Abstract Background The use of oral (PO) antibiotics and lipoglycopeptides are challenging the previous standard of osteomyelitis (OM) treatment, but there is currently a paucity of comparative data between these approaches. Methods This retrospective study included patients diagnosed with OM treated with intravenous (IV) antibiotics, PO antibiotics, or lipoglycopeptides between January 1, 2010 and June 1, 2020. Patients in the PO group could receive no more than 14 days of IV antibiotics prior to the PO course, and inclusion into the lipoglycopeptide group required at least 2 doses of drug to be administered. The primary outcome was occurrence of clinical failure within six months of completion of therapy, which was defined as new antibiotics or unplanned surgical intervention for an infection at the same site. Secondary outcomes included in-hospital length of stay (LOS), amputation within 6 months of therapy completion, and incidence of drug and line-related adverse effects. Previous osteomyelitis at index site, surgical intervention as a part of initial management, presence of Staphylococcus aureus on culture, utilization of outpatient parenteral antibiotic therapy (OPAT) services (IV group only), and concomitant PO therapy (lipoglycopeptide group only) were included in a bivariate analysis and variables with a p-value < 0.2 were included in a multivariate regression model. Results The IV group included 257 patients, while the PO and lipoglycopeptide groups included 20 and 15 patients respectively. In the IV group, 89 (35%) of the patients experienced clinical treatment failure compared to 5 (25%) in the PO group and 5 (33%) in the lipoglycopeptide group (p=0.71). Median LOS was significantly shorter in the PO group compared to the IV and LGP groups [1 day (IQR 0-2.5) vs. 7 days (IQR 4-10) and 4 days (IQR 4-9), p=0.003]. No difference between groups was observed for amputation within 6 months or incidence of adverse effects. The only variable included in the multivariate regression model was previous osteomyelitis at index site [OR 1.75, 95% CI (1.07 – 2.87)]. Conclusion PO and lipoglycopeptide therapy resulted in similar outcomes compared to IV antibiotics. Only previous OM at the same site was identified as an independent risk factor for failure. Disclosures Ryan P. Moenster, Pharm.D., FIDSA, AbbVie (Speaker’s Bureau)Melinta (Consultant, Speaker’s Bureau)
Fundamental causes of long COVID or Post-Acute Sequelae of COVID-19 (PASC) are still under investigation while it remains a significant burden to millions of patients worldwide even after a relatively mild acute Coronavirus Disease 2019 (COVID-19) episode. Treatment and management programs are yet to be developed. The foremost hypotheses for underlying PASC pathophysiology include: The persistence of the virus in certain tissues, hyperinflammation due to COVID-19 immune dysregulation, and microcoagulation. Reactivation of herpesviruses has been regularly observed in certain patients going through COVID-19 and PASC. Such reactivation is thought to facilitate the entry of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus into cells, enhancing the viral load, severity, and duration of symptoms. An unusual, non-hospitalized, and immunocompetent PASC patient is presented here. This study is a retrospective and descriptive review of the patient's clinical records with his consent. The prescriptions and clinical investigations were performed by his medical staff upon him seeking help voluntarily due to his symptoms. After suffering for about 12 months since his initial infection with SARS-CoV-2 in March 2020, he developed shingles in March 2021. He was prescribed 800 mg Acyclovir 5 times daily for 7 days by his primary care physician. He recovered not only from shingles but also from all of his PASC symptoms shortly after taking Acyclovir and resumed a normal life. Hence, the possible use of a well-known, safe, affordable anti-viral medication, Acyclovir, for long COVID patients is proposed. Full recovery of a long COVID patient after using solely Acyclovir for only 7 days is presented here for the first time. This observation supports the theory of SARS-CoV-2 lingering in various tissues of the body after several months as one of the causative factors for PASC: Since he recovered from all of his PASC symptoms and anti-viral Acyclovir might have acted against the remaining SARS-CoV-2 as well. Although more systematic clinical trials are needed to confirm these results, this finding could potentially transform the treatment options for PASC sufferers, especially with herpesvirus reactivation globally.
In this single institution retrospective medical record review, patients diagnosed with colorectal cancer from the years 2018-2022 were evaluated to distinguish an associative linear relationship between diagnosed colorectal cancer and a positive result for the presence of a microorganism. Based on the clinical incidence of this occurrence, it was observed patients with tumors in the left side of the colon had a higher incidence of a positive test result with a dominant microorganism. Species evaluation within this cohort found similarity to microorganisms identified as colorectal cancer biomarkers. These findings support clinical relevance and warrant further consideration for prospective study regarding microorganism involvement in colorectal cancer.
Antimicrobial resistance is a public health problem. The main factor favoring the development of antibiotic resistance is the abusive or inappropriate use of antibiotics. This study is the first to take all services into account and aims to describe antibiotic therapy practices in the Departmental and Teaching Hospital of Borgou-Alibori (DTH-BA). Patients and methods: This was a cross-sectional, descriptive survey conducted at DTH-BA from January 11 to 18, 2022. An exhaustive recruitment of all hospitalized patients was carried out through a single and punctual passage at 16:00 in each hospital department. Data were collected using the WHO's standard questionnaire for point prevalence surveys of antibiotic use, from PPS V6. The web application (GLASS-HAMUPPS) was used for data entry, validation and processing. Analysis was performed using EPI-INFO software. The survey protocol has been approved by the national health research ethics committee. Results: A total of 145 patients were included from 9 hospital wards. The sex ratio was 0.69. The mean age of hospitalized children was 3.13±4.17 years and that of adults was 35.76±15.54 years. The overall frequency of antibiotic treatment across all departments was 70.34%. Pediatrics (90.90%) and intensive care (87.50%) were in the lead. Empirical antibiotic therapy was used in 98.41% of cases. Amoxicillin/clavulanic acid was the most prescribed antibiotic (17.99%), followed by metronidazole (15.87%), ampicillin (15.35%) and ceftriaxone (14.28%). Community-acquired infections accounted for 61.91% of cases. The frequency of medical antibiotic prophylaxis was 22.22% and surgical prophylaxis was 11.64%. Conclusion: Antibiotic consumption was high at DTH-BA and involved almost exclusively probabilistic antibiotic therapy. A program of proper use and monitoring of antibiotic prescriptions, coupled with improved access to microbiological tests, is needed to improve practices.
