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Clinical microbiology and infection
Blackwell Science Ltd
Clinical microbiology and infection

Blackwell Science Ltd

1198-743X

Clinical microbiology and infection/Journal Clinical microbiology and infectionISTPSCI
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    Questioning the justification for a fourth SARS-CoV-2 vaccine

    Calderon-Margalit, RonitStrahilevitz, JacobPaltiel, Ora
    3页
      原文链接:
    • NSTL
    • Elsevier

    Inappropriate use of ivermectin during the COVID-19 pandemic: primum non nocere!

    Ergonul, OnderKrause, RobertRamon Pano-Pardo, JosePower, Nicholas R....
    3页
      原文链接:
    • NSTL
    • Elsevier

    Systematic review of factors promoting behaviour change toward antibiotic use in hospitals

    Pouly, EmilieCoppry, MaiderRogues, Anne-MarieDumartin, Catherine...
    9页
    查看更多>>摘要：Background: Antimicrobial stewardship (AMS) programmes include actions to improve antibiotic use. Objectives: This study aimed to identify factors of AMS interventions associated with behaviour change toward antibiotic use in hospitals, applying behavioural sciences. Data sources: PubMed and Scopus online databases were searched. Study eligibility criteria: Studies published between January 2015 and December 2020 were included. The required study outcomes were as follows: effect of the intervention reported in terms of antibiotic consumption, antibiotic costs, appropriateness of prescription, duration of therapy, proportion of patients treated with antibiotics, or time to appropriate antibiotic therapy. Participants: Participants included health care professionals involved in antibiotic prescription and use in hospitals and patients receiving or susceptible to receiving antibiotics. Interventions: Studies investigating AMS interventions in hospitals were included. Methods: Risk of bias was determined using the integrated quality criteria for review of multiple study designs tool. A systematic review of AMS interventions was conducted using the behaviour change wheel to identify behaviour changes functions of interventions; and the action, actor, context, target, and time framework to describe how they are implemented. Relationships between intervention functions and the action, actor, context, target, and time domains were explored to deduce factors for optimal implementation. Results: Among 124 studies reporting 123 interventions, 64% were effective in reducing antibiotic use or improving the quality of antibiotic prescription. In addition, 91% of the studies had a high risk of bias. The main functions retrieved in the effective interventions were enablement, environmental restructuring, and education. The most common subcategories were audit and feedback and real-time recommendation for enablement function, as well as material resources, human resources, and new tasks for environmental restructuring function. Most AMS interventions focused on prescriptions, targeted prescribers, and were implemented by pharmacists, infectious diseases specialists, and microbiologists. Interventions focusing on specific clinical situation were effective in 70% of cases. Conclusions: Knowledge of factors associated with behaviour changes will help address local barriers and enablers before implementing interventions. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Defining COVID-19-associated pulmonary aspergillosis: systematic review and meta-analysis

    Kariyawasam, Ruwandi M.Dingle, Tanis C.Kula, Brittany E.Vandermeer, Ben...
    8页
    查看更多>>摘要：Background: Pulmonary aspergillosis may complicate coronavirus disease 2019 (COVID-19) and contribute to excess mortality in intensive care unit (ICU) patients. The disease is poorly understood, in part due to discordant definitions across studies. Objectives: We sought to review the prevalence, diagnosis, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) and compare research definitions. Data sources: PubMed, Embase, Web of Science, and MedRxiv were searched from inception to October 12, 2021. Study eligibility criteria: ICU cohort studies and CAPA case series including >= 3 patients were included. Participants: Adult patients in ICUs with COVID-19. Interventions: Patients were reclassified according to four research definitions. We assessed risk of bias with an adaptation of the Joanna Briggs Institute cohort checklist tool for systematic reviews. Methods: We calculated CAPA prevalence using the Freeman-Tukey random effects method. Correlations between definitions were assessed with Spearman's rank test. Associations between antifungals and outcome were assessed with random effects meta-analysis. Results: Fifty-one studies were included. Among 3297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (prevalence 10%; 95% CI 8%-13%). Two hundred seventy-seven patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (rho = 0.268-0.447; p < 0.001), with the exception of Koehler and Verweij (rho = 0.893; p < 0.001); 33.9% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 8 days (interquartile range 5-14) in ICUs. Tracheobronchitis occurred in 3% of patients examined with bronchoscopy. The mortality rate was high (59.2%). Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival. Conclusions: The reported prevalence of CAPA is significant but may be exaggerated by nonstandard definitions. (C) 2022 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
      原文链接:
    • NSTL
    • Elsevier

