JAMMI最新文献

{"title":"Intensive Care Unit-onset Bloodstream Infections Represent a Distinct Category of Hospital-onset Infections: A Multicentre, Retrospective Cohort Study. Queensland Critical Care Network (QCCRN).","authors":"Alexis Tabah, Felicity Edwards, Mahesh Ramanan, Kyle C White, Kiran Shekar, Philippa McIlroy, Antony Attokaran, Siva Senthuran, James McCullough, Aashish Kumar, Stephen Luke, Neeraj Bhadange, Peter Garrett, Kevin B Laupland","doi":"10.3138/jammi-2024-0023","DOIUrl":"10.3138/jammi-2024-0023","url":null,"abstract":"<p><strong>Background: </strong>The location of onset of bloodstream infections (BSIs) associated with intensive care unit (ICU) admission may influence their clinical and epidemiological characteristics.</p><p><strong>Methods: </strong>A multicentre, retrospective cohort study was conducted in Queensland, Australia, and BSIs associated with ICU admission were identified and classified as community-onset, hospital-onset, or ICU-onset if first isolated within, after 48 hours but within 48 hours of ICU admission, or after 48 hours following ICU admission, respectively.</p><p><strong>Results: </strong>We included 3,540 episodes of ICU-associated BSI, with 1,693 classified as community-onset, 663 hospital-onset, and 1,184 ICU-onset. Compared with hospital-onset BSIs, patients with ICU-onset BSIs were younger, had fewer comorbidities, had lower APACHE II scores, and were more likely male. Patients with ICU-onset BSI were more likely to be surgical admissions and have a primary cardiovascular or neurological diagnosis. The distribution of infective agents varied significantly among community-, hospital-, and ICU-onset BSI groups. The all-cause 30-day case-fatality rates for first-episode community-onset, hospital-onset, and ICU-onset BSIs were 17.1%, 21.7%, and 23.5%, respectively (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>With different epidemiological features and causal pathogens, ICU-onset BSI represents a distinct BSI group arising in hospitalized patients.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"229-238"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650844","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":"Potentially Preventable? A Case of Recurrent Blastomycosis Involving the Central Nervous System.","authors":"Andrew Walkty, Terence Wuerz, Markus Stein, Jason Beiko, John Embil","doi":"10.3138/jammi-2024-0007","DOIUrl":"10.3138/jammi-2024-0007","url":null,"abstract":"<p><strong>Background: </strong>Blastomycosis is a disease caused by infection with thermally dimorphic fungi belonging to the <i>genus Blastomyces</i>. Central nervous system (CNS) involvement occurs in an estimated 1% to 10% of patients with blastomycosis, and treatment requires at least 12 months of antifungal therapy.</p><p><strong>Methods: </strong>We describe a 32-year-old male who presented with recurrent blastomycosis involving the CNS.</p><p><strong>Results: </strong>The patient was initially diagnosed with pulmonary blastomycosis with possible involvement of the CNS approximately 1 year prior to his current presentation. At that time, he was treated with amphotericin B deoxycholate and then subsequently transitioned to oral voriconazole. On discharge he only filled his voriconazole prescription for 8 weeks out of a planned year-long treatment course, due to an inability to afford it. He subsequently re-presented with symptoms of headache, nausea, and ataxia, and was found to have a right-sided cerebellar abscess. The abscess was drained and <i>Blastomyces</i> sp was isolated on culture. Following surgery, the patient was once again started on voriconazole after completing a course of liposomal amphotericin B. Social work was engaged early on during this admission. Fortunately, the patient's financial situation had improved and medication cost was no longer a barrier. When seen in follow-up, he remained on oral therapy and was doing well.</p><p><strong>Conclusions: </strong>A case of recurrent blastomycosis with involvement of the CNS is presented, where treatment failure occurred due to an inability of the patient to afford the required medication. Medication cost should always be considered and discussed with a patient when developing a treatment plan.