Background Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection which primarily affects immunocompromised individuals. The recommended dose of co-trimoxazole for treatment of PJP is 15–20 mg/kg/day of the trimethoprim component based on an underpowered 1975 study in 20 children with cancer. While this dose is effective, a lower dose may be sufficient and cause less toxicity.Method We conducted a retrospective cohort study of patients treated for ‘proven’ or ‘probable’ PJP at Christchurch Public Hospital, New Zealand between January 2018 and November 2023. We compared treatment limiting adverse drug reactions (ADR) and 30-day all-cause mortality in patients initiated on a conventional dose of co-trimoxazole (≥12.5 mg/kg/day) versus those initiated on a low dose of co-trimoxazole (<12.5 mg/kg/day).Results A total of 148 patients with a positive Pneumocystis jirovecii PCR or immunofluorescence result were treated with co-trimoxazole of whom 139 were categorised as having ‘proven’ or ‘probable’ PJP (36 low-dose (25.9%), 103 conventional-dose (74.1%)). A higher proportion of patients receiving conventional-dose co-trimoxazole required a treatment alteration due to an ADR (43.7%, 45/103) than patients receiving low-dose co-trimoxazole (16.7%, 6/36). There was no statistically significant difference in 30-day all-cause mortality between the low- and conventional-dose groups (adjusted hazard ratio for low- versus conventional-dose = 0.76, 95% confidence interval 0.29–1.98, p = 0.57).Conclusions In this comparatively large retrospective cohort, low-dose co-trimoxazole was associated with fewer treatment-limiting ADRs without an observed increase in mortality. These findings add to the growing body of observational evidence supporting the use of lower co-trimoxazole doses for the treatment of PJP.
BACKGROUND:It is uncertain whether the Centor criteria can be reliably assessed during telemedicine encounters with patients seeking care for a sore throat. Acquiring this knowledge is important as sore throat is a common reason for telemedicine consultations. OBJECTIVES: PRIMARY OBJECTIVE:To compare the inter-rater reliability of Centor score assessments via telemedicine versus in-person examinations. Secondary objectives: To investigate whether the interrater reliability varies when assessing patients who are children versus adults, and whether the telemedicine physician considered conditions for assessment as adequate. METHODS:A cross-sectional study in which each patient initially underwent a telemedicine evaluation, followed by an in-person assessment conducted by an independent physician who was kept unaware of the outcome of the initial evaluation. Agreement between both assessments was measured using Cohen's kappa coefficient. RESULTS:During 2020-2023 189 patients with a mean age of 31 years (SD 18) were included. Among them, 114 were female and 148 adults. Agreement was low with kappa between 0.47(95% CI 0.38 - 0.56) to 0.58 (95% CI 0.43-0.72) when comparing assessments of lymph nodes, tonsils and the total Centor score. Kappa was potentially acceptable for history of fever and absence of cough. Subgrouping participants into children and adults did not affect kappa of the total Centor score. CONCLUSION:Telemedicine examination in patients with an acute sore throat is not reliable for assessing Centor criteria.
BackgroundWe studied the duration of HPV detection and risk of (re-) detection for 25 HPV genotypes in a cohort of 132 women followed every eight weeks for up to two years between 2016 and 2020. Participants were between 18 and 25 years old at inclusion and half of them were vaccinated against HPV. They were recruited near the University and the STI detection centre in Montpellier, France.MethodsWe used genotype-specific longitudinal data to characterise the dynamics of HPV-detected episodes. We investigated the contribution of viral and host factors to the variations in the duration of HPV detection, and the time before (re-)detection of the same genotype using multivariate Cox regression models with frailty at the patient level.FindingsWe detected at least one HPV episode in 74% of the participants and re-detected the same genotype in 47% of them. Covariates related to socio-economic difficulties were associated with a lower risk of detectability loss (hazard ratio 0.45 with a 95% confidence interval, CI, from 0.21 to 0.97). The number of lifetime sexual partners was strongly associated with an increased risk of new positive detection (hazard ratio 2.40 with a 95%CI from 1.07 to 5.39). In contrast, vaccination was associated with a lower risk of displaying incident infections (hazard ratio of 0.64 with a 95%CI from 0.43 to 0.96).ConclusionIn the short term, vaccination shows clear signs of protection against new HPV detections, including for some genotypes not targeted by the vaccine, such as HPV31 and HPV51.
BACKGROUND:Throat carriage of methicillin-resistant Staphylococcus aureus (MRSA) has previously been associated with lower decolonisation treatment success rates. OBJECTIVES:To characterise decolonisation treatment and outcome in Danish MRSA throat carriers. METHODS:This retrospective population-based cohort study included MRSA throat carriers between July, 2018 and June, 2019, in the Capital Region of Denmark. Logistic regression analysis was performed to assess variables associated with becoming MRSA free. RESULTS:Of 178 patients included, 129 (72%) were MRSA free by the end of the study. Overall, 78 (44%) of patients became MRSA free following a treatment attempt. Twenty-six (15%) patients became MRSA free without treatment and 25 (14%) became MRSA free unrelated to a treatment attempt. The success rate of the first decolonisation treatment, mainly nasal mupirocin and chlorhexidine body wash, was 23%. Systemic clindamycin was given in 52 cases and had a success rate of 52%. Logistic regression showed that residing in a household with three to four additional MRSA carriers was negatively associated with becoming MRSA free, although not significant after adjustment. Having MRSA in a clinical sample prior to decolonisation was associated with a lower chance of becoming MRSA free after adjustment. Topical decolonisation treatment was associated with a lower probability of becoming MRSA free. CONCLUSION:In this Danish cohort of MRSA throat carriers, the overall success rate of decolonisation treatment was 44% and for systemic clindamycin 52%. A higher number of household MRSA carriers and a previous clinical MRSA infection were associated with a lower chance of becoming MRSA free.
BACKGROUND:Bacteroides fragilis group species are the most frequently encountered bacteria involved in anaerobic bacteraemia and associated with high mortality rates. In 2012, we performed the first national study of antimicrobial susceptibility in the B. fragilis group from blood cultures in Denmark. OBJECTIVES:The purpose of the present study was to compare the antimicrobial susceptibility rates of piperacillin-tazobactam, meropenem, clindamycin and metronidazole in the B. fragilis group from blood cultures in Denmark in 2022 with susceptibility rates from 2012. In addition, we wanted to investigate whether changes to susceptibility was related to the overall use of the specified antimicrobial agents from 2012 to 2022. METHODS:Antimicrobial susceptibility testing was performed in accordance with EUCAST guidelines using the agar dilution method and the disc diffusion method. RESULTS:The study showed a seemingly considerable increase in resistance in the B. fragilis group (n = 234) to piperacillin-tazobactam from a reported 8.5% in 2012 to 42.7% in 2022. Resistance towards meropenem also increased from a reported 3.4% to 10.7%. Most of the increase in resistance for piperacillin-tazobactam and meropenem is caused by a recent EUCAST breakpoint change. Metronidazole still has the lowest resistance rate for the B. fragilis group (one isolate, 0.4%) in this study. The sales of piperacillin-tazobactam in the same period revealed a corresponding increase (+130%), whereas meropenem sales were stable. CONCLUSION:The results underscore the need for timely routine antimicrobial susceptibility testing of B. fragilis group species and questions piperacillin-tazobactam monotherapy as empiric treatment for septic patients with a suspected abdominal source.