    What is the evidence base of used aggregated antibiotic resistance percentages to change empirical antibiotic treatment? A scoping review

    Auzin, AliSpits, MenoeskaTacconelli, EvelinaRodriguez-Bano, Jose...
    8页
    查看更多>>摘要：Objectives: Antibiotic resistance requires continuous monitoring by experts to decide whether empirical antibiotic therapies (EATs) should be replaced by alternative antibiotics. The exact moment and criteria for this change are unclear and generally based on consensus between experts. This scoping review aims to identify from the literature the resistance thresholds used for a change in EAT and the criteria on which they are based. Methods: Scoping review for which a comprehensive structured literature search was conducted. Rayyan, software for systematic reviews, was used for the screening of abstracts and titles. Data sources were Pubmed and a hand-search of reference lists and grey literature. Papers were eligible if they concerned any type of bacterial infectious disease and mentioned or defined antibiotic resistance thresholds for decision-making purposes for EAT. The inclusion and analysis of articles was done by two researchers; any conflicts were resolved through discussion or by consulting a third reviewer. Results: We identified 3146 unique papers. Following title/abstract screening, 125 papers were comprehensively read, and 16 papers were included. The included papers gave thresholds for urinary tract infections, respiratory tract infections, meningitis, skin and soft tissue infections, gonorrhoea, and bone and joint infections. Six criteria were found that were commonly used to base the thresholds on. These were: disease severity, efficacy of treatment, adverse drug events, risk of Clostridioides difficile infection, costs, and increased resistance. The number of criteria used to define each threshold varied from one to six between papers. Conclusions: The thresholds used for EATs are few, commonly based on expert opinion estimates, and can therefore have broad ranges. Used criteria underlying reported thresholds are heterogenous and require standardization. Considering the rising trend in resistance, there is a clear need for rigid tools to determine thresholds in order to support guideline development with the best and timely evidence. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
      原文链接:
    • NSTL
    • Elsevier

    Mortality and clinical cure rates for pneumonia: a systematic review, meta-analysis, and trial sequential analysis of randomized control trials comparing bactericidal and bacteriostatic antibiotic treatments

    Satta, GiovanniSinger, MervynArulkumaran, NishkanthaSnow, Timothy Arthur Chandos...
    10页
    查看更多>>摘要：Background: Bactericidal antibiotics are generally assumed to be superior to bacteriostatic antibiotics as first-line treatment for pneumonia. Objectives: We performed a systematic review, meta-analysis, and trial sequential analysis (TSA) of randomized controlled trials (RCTs) of bactericidal versus bacteriostatic antibiotics to ascertain clinical superiority. Clinical cure rate was the primary outcome. Secondary outcomes included all-cause mortality, microbiological eradication, treatment failure, and relapse rates. Data sources: PubMed, Cochrane Library, Embase, and MedRxiv Study eligibility criteria: Randomized control trials. Particiapants: Adult patients with bacterial pneumonia treated with antibiotics in the community or in-hospital. Interventions: Bacteriostatic versus bactericidal antibiotics. Assessment of risk of bias: The Cochrane Collaboration assessing risk of bias 2 tool. Methods of data synthesis: Data on dichotomous outcomes are presented as risk ratio (RR). A random-effects model with the generic Mantele-Haenszel method was used for integrating RRs for generalizability of findings. The I-2 method was used to assess the magnitude of variation secondary to heterogeneity. Results: Forty-three RCTs involving 10 752 patients met the eligibility criteria. The clinical cure rate (42 studies, 10 312 patients; RR: 1.02; 95% CI, 0.99-1.05; I-2: 37%; TSA-adjusted CI, 0.99-1.05), all-cause mortality (25 studies, 8302 patients; RR: 1.07; 95% CI, 0.81-1.42; I-2: 57%), microbiological eradication (24 studies, 2776 patients; RR: 1.00; 95% CI, 0.97-1.03; I-2: 0%), treatment failure (31 studies, 7296 patients; RR: 0.96; 95% CI, 0.83-1.11; I-2: 42%), and relapse rate (5 studies, 1111 patients; RR: 1.15; 95% CI, 0.50-2.63; I-2: 0%) were similar between bactericidal and bacteriostatic antibiotic treatments. Conclusions: Bactericidal agents are not associated with any statistical difference in clinical cure rates, mortality, microbiological eradication, treatment failure, or relapse rates compared with bacteriostatic antibiotics in the treatment of pneumonia. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Point-of-care testing for sexually transmitted infections in low-resource settings