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"312-316"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650847","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 (CPHLN) Diagnostic Recommendations for Neurosyphilis in Canada.","authors":"Bev Wudel, Rupeena Purewal, Todd F Hatchette, Derek Stein, Muhammad Morshed, Jessica Minion, Maud Vallée, Kristy Hayden, Camille Hamula","doi":"10.3138/jammi-2024-0022","DOIUrl":"10.3138/jammi-2024-0022","url":null,"abstract":"<p><p>Eight provinces and territories are currently experiencing syphilis outbreaks in Canada, with the national rate of infectious syphilis increasing significantly from 5.1 per 100,000 population in 2011 to 36.1 per 100,000 population in 2022. Neurosyphilis refers to infection of the central nervous system by <i>Treponema pallidum</i>, which may occur at any stage. It is to be expected that along with the syphilis outbreak, a concomitant rise in neurosyphilis cases will occur. It is important to note that Canadian national surveillance data on neurosyphilis is not currently published as it is inconsistently reported and often lumped in with secondary and tertiary syphilis rates. Future surveillance efforts must focus on properly identifying these cases to quantify the scope of the problem. This article summarizes Canadian Public Health Laboratory Network guidelines for neurosyphilis diagnosis.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"219-228"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650840","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":"Predicting COVID-19 Cases Across a Large University Campus Using Built Environment Surveillance.","authors":"Aaron Hinz, Jason A Moggridge, Hanna Ke, Alexandra Ma Hicks, Evgueni Doukhanine, Michael Fralick, Laura A Hug, Derek R MacFadden, Hebah S Mejbel, Caroline Nott, Ashley Raudanskis, Nisha Thampi, Alex Wong, Rees Kassen","doi":"10.3138/jammi-2024-0002","DOIUrl":"10.3138/jammi-2024-0002","url":null,"abstract":"<p><strong>Background: </strong>Environmental surveillance of SARS-CoV-2 via wastewater has become an invaluable tool for population-level surveillance. Built environment sampling may provide complementary spatially refined detection for viral surveillance in congregate settings such as universities.</p><p><strong>Methods: </strong>We conducted a prospective environmental surveillance study at the University of Ottawa between September 2021 and April 2022. Floor surface samples were collected twice weekly from six university buildings and analyzed for the presence of SARS-CoV-2 using quantitative PCR. A Poisson regression was used to model the campus-wide COVID-19 cases predicted from the fraction of floor swabs positive for SARS-CoV-2 RNA, building CO₂ levels, Wi-Fi usage, and SARS-CoV-2 RNA levels in city wastewater. Building-level cases were modelled using viral copies detected in floor samples as a predictor.</p><p><strong>Results: </strong>Over the 32-week study period, we collected 554 floor swabs at six university buildings. Overall, 13% of swabs were PCR positive for SARS-CoV-2, with positivity ranging between 4.8% and 32.7% among buildings. Both floor swab positivity (Spearman <i>r</i> = 0.74, 95% CI 0.53 to 0.87) and city wastewater signal (Spearman <i>r</i> = 0.50, 95% CI 0.18 to 0.73) positively correlated with on-campus COVID-19 cases. In addition, built environment detection was a predictor of cases linked to individual university buildings.</p><p><strong>Conclusions: </strong>Detection of SARS-CoV-2 RNA on floors and viral RNA levels in city-wide wastewater were strongly associated with the incidence of COVID-19 cases on a university campus. These data suggest a potential role for institutional built environment sampling, used together with wastewater surveillance, for predicting COVID-19 cases at both campus-wide and building-level scales.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"284-293"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650848","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 Antibiotic Prescribing for Sepsis (CAPS) Study: A <i>Post Hoc</i> Analysis of the FABLED Cohort Study.","authors":"David Lasry, Todd C Lee, Katryn Paquette, Koray Demir, Cedric Yansouni, David Sweet, Matthew P Cheng, Alexander Lawandi","doi":"10.3138/jammi-2024-0024","DOIUrl":"10.3138/jammi-2024-0024","url":null,"abstract":"<p><strong>Background: </strong>Understanding the microbiology and optimal pharmacotherapy of patients with community-onset sepsis is key to improving outcomes. Yet, empiric therapies prescribed in Canadian emergency departments as they relate to microbial etiology and focus of infection are inadequately described.</p><p><strong>Methods: </strong>We performed a <i>post hoc</i> analysis of the FABLED cohort study, which quantified the effect of antimicrobials on blood culture yield in septic patients. Patients presenting with sepsis were enrolled in six Canadian emergency departments between 2013 and 2018. We characterized the appropriateness of empiric therapies relative to the pathogens isolated and focus of infection identified.