The growing spread of antimicrobial resistance is a major problem on a global level that has provoked several health and government organizations to call for action to counteract the problem. The frequent misuse of antibiotics is prevalent within hospital settings, especially during the COVID-19 era. The introduction of antibiotic stewardship initiatives has demonstrated the capability to decrease both unwarranted antibiotic consumption and the prevalence of drug-resistant microbes. Educating individuals is a pivotal element of such programs. Nevertheless, the impact of educational efforts targeting appropriate antibiotic usage has yet to be thoroughly evaluated. Ibrahim Bin Hamad Obaidullah Hospital (IBHOH) and Old Geriatric Hospital (OGH) in Ras Al Khaimah, UAE, are 250-bed secondary hospitals managed by Emirates Health Services (EHS). We classify antimicrobial agents as "controlled" or "uncontrolled." Controlled agents require approval from an Infectious Diseases (ID) consultant and clinical pharmacist and a web-based antimicrobial control system is used for this purpose. The Antimicrobial Stewardship Program (ASP) was implemented starting in October 2021 the ASP team reviews cases based on the "5 Rs" principle, records their decisions in the hospital's Electronic Medical Record (EMR) and discontinues controlled antimicrobial medication if disapproved within 48 h. Uncontrolled agents do not require ID physician approval. The consumption of antibiotics during the Pre-implementation period (period 1) from 1 April 2021 to 30 September 2021 and the post-implementation period (period 2) from 1 October 2021 to 30 March 2022 was recorded. The need for individual informed consent was waived for this study as it was considered a surveillance activity. Statistical analysis involved the use of the student’s t-test for parametric data and either the chi-square test or Fisher's exact test for nonparametric data, as deemed appropriate. Significance was established when the p-value was less than 0.05. These analyses were conducted using MedCalc® version 12.3.0, developed by MedCalc software in Mariakerke, Belgium. A total of 1583 patients were admitted in the pre-implementation period compared to 2718 patients admitted in the post-implementation period. During the pre-implementation period, 118 patients died compared to 103 patients who died in the post-implementation period. Compared with the pre-implementation period, there was a significant decrease of more than 69% in total antimicrobial consumption with a more than 75% reduction in controlled antibiotic consumption, specifically colistin, linezolid and meropenem. There was a significant reduction in patient mortality between the pre-implementation period and the post-implementation period (p<0.0001) A focused ASP program is effective in controlling the use of controlled antimicrobial agents, reducing hospital mortality. minimizing financial burden and promoting cost-effectiveness.
COVID-19 due to SARS-CoV-2 is a global pandemic that presents a serious challenge from many angles for healthcare professionals. The virus causes a potentially fatal disease that is easily transmitted among patients and caregivers, hence specific dead body care is required for such patients. Our study was conducted to identify knowledge, attitude, and practice regarding COVID-19 dead body care among hospital nursing personnel. A cross sectional survey-based study was performed involving 282 nurses who worked in COVID-19 units during data collection from July 2020 to September 2020. The online structured questionnaire was based on world health organization guidelines, institutional infection control protocols, and course material regarding emerging respiratory diseases including COVID-19. We found that work experience in the COVID-19 unit had a significant impact on knowledge and practice regarding COVID-19 dead body care. Similarly, we observed that training improved the knowledge and practice of nursing personnel regarding dead body care. Good knowledge, attitude, and practice were observed in experienced and trained nurses (p-value <0.005). No significant changes were observed with age, gender, and education qualification. Overall knowledge, attitude, and practice regarding COVID-19 dead body care were moderate to good. Adequate training among nurses should prevent the transmission of disease due to occupational exposure.
Acute purulent pericarditis is rare and more prevalent in the pre-antibiotic era with high mortality, around 40% despite optimal treatment. The diagnosis can be difficult, requiring the practice of a pericardiocentesis in cases with a high index of suspicion. When such a rare entity coincides with another one more frequently the diagnosis can become tricky. We present the case of a man with a previous thoracic surgery who was admitted due to an ST Elevation Myocardial Infarction (STEMI) and was finally diagnosed with Methicillin Susceptible Staphylococcus Aureus (MSSA) purulent pericarditis requiring cardiac surgery. The main difficulty, in this case, was the differentiation between hemopericardium and purulent pericardium. Despite the initial difficulties, the systematic study of febrile syndrome and bacteremia allowed reaching the final diagnosis.
The pandemic of COVID-19 is the largest in this century. Aside from the acute infection, some of the patients have been challenged with a complication that is known as long COVID-19. The symptoms of long COVID-19 are extensive and diverse. Long COVID-19 continues to plague many patients post-COVID-19 infection. No universal treatment has been found. This study presents four patients who suffered from long COVID-19. Each patient presented with a different and diverse symptom of long COVID-19. Each of the patient's symptoms resolved or greatly improved upon taking the anti-viral drug acyclovir. Acyclovir has been in use since 1981 and is generally considered safe. A novel theory as to the pathophysiology of long COVID-19 symptoms and the result of a new treatment is presented. The purpose of this study is to provide a foundation for much bigger studies and useful resources for further testing to halt long COVID-19.
