Background:Annual influenza vaccination is recommended for solid organ transplant (SOT) recipients, with various strategies explored to enhance efficacy. Given the ongoing uncertainty about the benefits and potential risks of different strategies in influenza vaccination in SOT recipients, comparing the indirect comparisons of the available evidence is necessary. Methods:We searched MEDLINE, Embase, CENTRAL, and CINAHL from inception to March 2025 to identify randomized controlled trials that compared different influenza vaccinations in SOT recipients. We conducted a network meta-analysis and used the GRADE approach to assess the certainty of evidence, categorize interventions, and present the findings. The protocol for this systematic review was registered in PROSPERO (CRD42024537277). Results:A total of 13 articles met our eligibility criteria (with 2,298 participants) and assessed 10 vaccination strategies. The high-dose (60IMSD) influenza vaccine was superior to the standard influenza vaccination regarding the seroconversion rate for H1N1 (RR 2.27, 95% CI 1.52 to 3.39; high certainty) and H3N2 (RR 1.61, 95% CI 1.34 to 1.94; high certainty). All of the included vaccination strategies might have no difference in graft rejection and other adverse events compared with the standard vaccination. Conclusions:We found that the 60IMSD vaccine demonstrated better immunogenicity outcomes compared with all other influenza vaccines studied in SOT recipients. Additionally, we observed little or no difference among various influenza vaccination strategies in terms of graft rejection and other serious adverse events (SAEs) or non-serious adverse events (non-SAEs).

Abstract Background: Penicillin allergy labels (PALs) affect about 10% of people, are mostly low risk, and more common in females. Sex-based differences in prevalence and characteristics remain unclear. This study examined associations between sex, PAL, and relevant covariates, in an Ontario ambulatory hospital population. Methods: A cross-sectional study of adults ( ≥18 years) seen at the hospital’s Urgent Medicine Clinic from 2015–2024 was conducted. Descriptive statistics compared patients by PAL status. Unadjusted and multivariable logistic regression models evaluated associations between sex and PAL, adjusting for covariates. Results: Among 29,645 patients (59.7% female), 3,026 (10.2%) had a documented beta-lactam allergy, of which 2,777 (9.4%) were PALs, and most (91.7%) were low risk. Females were twice as likely to have a PAL (11.6% vs 6.0%; unadjusted OR 2.17, 95% CI 2.14–2.19) and more often reported multiple medication allergies (30% vs 16%; OR 2.25, P < .05). After adjusting for covariates, female sex (OR 1.47, 95% CI 1.34–1.62), atopic conditions (OR 1.46, 95% CI 1.29–1.66), age ( >80 years [vs <65 years]: OR 1.16, 95% CI 1.02–1.32), and number of other medication allergies (2: OR 10.44, 95% CI 9.28–11.74; ≥3: OR 13.33, 95% CI 11.72–15.16 vs 0 or 1) were associated with higher odds of PAL. Conclusion: Approximately 10% of patients had a PAL, mostly low risk and female predominant. Multivariable analysis identified female sex, atopy, older age, and multiple medication allergies as independent predictors; autoimmune and metabolic conditions were not. Longitudinal studies using validated allergy data and intersectionality can guide equitable evaluation.

Background: Artificial Intelligence (AI) has emerged as a valuable tool in health care, supporting diagnostics and decision making. However, integration into clinical practice presents challenges, including data quality, accessibility, and regional guideline variations. This study evaluates four major AI platforms (ChatGPT, Meta AI, Copilot, and OpenEvidence) against CDC infection control guidelines for varicella and measles across Canada, Malaysia, and the United Kingdom. The objective was to assess the accuracy and consistency of AI responses on infection control measures compared with CDC guidelines and to evaluate how platforms handle complex scenarios. Methods: A comparative analysis of the four AI platforms was conducted using structured questions and clinical case scenarios on varicella and measles. Responses were evaluated for alignment with CDC guidelines. Platform accessibility was tested from Canada, Malaysia, and the United Kingdom, and regional variations were analyzed. Results: All platforms provided generally accurate information, but discrepancies were noted. ChatGPT and Meta AI mostly aligned with CDC guidelines, while OpenEvidence and Copilot omitted key epidemiological criteria. Meta AI lacked a full explanation of varicella laboratory criteria and was inaccessible in Malaysia. Regional differences in measles postexposure prophylaxis (PEP) were observed, particularly in Copilot and OpenEvidence. Response consistency varied between platforms. Conclusions: AI platforms show promise in supporting infection control but exhibit regional variability. Continued refinement of AI tools is essential to ensure their global applicability and accuracy. Consultation with an infection prevention and control (IPAC) physician remains vital for complex cases.

