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Antibiotics (Basel, Switzerland) Dec 2021Sepsis is a serious and expensive healthcare problem, when caused by a multidrug-resistant (MDR) bacteria mortality and costs increase. A reduction in the time until the... (Review)
Review
INTRODUCTION
Sepsis is a serious and expensive healthcare problem, when caused by a multidrug-resistant (MDR) bacteria mortality and costs increase. A reduction in the time until the start of treatment improves clinical results. The objective is to perform a systematic review of economic evaluations to analyze the cost-effectiveness of diagnostic methods in sepsis and to draw lessons on the methods used to incorporate antimicrobial resistance (AMR) in these studies.
MATERIAL AND METHODS
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Consolidated Health Economic Evaluation Reporting standards (CHEERS) checklist was used to extract the information from the texts.
RESULTS
A total of 16 articles were found. A decision model was performed in 14. We found two ways to handle resistance while modelling: the test could identify infections caused by a resistant pathogen or resistance-related inputs, or outcomes were included (the incidence of AMR in sepsis patients, antibiotic use, and infection caused by resistant bacterial pathogens).
CONCLUSION
Using a diagnostic technique to detect sepsis early on is more cost-effective than standard care. Setting a direct relationship between the implementation of a testing strategy and the reduction of AMR cases, we made several assumptions about the efficacy of antibiotics and the length-of-stay of patients.
PubMed: 35052904
DOI: 10.3390/antibiotics11010027 -
Journal of Infection and Public Health Mar 2022Understanding the transmissibility and pathogenicity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for control policies, but evidence... (Meta-Analysis)
Meta-Analysis Review
Transmissibility and pathogenicity of the severe acute respiratory syndrome coronavirus 2: A systematic review and meta-analysis of secondary attack rate and asymptomatic infection.
BACKGROUND
Understanding the transmissibility and pathogenicity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for control policies, but evidence remains limited.
METHODS
We presented a systematic and meta-analytic summary concerning the transmissibility and pathogenicity of COVID-19.
RESULTS
A total of 105 studies were identified, with 35042 infected cases and 897912 close contacts. 48.6% (51/105) of studies on secondary transmissions were from China. We estimated a total SIR of 7.8% (95% confidence interval [CI], 6.8%-8.8%), SAR of 6.6% (95% CI, 5.7%-7.5%), and symptomatic infection ratio of 86.9% (95%CI, 83.9%-89.9%) with a disease series interval of 5.84 (95%CI, 4.92-6.94) days. Household contacts had a higher risk of both symptomatic and asymptomatic infection, and transmission was driven between index cases and second-generation cases, with little transmission occurring in second-to-later-generation cases (SIR, 12.4% vs. 3.6%). The symptomatic infection ratio was not significantly different in terms of infection time, generation, type of contact, and index cases.
CONCLUSIONS
Our results suggest a higher risk of infection among household contacts. Transmissibility decreased with generations during the intervention. Pathogenicity of SARS-CoV-2 varied among territories, but didn't change over time. Strict isolation and medical observation measures should be implemented.
Topics: Asymptomatic Infections; COVID-19; Contact Tracing; Family Characteristics; Humans; Incidence; SARS-CoV-2; Virulence
PubMed: 35123279
DOI: 10.1016/j.jiph.2022.01.015 -
Osong Public Health and Research... Feb 2022Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of...
Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of antibiotic resistance. Thus, this systematic review was conducted to alert clinicians to this pathogen's potential antimicrobial resistance. A review of the literature was conducted for experimental reports and systematic reviews on the topics of plague, Y. pestis, and antibiotic resistance. From 1995 to 2021, 7 Y. pestis isolates with 4 antibiotic resistance mechanisms were reported. In Y. pestis 17/95, 16/95, and 2180H, resistance was mediated by transferable plasmids. Each plasmid contained resistance genes encoded within specific transposons. Strain 17/95 presented multiple drug resistance, since plasmid 1202 contained 10 resistance determinants. Strains 16/95 and 2180H showed single antibiotic resistance because both additional plasmids in these strains carried only 1 antimicrobial determinant. Strains 12/87, S19960127, 56/13, and 59/13 exhibited streptomycin resistance due to an rpsl gene mutation, a novel mechanism that was discovered recently. Y. pestis can acquire antibiotic resistance in nature not only via conjugative transfer of antimicrobial-resistant plasmids from other bacteria, but also by gene point mutations. Global surveillance should be strengthened to identify antibiotic-resistant Y. pestis strains by whole-genome sequencing and drug susceptibility testing.