    Vargas, S.Calvo, G.Qquellon, J.Vasquez, F....
    6页
    查看更多>>摘要：Background: Both the global incidence and the prevalence of sexually transmitted infections (STIs) continue to increase, affecting hundreds of millions of individuals, particularly in low-to middle-income countries. Although a definitive diagnosis is desirable to inform STI treatment, syndromic management is the most widely used strategy in resource-limited settings. With the development of point-of-care (POC) tests, it is important to discuss how laboratories will need to adapt to new training and supervisory roles in support of testing, which will largely be performed by peripheral clinical staff. Objectives: To discuss potential applications of STI POC tests, how they could improve existing STI control strategies and the role of clinical and reference laboratories in support of initiatives to improve STI management and control activities. Sources: Narrative literature review and expert opinion. Content: The paper outlines the current status of the STI epidemic worldwide and discusses the problems associated with current approaches to control these infections, particularly in low-resource settings. The roles of clinical and reference laboratories will need to change to provide support for POC and near-patient STI testing as these technologies are introduced into clinical as well as laboratory settings. (C) 2021 World Health Organization; licensee European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    How to: ECOFFs-the why, the how, and the don'ts of EUCAST epidemiological cutoff values

    Kahlmeter, GunnarTurnidge, John
    3页
    查看更多>>摘要：Background: Identifying the MIC wild-type distribution and its delineation of species targeted for receiving antimicrobial agent breakpoints is an important first step for determining clinical breakpoints. Having the main responsibility in the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for characterizing the wild-type distributions and setting epidemiological cut-off values (ECOFFs), we explain the why, the how, and frequent misconceptions of wild-type MIC distributions and ECOFFs. Objectives: To clarify how wild-type MIC distributions and ECOFFs for agents and important target organisms are defined and determined and why these are important tools in microbiology, as well as to point to common misunderstandings and inappropriate use. Sources: The EUCAST database of >40 000 MIC distributions; publications addressing the definition of wild-type MIC distributions, and ECOFFs in bacteria and fungi; and the EUCAST Standard Operating Procedure 10 Documents published by the European Centre for Disease Control and the European Food Safety Agency. Content: The rationale for defining wild-type distributions and ECOFFs is explained. Setting breakpoints that bisect wild-type MIC distributions leads to poor methodological reproducibility and poor correlation between clinical outcome and susceptibility testing results. The methods applied by EUCAST to select distributions for aggregation and website display are described, highlighting the importance of incorporating data from multiple sources and methods. The methods used by EUCAST to estimate ECOFFs are outlined. Finally, the common misunderstandings of these processes are addressed. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    ESCMID rapid guidelines for assessment and management of long COVID

    Yelin, DanaMoschopoulos, Charalampos D.Margalit, IliGkrania-Klotsas, Effrossyni...
    18页
    查看更多>>摘要：Scope: The aim of these guidelines is to provide evidence-based recommendations for the assessment and management of individuals with persistent symptoms after acute COVID-19 infection and to provide a definition for this entity, termed 'long COVID'. Methods: We performed a search of the literature on studies addressing epidemiology, symptoms, assessment, and treatment of long COVID. The recommendations were grouped by these headings and by organ systems for assessment and treatment. An expert opinion definition of long COVID is provided. Symptoms were reviewed by a search of the available literature. For assessment recommendations, we aimed to perform a diagnostic meta-analysis, but no studies provided relevant results. For treatment recommendations we performed a systematic review of the literature in accordance with the PRISMA statement. We aimed to evaluate patient-related outcomes, including quality of life, return to baseline physical activity, and return to work. Quality assessment of studies included in the systematic review is provided according to study design. Recommendations: Evidence was insufficient to provide any recommendation other than conditional guidance. The panel recommends considering routine blood tests, chest imaging, and pulmonary functions tests for patients with persistent respiratory symptoms at 3 months. Other tests should be performed mainly to exclude other conditions according to symptoms. For management, no evidence-based recommendations could be provided. Physical and respiratory rehabilitation should be considered. On the basis of limited evidence, the panel suggests designing high-quality prospective clinical studies/trials, including a control group, to further evaluate the assessment and management of individuals with persistent symptoms of COVID-19. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    A strain uncoloured by Gram staining in a pleural fluid

    Martin, Emilie CardotDolidon, SamuelLesprit, PhilippeVasse, Marc...
    2页
      原文链接:
    • NSTL
    • Elsevier