Abstract Background The worldwide occurrence of nontuberculous Mycobacterium (NTM) infections is rising. In Canada, there is a continuing surge in infections caused by Mycobacterium avium complex (MAC). Treating NTM infections is challenging and requires multidrug regimens with antimicrobial susceptibilities to guide therapy. Generally, aminoglycosides have moderate in-vitro activity against NTM isolates. However, the synergistic effect with other antimicrobials makes it an attractive choice for clinicians, especially in the management of severe or refractory cases. The recommended duration of intravenous aminoglycosides is debatable due to side effects and the need for therapeutic monitoring. Moreover, NTMs are becoming more resistant to aminoglycosides. This study aims to assess clinical practice variations in aminoglycoside use among NTM infections in terms of duration and monitoring in London, Canada. Patient Characteristics and Clinical Presentation Methods Retrospective study reviewing the characteristics of 30 patients diagnosed with NTM infection between January 1, 2019 and December 31, 2023 in three tertiary care hospitals in London, Ontario, Canada.Table 2:NTM Susceptibility Report Results Mean age at diagnosis was 60.8 years. Seventeen (57%) were male and 13 (43%) were female. The presentations included pulmonary NTM infections in 19 (63%) and skin and soft tissue infections in four (13%). Among all identified species, MAC was the most common. Fifteen (50%) patients received IV aminoglycosides, with 7 (32%) having documented susceptibility to aminoglycosides. Duration of aminoglycoside use varied among patients, ranging from 2 to 24 weeks. Of the patients started on an IV aminoglycoside, 3 (20%) developed ototoxicity and 2 (13%) had acute kidney injury. Serum aminoglycoside levels were checked in 12 (80%), but only 7 patients (47%) had at least one audiology screen. In terms of outcomes, 7 (23%) achieved clinical cure while 9 (30%) had refractory disease, 7 (78%) of which were pulmonary. Two (57%) of the cured patients and 2 (22%) of the refractory patients had received an aminoglycoside. Aminoglycoside Use and Monitoring Conclusion Aminoglycoside use for the treatment of NTMs is variable among clinicians, mostly due to concerns for side effects and the need for consistent drug monitoring, which limits its implementation in outpatient settings. Clinical Outcomes Disclosures Lise Bondy, Assistant Professor, Pfizer: Honoraria|Viiv: Advisor/Consultant Michael Silverman, MD, FRCP, FACP, AAHIVMed, Pfizer: Grant/Research Support

Abstract Background Seasonal influenza can cause serious illness and even death, especially in immunocompromised people such as solid organ transplant recipients (SOT). Early results from some studies show that high dose (HD) intramuscular (IM) vaccine might help boost the body's immune response in transplant patients. Given the uncertain benefits and harms associated with various IM vaccine doses a synthetized appraisal of the evidence is warranted.Figure 1:Seroconversion rate in Influenza A(H1N1) (SC H1N1) Forest plot Methods Randomized controlled trials of adults who underwent SOT and received IM influenza vaccine and compared , IM influenza HD vaccine with standard dose. The outcomes of interests are seroconversion rate (SCR) for H1N1,H3N2, and graft rejection after vaccination. We searched MEDLINE, Embase, and Cochrane CENTRAL until Jan 2024. Screening, data extraction, risk of bias and certainty of evidence assessment were assessed by two reviewers.Figure 2:Seroconversion rate in Influenza A (H3N2) (SC H3N2) Forest plot Results Pooling data from the 5 studies (1281 patients) shows moderate quality of evidence in the SCR towards using HD influenza vaccine in H1N1 type and high-quality evidence for H3N2 type . (RR 1.87 (1.25 to 2.79), RR 1.54 [1.31 to 1.80]). Analysis of five studies indicated that HD influenza vaccine results in no difference in graft rejection. (RR 0.73 [0.37 to 1.45]). High quality evidence showed that HD influenza vaccine reduce serious adverse events in SOT patients. (RR 0.71 [0.52 to 0.96]). Data from three studies shows HD influenza vaccine may results in little to no difference in confirmed clinically influenza. (low certainty of evidence) (RR 1.16 [0.58 to 2.29]).Figure 3:Graft rejection (GR) Forest plot Conclusion Our systematic review indicates that HD influenza vaccine probably increases SCR in H1N1 and increases SCR in H3N2.HD vaccine, also may not increase graft rejection and reduces serious adverse events in SOT patients. GRADE Summary of Findings (SoF) Table Disclosures Reza Rahimi Shahmirzadi, MD, Pfizer: Grant/Research Support Meisam Abdar Esfahani, MD, Pfizer: Grant/Research Support Michael Silverman, MD, FRCP, FACP, AAHIVMed, Pfizer: Grant/Research Support

