi":"10.3138/jammi-2025-0203","DOIUrl":"10.3138/jammi-2025-0203","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 1","pages":"2-5"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10 Years of <i>JAMMI</i>: The Tin Anniversary.","authors":"Gerald A Evans","doi":"10.3138/jammi-10-1-ed","DOIUrl":"https://doi.org/10.3138/jammi-10-1-ed","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Perspectives, Experiences, Beliefs, and Knowledge of Health Care Practitioners on the Diagnosis and Treatment of Lyme Disease in Canada.","authors":"Madison Robertson, Emilie Norris-Roozmon, Rylan Egan","doi":"10.3138/jammi-2024-0006","DOIUrl":"10.3138/jammi-2024-0006","url":null,"abstract":"<p><strong>Background: </strong>Lyme disease (LD) is a multisystemic disease without a current approved human vaccine. Increasing infection rates have created pressure to improve the diagnosis and treatment of LD in Canada. This study aims to inform LD care through the exploration of health care practitioner (HCP) perspectives, experiences, beliefs, and knowledge of LD diagnosis and treatment.</p><p><strong>Methods: </strong>Canadian HCPs took part in bilingual (English and French) semi-structured interviews to explore their experiences and perspectives related to LD diagnosis and treatment. Major themes within and between participants were identified using inductive thematic analysis and axial coding.</p><p><strong>Results: </strong>A total of 43 HCPs working in LD-related fields participated in this study. Four major themes were identified; HCPs have: 1) Similar perspectives regarding antibiotic use, regional influences, and physician referral; 2) diverse perspectives on the use of serology testing and barriers for LD diagnosis and treatment between endemic and nonendemic regions; 3) challenges and disagreement toward diagnosing and treating chronic LD; and 4) trust in one (among several) LD guidelines, yet consult a variety of secondary sources for additional LD knowledge.</p><p><strong>Discussion: </strong>The findings reveal a pressing need for greater consistency among HCPs regarding the diagnosis and treatment of LD in Canada. Variation can be attributed to diverse beliefs, perspectives, and approaches within LD practitioners generally, but is particularly evident when addressing, acknowledging, and defining chronic LD.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 1","pages":"53-72"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin Treatment for Multi-Drug Resistant Extrapulmonary Tuberculosis in Canada: A Report.","authors":"Jollee St Fung, Victoria J Cook, James Johnston, William J Connors","doi":"10.3138/jammi-2024-0025","DOIUrl":"10.3138/jammi-2024-0025","url":null,"abstract":"<p><strong>Background: </strong>Updated global tuberculosis (TB) guidelines recommend the novel oral 6-month bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) regimen for multidrug-resistant TB (MDR-TB) based on superior efficacy and reduced toxicity demonstrated in clinical trials. These trials were dominated by isolated pulmonary TB; thus, data for BPaLM effectiveness for extrapulmonary tuberculosis (EPTB) remains limited.</p><p><strong>Methods: </strong>We describe the safe and effective use of BPaLM in a patient for the treatment of MDR-TB involving an extrapulmonary site.</p><p><strong>Results: </strong>Bedaquiline and pretomanid were obtained through the Health Canada Special Access Program and from the manufacturers 3 weeks later. The patient with gastrointestinal and subclinical pulmonary TB tolerated the 6 months of BPaLM well with no treatment interruptions. There was sustained microbiological and clinical response at 6 months after treatment completion.</p><p><strong>Conclusion: </strong>Shorter duration, improved effectiveness, and reduced toxicity suggests that BPaLM should be considered when determining the ideal treatment regimen for MDR-TB. A more streamlined process for the procurement of bedaquiline and pretomanid will help minimize treatment initiation delay and overall isolation period. Further research is also needed to clarify longer-term outcomes and optimal dosing of BPaLM for EPTB, especially in more severe forms of disease or with malabsorption concerns.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 2","pages":"203-208"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12253933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Adherence With In-Patient Prospective Audit and Feedback Recommendations on Patient and Economic Outcomes.","authors":"Sydney London, Gerry McDonald, Kobe Roberts, Cheryl Foo, Natalie Bridger, Joanna Joyce, Peter Daley","doi":"10.3138/jammi-2023-0041","DOIUrl":"10.3138/jammi-2023-0041","url":null,"abstract":"<p><strong>Introduction: </strong>Prospective audit and feedback (PAF) are an antimicrobial stewardship intervention that reduces use of broad-spectrum antimicrobials among in-patients. The objective of this study was to assess the impact of adherence to PAF recommendations on the duration of broad-spectrum antimicrobials and patient outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included adult in-patients at two tertiary care hospitals in St. John's, Newfoundland and Labrador Canada. PAF included all prescriptions for piperacillin/tazobactam, meropenem, ertapenem, and imipenem, reviewed by an infectious disease specialist on day 3 of therapy, with recommendations provided in the electronic medical record. The primary outcome was duration of treatment following PAF. Secondary outcomes were time to all-cause mortality, time to readmission, length of stay, and time to <i>Clostridiodes difficile</i> infection. Adherence categories were compared.</p><p><strong>Results: </strong>Of the recommendations, 394 out of 786 (50.1%) were completely followed, 18.3% were partially followed, and 31.6% were not followed. There were no significant differences in adherence category based on patient age (<i>p</i> = 0.48) or sex (<i>p</i> = 0.93). Adherence category was associated with a graded reduction in mean duration of target antimicrobial treatment following PAF (<i>p</i> < 0.001), and length of stay after PAF (<i>p</i> < 0.05). Adherence category was not associated with mortality (log-rank = 0.58), readmission rate (log-rank <i>p</i> = 0.33), <i>C. difficile</i> DNA (log-rank <i>p</i> = 0.24) or <i>C. difficile</i> toxin (log-rank <i>p</i> = 0.084).</p><p><strong>Conclusions: </strong>Adherence to PAF reduces antimicrobial use and length of stay without creating harms, such as readmission. This shows that PAF can be beneficial, and future research should be tailored to increasing adherence to PAF recommendations.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 1","pages":"32-39"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck Mass: Tularemia Misdiagnosed as a Possible Malignancy.","authors":"Élodie Gemme, Philippe Lagacé-Wiens, Yoav Keynan, Terry Wuerz, James McEachern, John M Embil","doi":"10.3138/jammi-2024-0031","DOIUrl":"10.3138/jammi-2024-0031","url":null,"abstract":"<p><strong>Background: </strong>Tularemia is a zoonotic disease of the Northern Hemisphere caused by <i>Francisella tularensis</i>. Given its diverse animal reservoir and wide range of transmission modes, a thorough history of potential exposure is paramount. In the right context, fever combined with skin eruption and lymphadenopathy should raise the possibility of tularemia. Additionally, health care providers should be mindful that <i>F. tularensis</i> is a risk group 3 pathogen and a category A bioterrorism agent and presents a risk for laboratory personnel due to its aerosolization potential, low infectious dose, and fatality rate ranging from 2% to 60%.</p><p><strong>Method: </strong>Retrospective single chart review.</p><p><strong>Results: </strong>We describe a 65-year-old man with tularemia working as a bear-hunting guide whose management was delayed despite a fairly typical presentation due to lack of awareness regarding this disease. This case also demonstrates the need for safer referral practices and improved communications with the laboratory to ensure personnel are taking the appropriate measures while handling patient samples to avoid potentially serious consequences.</p><p><strong>Conclusion: </strong>The diagnosis was confirmed from a neck mass biopsy and the patient made a complete recovery with appropriate antibiotic treatment.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 1","pages":"84-89"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}