</p><p><strong>Results: </strong>The data of 315 patients with sepsis was analyzed. Broad-spectrum antibiotics were used in 68.6% of the cohort. Despite this, <i>Pseudomonas</i> was never isolated in any blood cultures, and drug-resistant organisms were only encountered in 4.8% of the cohort. Among patients with bacteremia (n = 100), 28% of patients received appropriate antibiotic therapy whereas the remainder received therapies that were either overly narrow (16%) or unnecessarily broad (56%) in spectrum. Among patients with an identified focus of infection (n = 266), 30.5% received appropriate empiric antibiotics. Prescribing patterns that were overly broad, overly narrow, or a combination of the two were observed in 39.8%, 7.5%, and 22.2% of patients, respectively. Thirty-day mortality was lowest among patients receiving appropriate therapy relative to the final pathogen isolated and presumed infectious focus.</p><p><strong>Conclusions: </strong>Empiric therapies for septic patients in Canada were overly broad given the rare isolation of drug-resistant pathogens. Though likely confounded by severity of illness, optimal outcomes were observed when therapy was appropriate relative to the causative pathogen and infectious focus.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"239-248"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650839","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":"Misattribution Bias of COVID-19 Hospitalizations in Alberta Using an Admission Algorithm.","authors":"Tri Dinh, Jordan Ross, Samantha James, Kristin Klein, A Uma Chandran, Oscar Larios, David Strong, John M Conly","doi":"10.3138/jammi-2024-0011","DOIUrl":"10.3138/jammi-2024-0011","url":null,"abstract":"<p><strong>Background: </strong>With initial waves of COVID-19, many public health systems assumed each COVID-19 positive hospitalization was a direct cause from COVID-19 infection. Since January 2022, Alberta Health Services Communicable Disease Control Hospitalization Team (CDC-HT) implemented an admission criteria algorithm to adjudicate COVID-19 as a direct, contributing, or unrelated cause for all COVID-19 admissions in Alberta.</p><p><strong>Methods: </strong>This quality improvement initiative sought to improve the admission algorithm's precision in reporting COVID-19 admissions. Patient hospitalization records from January-February 2022 with a positive COVID-19 test in the last 30 days were proportionally sampled in a geographically stratified manner across Alberta health zones. 261 patient records were sampled and determination of COVID-19 attribution by CDC-HT algorithm was compared to adjudication by a panel of infectious diseases physicians with extensive COVID-19 clinical experience.</p><p><strong>Results: </strong>Of 261 sampled COVID-19 admissions, blinded physician adjudication determined 39.9% were direct-cause, 17.2% contributing-cause, and 37.6% unrelated-cause. Within the same cohort the CDC-HT admission algorithm adjudicated 42.9% direct-cause, 24.5% contributing-cause, and 30.3% unrelated-cause. Cohen's kappa was 0.475, providing only moderate agreement. The majority of discrepancy was from over-attribution of unrelated hospitalizations as contributing cause. Implementation of this algorithm in Alberta throughout 2022 showed a fluctuating proportion of direct plus contributing COVID-19 hospitalizations as low as 40%.</p><p><strong>Conclusion: </strong>There was misattribution bias in COVID-19 hospitalization determination using the admission algorithm. The findings from this analysis led to improvements in the algorithm to improve precision. Public health jurisdictions should review their COVID-19 hospitalization reporting approaches to ensure validity and consideration of incidental cases.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"274-283"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650846","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":"A National Discussion of COVID-19 on Twitter.","authors":"Marlon I Diaz, Christoph U Lehmann, Philip W Lam, Richard J Medford","doi":"10.3138/jammi-2024-0004","DOIUrl":"10.3138/jammi-2024-0004","url":null,"abstract":"<p><strong>Introduction: </strong>During the COVID-19 pandemic, social media became increasingly relied upon for health information in Canada. By analyzing georeferenced tweets using natural language processing, we aimed to understand regional discussions and concerns about school closures, masking, vaccines, and lockdowns during the pandemic's first two years.</p><p><strong>Methods: </strong>Using Twitter's application programming interface, we collected English-language tweets with keywords related to COVID-19 posted between January 1, 2020 and February 22, 2022 from Canadian users.