Introduction: Treatment of acute bacterial skin and skin structure infections (ABSSSIs) with intravenous (IV) antibiotics is difficult in marginalized populations, such as people who inject drugs, due to issues such as unstable housing or mental health conditions. These factors often require extended hospital admissions for IV antibiotics. Dalbavancin, a novel lipoglycopeptide antibiotic effective against gram-positive bacteria, lasts over 14 days and may be suitable for patients who struggle with traditional IV antibiotic administration. Methods: This was a case series in which we reviewed 19 patients referred to our Cellulitis Clinic in London, Ontario, Canada, between February 1 and July 30, 2023, who received a single dose of IV dalbavancin for ABSSSIs as outpatients. Those who were enrolled had severe infections requiring IV antibiotics, with psychosocial factors precluding outpatient IV therapy, or were at high risk of non-adherence to oral antibiotics. Results: The median age of patients was 43 (range 36 to 56); they were mostly male (74%), unemployed (89%), and with unstable housing (58%). Positive outcomes were observed in 13/19 (68%) patients, with 3/19 having indeterminate outcomes (could not be reached for follow-up but were not admitted to any institution within our catchment area) and 3/19 having negative outcomes (needed further antibiotics following dalbavancin). Conclusion: Our experience shows that a single IV dose of dalbavancin is effective in treating ABSSSIs in patients with complex psychosocial factors, as positive outcomes were observed in most patients. Dalbavancin eliminates the need for indwelling IV access and may reduce hospital admissions for patients in whom traditional antibiotic regimens may be challenging.

Background: Oral challenges with amoxicillin or other penicillins are safe and effective for delabeling low-risk penicillin allergy histories. While approximately 90% of reported penicillin allergies can be safely delabeled, detailed data on reaction frequency, types, and timing during and after delabeling interventions remain limited. Such data are crucial to optimizing protocols and integrating oral challenges into routine practice. This study aims to characterize the interventions commonly used for oral challenge, classify reported reactions, and identify reported predictors of hypersensitivity reactions in randomized controlled trials and quasi-experimental studies involving an oral challenge for patients with low-risk penicillin allergies. Methods: This study leverages data from a systematic review and meta-analysis assessing the effectiveness of oral challenge interventions in patients with low-risk penicillin allergies. This descriptive analysis summarizes the adverse reactions experienced among patients in published studies who received oral challenge. Participant demographics, intervention protocols, frequency, type, and timing of post-challenge adverse reactions are reported. Reactions are categorized as immediate, delayed, or other, with frequencies summarized using descriptive statistics. A random effects meta-analysis quantifies a pooled adverse reaction rate. Predictors of hypersensitivity reactions were synthesized narratively. Results: Across 26 studies (2 randomized trials, 24 quasi-experimental studies) evaluating an oral challenge for patients with a low-risk penicillin allergy, the average participant age was 56 years, with a predominance of females (61%) and limited ethnic diversity with 88% reported or identifying as White. Amoxicillin was the most frequenty used oral challenge agent, typically administered as a single 250 mg oral dose. The incidence of reaction or non-delabeling was 4% (95% Confidence Interval 3%, 6%), I2 = 43%, P = .0001. Cutaneous manifestations, such as rashes, were the most frequent reactions. Delayed reactions, primarily mild maculopapular rashes, were uncommon and managed with antihistamines or topical steroids. Risk factors for oral challenge reactions included higher baseline allergy burden and shorter intervals to oral challenge since the index reaction. Conclusion: Oral challenge strategies to delabel low-risk penicillin allergies can involve single doses of amoxicillin or other penicillins with monitoring protocols that can be managed in ambulatory settings. However, although these delabeling strategies are becoming more prevalent, continued study of standardized protocols and follow-up are essential for effective and replicable delabeling strategies. Future research should prioritize diverse populations and equity-driven frameworks to improve generalizability to all individuals and to resource limited settings.