PubMed: 35255676
DOI: 10.24171/j.phrp.2021.0288 -
Gut Microbes 2024Repeated exposure to antibiotics and changes in the diet and environment shift the gut microbial diversity and composition, making the host susceptible to pathogenic... (Meta-Analysis)
Meta-Analysis Review
Repeated exposure to antibiotics and changes in the diet and environment shift the gut microbial diversity and composition, making the host susceptible to pathogenic infection. The emergence and ongoing spread of AMR pathogens is a challenging public health issue. Recent evidence showed that probiotics and prebiotics may play a role in decolonizing drug-resistant pathogens by enhancing the colonization resistance in the gut. This review aims to analyze available evidence from human-controlled trials to determine the effect size of probiotic interventions in decolonizing AMR pathogenic bacteria from the gut. We further studied the effects of prebiotics in human and animal studies. PubMed, Embase, Web of Science, Scopus, and CINAHL were used to collect articles. The random-effects model meta-analysis was used to pool the data. GRADE Pro and Cochrane collaboration tools were used to assess the bias and quality of evidence. Out of 1395 citations, 29 RCTs were eligible, involving 2871 subjects who underwent either probiotics or placebo treatment to decolonize AMR pathogens. The persistence of pathogenic bacteria after treatment was 22%(probiotics) and 30.8%(placebo). The pooled odds ratio was 0.59(95% CI:0.43-0.81), favoring probiotics with moderate certainty ( = 0.0001) and low heterogeneity ( = 49.2%, = 0.0001). The funnel plot showed no asymmetry in the study distribution (Kendall'sTau = -1.06, = 0.445). In subgroup, showed the highest decolonization (82.4%) in probiotics group. -based probiotics and decolonize 71% and 77% of pathogens effectively. The types of probiotics ( < 0.018) and pathogens ( < 0.02) significantly moderate the outcome of decolonization, whereas the dosages and regions of the studies were insignificant ( < 0.05). Prebiotics reduced the pathogens from 30% to 80% of initial challenges. Moderate certainty of evidence suggests that probiotics and prebiotics may decolonize pathogens through modulation of gut diversity. However, more clinical outcomes are required on particular strains to confirm the decolonization of the pathogens. Protocol registration: PROSPERO (ID = CRD42021276045).
Topics: Probiotics; Humans; Prebiotics; Gastrointestinal Microbiome; Bacteria; Animals; Treatment Outcome; Anti-Bacterial Agents; Bacterial Infections; Gastrointestinal Tract
PubMed: 38778521
DOI: 10.1080/19490976.2024.2356279 -
Frontiers in Medicine 2023The pathogenic role of variants in TCF4 and COL8A2 in causing Fuchs' endothelial corneal dystrophy (FECD) is not controversial and has been confirmed by numerous...
INTRODUCTION
The pathogenic role of variants in TCF4 and COL8A2 in causing Fuchs' endothelial corneal dystrophy (FECD) is not controversial and has been confirmed by numerous studies. The causal role of other genes, SLC4A11, ZEB1, LOXHD1, and AGBL1, which have been reported to be associated with FECD, is more complicated and less obvious. We performed a systematic review of the variants in the above-mentioned genes in FECD cases, taking into account the currently available population frequency information, transcriptomic data, and the results of functional studies to assess their pathogenicity.
METHODS
Search for articles published in 2005-2022 was performed manually between July 2022 and February 2023. We searched for original research articles in peer-reviewed journals, written in English. Variants in the genes of interest identified in patients with FECD were extracted for the analysis. We classified each presented variant by pathogenicity status according to the ACMG criteria implemented in the Varsome tool. Diagnosis, segregation data, presence of affected relatives, functional analysis results, and gene expression in the corneal endothelium were taken into account. Data on the expression of genes of interest in the corneal endothelium were extracted from articles in which transcriptome analysis was performed. The identification of at least one variant in a gene classified as pathogenic or significantly associated with FECD was required to confirm the causal role of the gene in FECD.