</p><p><strong>Results: </strong>Out of all retained tweets, 2,851,951 (47.9%) were about vaccines, 1,344,008 (22.6%) about lockdowns, 1,011,909 (17%) about schooling, and 752,014 (12.6%) about masking. Tweets on schooling received the most engagement, with the highest rates of likes (17.3%), retweets (18.7%), replies (10%), and quotes (6.8%). The most common emotions expressed were trust, fear, and anticipation, with lockdown tweets showing greater fear and sadness. Overall, sentiment was negative, particularly regarding lockdowns in the Northwest Territories and Alberta.</p><p><strong>Discussion: </strong>During the COVID-19 pandemic, Twitter became an essential tool for analyzing public sentiment regarding government actions. Users showed the most interest in vaccines, followed by lockdowns, schooling, and masking, with the highest engagement on schooling tweets. Our analysis of sentiment, emotion, and content revealed valuable insights into public beliefs about COVID-19 in Canada, highlighting regional differences and shifts in sentiment, particularly negative reactions to school closures as government recommendations evolved. Our study adds to the growing evidence supporting the use of natural language processing for real-time analysis of social media content to early identify public health concerns.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"294-307"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650838","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":"Why Randomized Controlled Trials are Necessary to Address the Effectiveness of Non-Pharmacological Interventions During a Public Health Emergency Such as COVID-19.","authors":"Mark Loeb, Dominik Mertz, Zain Chagla, John Conly","doi":"10.3138/jammi-9-4-ed","DOIUrl":"10.3138/jammi-9-4-ed","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"197-199"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660662","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":"Controversies in the Management of Congenital Syphilis.","authors":"Joan L Robinson, Alena Tse-Chang, Sergio Fanella","doi":"10.3138/jammi-2024-1103","DOIUrl":"10.3138/jammi-2024-1103","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 4","pages":"204-207"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650841","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":"Hepatitis C Screening in Community Pharmacies-A Feasibility and Knowledge Transfer Study: PHARMA-C.","authors":"Rose Prévost, Émilie Roy-St-Pierre, Kamilia Idir, Azam Khodamoradi, Frédéric Provost, Dominic Martel, Nancy L Sheehan, Valérie Martel-Laferrière, Rachel Therrien","doi":"10.3138/jammi-2024-0010","DOIUrl":"10.3138/jammi-2024-0010","url":null,"abstract":"<p><strong>Background: </strong>New strategies are needed to increase access to hepatitis C virus (HCV) testing. This study evaluated the feasibility of HCV rapid testing in community pharmacies in Quebec (Canada) and assessed knowledge transfer (KT).</p><p><strong>Methods: </strong>PHARMA-C was a 6-month (February to September 2022) prospective KT study. Community pharmacists (CPs) were recruited and trained to identify HCV risk factors, conduct rapid antibody tests (OraQuickHCV), and pre- and post-test counselling, and link positive cases to care. Health care users (HUs) were included according to HCV risk factors. An advisory committee and focus groups provided guidance, feedback, and identified barriers and facilitators to improve the program. A pre- and post-intervention questionnaire was completed by CPs to assess feasibility and KT. HUs completed a satisfaction survey.</p><p><strong>Results: </strong>A total of 32 CPs were included and 16 performed 101 HCV tests. Two positive cases were identified and linked to care. Comparison of pre- and post-intervention surveys shows that pharmacists felt more confident in identifying HCV risk factors, communicating information to patients related to HCV, and performing the HCV screening test at the end of the intervention. HCV screening in pharmacies was considered feasible by 77.8% of CPs. The intervention lasted approximately 22 minutes. The main barriers to implementation were lack of time and fear of stigmatizing HUs. Promotional material and training were the main facilitators.</p><p><strong>Conclusion: </strong>HCV point-of-care testing by CPs is feasible in Quebec. Expanding pharmacists' scope of practice to include HCV screening and increasing pharmacists' role in the HCV care cascade is encouraged in order to further efforts toward HCV elimination.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"9 3","pages":"161-172"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486357","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}