AIMS:Sex and gender may influence penicillin allergy label (PAL) prevalence and outcomes. This review evaluates the effectiveness and safety of direct delabelling (DD) and oral challenge (OC) for low-risk patients and examines sex and gender differences in reporting and outcomes. METHODS:We searched PubMed, Database of Abstracts of Reviews and Effects, ClinicalTrials.gov, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, medRxiv, Ovid MEDLINE, and Ovid EMBASE until February 2024 for studies including DD or OC compared to no intervention, skin testing or other methods. Two reviewers assessed quality. Meta-analyses were conducted, and subgroup analyses were carried out if I2 >   75%. Descriptive data was analysed using NVivo 14 and reported narratively. RESULTS:From 1046 screened studies, 28 met inclusion criteria (two RCTs, 26 quasi-experimental studies). Sex at baseline was reported in 86% of studies, with 61% females: 18% disaggregated outcomes by sex with a female mean delabelling rate of 66%. Gender variables were not reported. OC was not found to be more or less as effective comparaed to skin testing in RCTs (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.95, 1.13, I2 = 74%). DD interventions had a 27% delabelling rate (95% CI 10%, 50%, I2 = 96%), with nursing staff achieving 29% (95% CI 15%, 47%, I2 = 63%) and allergists/immunologists 6% (95% CI 0.00, 0.00, I2 = 20%). Quasi-experimental studies reported 90% delabelling for OC, with 59% by allergists/immunologists and 90% by pharmacists. Adverse events averaged 4% and were non-severe. CONCLUSIONS:DD and OC are effective for delabelling low-risk penicillin allergies. Comprehensive data is lacking on sex and gender differences, indicating a need for further research.

BACKGROUND:Approximately, 10% of people report a penicillin allergy; however, more than 90% can safely undergo delabeling after a detailed history, oral challenge, or other investigations such as penicillin skin testing (PST). Although PST is the gold standard, the results can be heterogeneous, and awaiting specialist assessment may take an inordinate amount of time. Therefore, oral provocation challenge has become acceptable for individuals with low-risk penicillin allergy histories. There also appears to be an association with increased prevalence of adverse drug reaction reporting in female individuals, which may translate to penicillin allergy prevalence; however, the evidence has not been assessed through a sex and gender lens. This systematic review will identify and synthesize the findings from studies that report measures of effectiveness and safety of interventions aimed at delabeling penicillin allergies in low-risk individuals. Information related to sex and gender will be extracted, where available, to understand potential differences in allergy reporting and patient outcomes. METHODS:The Cochrane Handbook for Systematic Reviews of Interventions and the Centre for Review and Dissemination's Guidance for Undertaking Reviews in Health Care will be used as frameworks for conducting this systematic review. The literature search will be conducted by a medical librarian (B. M. M.) and will consist of a search strategy to identify and retrieve published studies that meet our inclusion criteria. Studies that require penicillin skin testing (PST) as a step prior to other interventions will be excluded. Integrated knowledge translation involving co-design was carried out for this systematic review protocol creation. Data extraction will be conducted at four levels: (1) study level, (2) patient level, (3) intervention level, and (4) outcome level. A narrative descriptive synthesis of results and risk of bias of all included studies will be provided, and, if relevant, a meta-analysis will be performed. DISCUSSION:The dissemination of findings from this knowledge synthesis to various stakeholders is intended to inform on options for evidence-based interventions to aid in delabeling penicillin allergies in individuals with a low risk of experiencing a hypersensitivity reaction. Detailed reporting on the characteristics of delabeling interventions as well as the effectiveness of similar interventions will benefit policy makers considering the implementation of a penicillin allergy delabeling protocol. Additionally, findings from this systematic review will report on the current evidence regarding the role of sex and gender in both the prevalence and outcomes associated with the presence of penicillin allergies. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42022336457.