RESULTS
The analysis included 34 articles with 102 unique ZEB1 variants, 20 articles with 64 SLC4A11 variants, six articles with 26 LOXHD1 variants, and five articles with four AGBL1 variants. Pathogenic status was confirmed for seven SLC4A11 variants found in FECD. No variants in ZEB1, LOXHD1, and AGBL1 genes were classified as pathogenic for FECD. According to the transcriptome data, AGBL1 and LOXHD1 were not expressed in the corneal endothelium. Functional evidence for the association of LOXHD1, and AGBL1 with FECD was conflicting.
CONCLUSION
Our analysis confirmed the causal role of SLC4A11 variants in the development of FECD. The causal role of ZEB1, LOXHD1, and AGBL1 variants in FECD has not been confirmed. Further evidence from familial cases and functional analysis is needed to confirm their causal roles in FECD.
PubMed: 37441688
DOI: 10.3389/fmed.2023.1153122 -
International Journal of Epidemiology Oct 2022Estimates of the relative contribution of different pathogens to all-cause diarrhoea mortality are needed to inform global diarrhoea burden models and prioritize... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Estimates of the relative contribution of different pathogens to all-cause diarrhoea mortality are needed to inform global diarrhoea burden models and prioritize interventions. We aimed to investigate and estimate heterogeneity in the case fatality risk (CFR) of different diarrhoeal pathogens.
METHODS
We conducted a systematic review and meta-analysis of studies that reported cases and deaths for 15 enteric pathogens published between 1990 and 2019. The primary outcome was the pathogen-specific CFR stratified by age group, country-specific under-5 mortality rate, setting, study year and rotavirus vaccine introduction status. We developed fixed-effects and multilevel mixed-effects logistic regression models to estimate the pooled CFR overall and for each pathogen, controlling for potential predictors of heterogeneity.
RESULTS
A total of 416 studies met review criteria and were included in the analysis. The overall crude CFR for all pathogens was 0.65%, but there was considerable heterogeneity between and within studies. The overall CFR estimated from a random-effects model was 0.04% (95% CI: 0.026%-0.062%), whereas the pathogen-specific CFR estimates ranged from 0% to 2.7%. When pathogens were included as predictors of the CFR in the overall model, the highest and lowest odds ratios were found for enteropathogenic Escherichia coli (EPEC) [odds ratio (OR) = 3.0, 95% CI: 1.28-7.07] and rotavirus (OR = 0.23, 95% CI: 0.13-0.39), respectively.
CONCLUSION
We provide comprehensive estimates of the CFR across different diarrhoeal pathogens and highlight pathogens for which more studies are needed. The results motivate the need for diarrhoeal interventions and could help prioritize pathogens for vaccine development.
Topics: Diarrhea; Humans; Odds Ratio; Rotavirus Vaccines
PubMed: 35578827
DOI: 10.1093/ije/dyac098 -
PloS One 2021Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported.
METHODS
The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented.
FINDINGS
No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity.
INTERPRETATION
C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.
Topics: Asthma; Biomarkers; Case-Control Studies; Chlamydia Infections; Chlamydophila Infections; Chlamydophila pneumoniae; Chronic Disease; Cross-Sectional Studies; Humans; Prospective Studies; Respiratory Tract Infections; Risk Factors
PubMed: 33872336
DOI: 10.1371/journal.pone.0250034 -
Porcine Health Management Oct 2023Understanding the financial consequences of endemically prevalent pathogens within the porcine respiratory disease complex (PRDC) and the effects of interventions... (Review)
Review
BACKGROUND
Understanding the financial consequences of endemically prevalent pathogens within the porcine respiratory disease complex (PRDC) and the effects of interventions assists decision-making regarding disease prevention and control. The aim of this systematic review was to identify what economic studies have been carried out on infectious endemic respiratory disease in pigs, what methods are being used, and, when feasible, to identify the economic impacts of PRDC pathogens and the costs and benefits of interventions.