BACKGROUND:Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. METHODS:In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days. Antibiotic selection, dosing, and route were at the discretion of the treating team. We excluded patients with severe immunosuppression, foci requiring prolonged treatment, single cultures with possible contaminants, or cultures yielding Staphylococcus aureus. The primary outcome was death from any cause by 90 days after diagnosis of the bloodstream infection, with a noninferiority margin of 4 percentage points. RESULTS:Across 74 hospitals in seven countries, 3608 patients underwent randomization and were included in the intention-to-treat analysis; 1814 patients were assigned to 7 days of antibiotic treatment, and 1794 to 14 days. At enrollment, 55.0% of patients were in the ICU and 45.0% were on hospital wards. Infections were acquired in the community (75.4%), hospital wards (13.4%) and ICUs (11.2%). Bacteremia most commonly originated from the urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%). By 90 days, 261 patients (14.5%) receiving antibiotics for 7 days had died and 286 patients (16.1%) receiving antibiotics for 14 days had died (difference, -1.6 percentage points [95.7% confidence interval {CI}, -4.0 to 0.8]), which showed the noninferiority of the shorter treatment duration. Patients were treated for longer than the assigned duration in 23.1% of the patients in the 7-day group and in 10.7% of the patients in the 14-day group. A per-protocol analysis also showed noninferiority (difference, -2.0 percentage points [95% CI, -4.5 to 0.6]). These findings were generally consistent across secondary clinical outcomes and across prespecified subgroups defined according to patient, pathogen, and syndrome characteristics. CONCLUSIONS:Among hospitalized patients with bloodstream infection, antibiotic treatment for 7 days was noninferior to treatment for 14 days. (Funded by the Canadian Institutes of Health Research and others; BALANCE ClinicalTrials.gov number, NCT03005145.).

BackgroundAppropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology—Head and Neck Surgery (OHNS).ObjectiveThe objective of the study is to achieve 90% compliance with evidence‐based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS.MethodsThe pre‐intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019–2020) whereas the post‐intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020–May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self‐reported perception of following evidence‐based guidelines.ResultsCompliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre‐intervention to 59.0% post‐intervention (p < 0.001). Agent compliance did not improve from pre‐ to post‐intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence‐based antimicrobial prophylaxis guidelines.ConclusionCompliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates.Level of Evidence3 Laryngoscope, 133:3403–3408, 2023

Innovation in laboratory testing algorithms to address seemingly uncontrollable global supply chain shortages in plastics and other consumables during emergencies such as the current COVID-19 pandemic have been urgently needed. We report our experience with specimen pooling on SARS-CoV-2 testing in an acute care hospital microbiology laboratory during a high testing demand period that exceeded available processing capacity. A fully automated four-in-one pooling algorithm was designed and validated. Correlation and agreement were calculated. A custom Microsoft Excel tool was designed for use by the technologists to aid interpretation, verification and result entry. Cost-per-test impact for pooling was measured in reference to the consumable cost and was denoted as the percentage reduction of cost versus the baseline cost-per-test of testing specimens individually. Validation showed a strong correlation between the signals observed when testing specimens individually versus those that were pooled. Average crossing point difference was 1.352 cycles (95% confidence interval of -0.235 and 2.940). Overall agreement observed between individually and pooled tested specimens was 96.8%. Stratified agreement showed an expected decreased performance of pooling for weakly positive specimens dropping below 60% after a crossing point of 35. Post-implementation data showed the consumable cost-savings achieved through this algorithm was 85.5% after 8 months, creating both testing and resource capacity. Pooling is an effective method to be used for SARS-CoV-2 testing during the current pandemic to address resource shortages and provide quick turnaround times for high test volumes without compromising performance.

BACKGROUND:Characterizing the multiorgan manifestations and outcomes of patients hospitalized with COVID-19 will inform resource requirements to address the long-term burden of this disease. We conducted a descriptive analysis using prospectively collected data to describe the clinical characteristics and spectrum of organ dysfunction, and in-hospital and longer-term clinical outcomes of patients hospitalized with COVID-19 during the first wave of the pandemic at a Canadian centre.METHODS:We conducted a prospective case series involving adult patients (aged ≥ 18 yr) with COVID-19 admitted to 1 of 2 hospitals in London, Ontario, from Mar. 17 to June 18, 2020, during the first wave of the pandemic. We recorded patients' baseline characteristics, physiologic parameters, measures of organ function and therapies administered during hospitalization among patients in the intensive care unit (ICU) and in non-ICU settings, and compared the characteristics of hospital survivors and nonsurvivors. Finally, we recorded follow-up thoracic computed tomography (CT) and echocardiographic findings after hospital discharge.RESULTS:We enrolled 100 consecutive patients (47 women) hospitalized with COVID-19, including 32 patients who received ICU care and 68 who received treatment in non-ICU settings. Respiratory sequelae were common: 23.0% received high-flow oxygen by nasal cannula, 9.0% received noninvasive ventilation, 24.0% received invasive mechanical ventilation and 2.0% received venovenous extracorporeal membrane oxygenation. Overall, 9.0% of patients had cerebrovascular events (3.0% ischemic stroke, 6.0% intracranial hemorrhage), and 6.0% had pulmonary embolism. After discharge, 11 of 19 patients had persistent abnormalities on CT thorax, and 6 of 15 had persistent cardiac dysfunction on echocardiography.INTERPRETATION:This study provides further evidence that COVID-19 is a multisystem disease involving neurologic, cardiac and thrombotic dysfunction, without evidence of hepatic dysfunction. Patients have persistent organ dysfunction after hospital discharge, underscoring the need for research on long-term outcomes of COVID-19 survivors.

We sought to explore the relationship between body mass index (BMI) and neurologic outcomes following acute COVID-19 infection. We conducted a retrospective electronic medical record-based cohort study enrolling adults with laboratory-confirmed acute COVID-19 infection who presented to 1 of 12 academic and community hospitals in Southwestern Ontario, Canada between April 1, 2020 and July 31, 2021. Primary subjective (anosmia, dysgeusia, and/or headache) and objective (aseptic meningitis, ataxia, delirium, encephalopathy, encephalitis, intracranial hemorrhage, ischemic stroke, and/or seizure) composite neurologic outcomes were assessed, comparing obese and overweight individuals to those with underweight/normal BMI indices, adjusting for baseline characteristics. Secondary outcomes (severity of illness, length of hospital stay, SARS-CoV-2 viral load, mortality) were similarly analyzed. A total of 1437 enrolled individuals, of whom 307 (21%), 456 (32%), and 674 (47%) were underweight/normal, overweight, and obese, respectively. On multivariable analysis, there was no association between BMI category and the composite outcome for subjective (odds ratio [OR] 1.17, 95% CI 0.84-1.64, Bonferroni p = 1.00 for obese; OR 1.02, 95% CI 0.70-1.48; Bonferroni p = 1.00 for overweight) and objective (OR 0.74, 95% CI 0.42-1.30, p = 0.29 for obese; OR = 0.80, 95% CI 0.45-1.43, p = 0.45 for overweight) neurologic manifestations. There was no association between BMI category and any secondary outcome measure and no evidence of effect modification by age or sex. This study demonstrates the absence of an association between BMI and neurologic manifestations following acute COVID-19 illness. Prospective studies using standardized data collection tools and direct measures of body fat are warranted to obtain more valid effect estimates.

Human monkeypox is a viral zoonosis endemic to West and Central Africa that has recently generated increased interest and concern on a global scale as an emerging infectious disease threat in the midst of the slowly relenting COVID-2019 disease pandemic. The hallmark of infection is the development of a flu-like prodrome followed by the appearance of a smallpox-like exanthem.

Background:Antimicrobial resistance (AMR) is a public health issue with significant impact on health care. Antibiogram development and deployment is a key strategy for managing and preventing AMR. Our objective was to develop an Ontario antibiogram as part of a larger provincial initiative aimed at advancing antimicrobial stewardship in the province.Methods:As part of a voluntary provincial online survey, antibiogram data from 100 of 201 (49.8%) Ontario hospitals were collected and included. All hospitals in Ontario were eligible to participate except those providing only mental health or ambulatory services. Weighted provincial and regional antibiotic susceptibilities (percentages) were conducted using descriptive statistical analyses, and an interactive antibiogram spreadsheet was developed. Respondent-identified barriers to collecting and interpreting antibiogram data are presented descriptively.Results:There was wide regional variability in antimicrobial-resistant organisms across Ontario. Provincial methicillin-resistant Staphylococcus aureus prevalence was 24.6%, ranging from 5.9% to 43.7% regionally. Provincial Escherichia coli resistance to ceftriaxone and ciprofloxacin was 13.8% (regional range 6.0%-25.1%) and 22.5% (regional range 9.8-37.8%), respectively. Klebsiella spp resistance to ceftriaxone and ciprofloxacin was similar across all health regions, with overall provincial rates of 7.5% and 5.6%, respectively.Conclusions:We have demonstrated that integrating hospital AMR tracking and reporting as part of a larger voluntary provincial antimicrobial stewardship program initiative is a feasible approach to capturing AMR data. The provincial antibiogram serves as a benchmark for the current state of AMR provincially and across health regions.