RESULTS
By following the PRISMA method, a total of 58 studies were deemed eligible for the purpose of this systematic review. Twenty-six studies used data derived from European countries, 18 from the US, 6 from Asia, 4 from Oceania, and 4 from other countries, i.e., Canada, Mexico, and Brazil. Main findings from selected publications were: (1) The studies mainly considered endemic scenarios on commercial fattening farms; (2) The porcine reproductive and respiratory syndrome virus was by far the most studied pathogen, followed by Mycoplasma hyopneumoniae, but the absence or presence of other endemic respiratory pathogens was often not verified or accounted for; (3) Most studies calculated the economic impact using primary production data, whereas twelve studies modelled the impact using secondary data only; (4) Seven different economic methods were applied across studies; (5) A large variation exists in the cost and revenue components considered in calculations, with feed costs and reduced carcass value included the most often; (6) The reported median economic impact of one or several co-existing respiratory pathogen(s) ranged from €1.70 to €8.90 per nursery pig, €2.30 to €15.35 per fattening pig, and €100 to €323 per sow per year; and (7) Vaccination was the most studied intervention, and the outcomes of all but three intervention-focused studies were neutral or positive.
CONCLUSION
The outcomes and discussion from this systematic review provide insight into the studies, their methods, the advantages and limitations of the existing research, and the reported impacts from the endemic respiratory disease complex for pig production systems worldwide. Future research should improve the consistency and comparability of economic assessments by ensuring the inclusion of high impact cost and revenue components and expressing results similarly.
PubMed: 37848972
DOI: 10.1186/s40813-023-00342-w -
European Cells & Materials Oct 2021Osteomyelitis is an inflammatory bone disease caused by an infecting microorganism leading to a gradual bone loss. Due to the difficulty in studying osteomyelitis...
Osteomyelitis is an inflammatory bone disease caused by an infecting microorganism leading to a gradual bone loss. Due to the difficulty in studying osteomyelitis directly in patients, animal models allow researchers to investigate the pathogenesis of the infection and the development of novel prophylactic, anti-inflammatory and antimicrobial treatment strategies. This review is specifically focused on the in vivo mouse osteomyelitis studies available in literature. Thus, a systematic search on Web of Science and PubMed was conducted using the query "(infection) AND (mice OR mouse OR murine) AND (model OR models) AND (arthroplasty OR fracture OR (internal fixator) OR (internal fixation OR prosthesis OR implant OR osteomyelitis)". After critical assessment of the studies according to the inclusion and exclusion criteria, 135 studies were included in the detailed analysis. Based on the model characteristics, the studies were classified into five subject groups: haematogenous osteomyelitis, post-traumatic osteomyelitis, bone-implant-related infection, peri-prosthetic joint infection, fracture-related infection. In addition, the characteristics of the mice used, such as inbred strain, age or gender, the characteristics of the pathogens used, the inoculation methods, the type of anaesthesia and analgesia used during surgery and the procedures for evaluating the pathogenicity of the infecting micro-organism were described. Overall, the mouse is an excellent first step in vivo model to study the pathogenesis, inflammation and healing process of osteomyelitis and to evaluate novel prophylaxis and treatment strategies.
Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Humans; Inflammation; Mice; Osteomyelitis; Staphylococcal Infections
PubMed: 34672359
DOI: 10.22203/eCM.v042a22 -
Clinical Microbiology and Infection :... Mar 2024Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action.
OBJECTIVES
Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe.
METHODS
A systematic review and Bayesian meta-analysis.
DATA SOURCES
MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022.
STUDY ELIGIBILITY CRITERIA
Resource use and cost outcomes (including excess length of stay, overall costs, and other excess in or outpatient costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium, and patients with drug-susceptible or no infection.
PARTICIPANTS
All patients diagnosed with drug-resistant bloodstream infections (BSIs).
INTERVENTIONS
NA.
ASSESSMENT OF RISK OF BIAS
An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks.
METHODS OF DATA SYNTHESIS
Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates.
RESULTS
Of 5969 screened publications, 37 were included in the review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], -0.72 to 4.17) and 1.78 (95% CrI, -0.02 to 3.38) days, respectively.
CONCLUSIONS
Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed.
Topics: Humans; Methicillin-Resistant Staphylococcus aureus; Bayes Theorem; Anti-Bacterial Agents; Anti-Infective Agents; Escherichia coli; Pseudomonas aeruginosa; Drug Resistance, Bacterial
PubMed: 38128781
DOI: 10.1016/j.cmi.2023.12.013