ABSTRACT
Intro: This study aimed at evaluating healthcare-related sepses caused by three multi-drug resistant Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital in 2018-2020, particularly concerning therapy, antibiotic-resistance and outcomes, by also comparing the pre-COVID (2018-2019) and COVID (2020) periods. Method(s): An observational, retrospective-cohort analysis was based on data related to patients admitted to the "SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (Italy) between 2018 and 2020, with septic episodes from bacteria of the examined species, whose antibiogram proved resistance to >= 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients' medical records and the hospital's computer-based application. Statistics involved Fisher-test comparisons and cumulative incidence analyses. Finding(s): Inclusion criteria led to enrolment of 174 patients. Comparison between 2020 and 2018-2019 showed a relative increase in A. baumannii cases, at the expense of the other species (p<0.0001), and an increasing resistance trend for K. pneumoniae, with a higher proportion of cases resistant to 3-4 classes of antimicrobials (p<0.0001). Overall, most patients were treated with carbapenems (72.4%), although the COVID period saw a significant rise in the use of polymyxins, particularly colistin (62.5% vs 36%, p=0.0005). In both periods, more than half patients recovered (53-57%) and around one third died (27-34%), but with different outcomes according to the infecting bacterium, generally better for P. aeruginosa (70% recovered at 60 days) and worse for A. baumannii (55% recovered). Discussion(s): The study confirmed the importance of the burden connected to healthcare-related sepses. Moreover, since the COVID outbreak, a trend could be spotted towards higher relative incidence of complex cases, caused by antimicrobial-resistant bacteria and thus requiring second-line therapy. Conclusion(s): These findings underline the importance of appropriate antimicrobial stewardship and infection control in view of the evolving healthcare needs.Copyright © 2023
ABSTRACT
Background The debate on vaccination strategies has been periodically involving researchers, policymakers, and also the population. Interest waves have occurred both after a revival of childhood infectious diseases in 2016-2017, due to low vaccine coverages, and during the recent Coronavirus outbreak. This study aimed at overviewing vaccination strategies (and corresponding vaccine coverages) for childhood vaccinations and SARS-CoV-2. Methods Measles was chosen as a childhood vaccination indicator. Policy data were retrieved from health institutions (either European or national/regional) and, for COVID-19, also from press agencies and newspaper websites. Vaccine coverage data were retrieved from the World Bank, World Health Organisation, and UNICEF databases (for childhood vaccines), and from the “Our World in Data” platform for SARS-CoV-2. A qualitative comparison was performed between the two contexts. Results Unlike childhood vaccinations, few countries (and only Austria in Europe) imposed generalised COVID-19 mandates, most countries preferring targeted mandates for higher-risk groups. Many countries confirmed their traditional voluntary vaccination approach also for COVID-19, while countries historically relying on compulsory vaccination strategies, such as Slovenia and Hungary, surprisingly opted for voluntary SARS-CoV-2 vaccination, with unsatisfactory results. However, no tangible crude association was generally found between vaccination policies and achieved coverages, although factors such as cultural background, education, and religion appeared to influence the impact of vaccination policies. Conclusions The COVID-19 experience has enriched pre-existent vaccination strategy debates by adding interesting elements concerning attitudes toward vaccines in a novel context. Reading the available results in the frame of vaccine hesitancy determinants can help to understand the relationship between policies and actual coverages. Key messages Few countries have imposed generalised mandates for COVID-19, while many preferred targeted obligations for high-risk groups and some countries surprisingly opted for a voluntary approach. Accurately considering social and cultural determinants allows understanding the chance of success of vaccination strategies, ahead of fostering the right policymaking approach for each population.
ABSTRACT
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic. Currently, the diagnosis of COVID-19 is confirmed by detecting SARS-CoV-2 via RealTime-RT-PCR in rhino-pharyngeal swab. Serological test is required to evaluate a previous exposure to the virus, as well as antibody response. The aim of this multicentric study is to analyse the antibody response following COVID-19 vaccination in healthcare workers and guests of nursing homes, and to determine differences between subjects with or without a confirmed previous infection. Methods Our study included 657 subjects, recruited from guests and healthcare workers of nursing homes in the Piedmont region. 10 days after the completion of the vaccination cycle, a blood sample was taken from the subjects to measure IgG against SARS-CoV-2 spike protein. Serological testing was performed using an enzyme immunoassay kit (EUROIMMUN Anti-SARS-CoV-2 QuantiVac ELISA). We performed statistical analysis with R software. Results We recruited 657 subjects aged between 19 to 106. Among them, 404 had a previous infection and 253 didn't have a known previous infection. The serological examination resulted positive in 655 subjects and negative in 2 (X¯ IgG 1095 RU/ml). Samples with titer> 1200 RU/ml will be further diluted to identify the titer and differences from the baseline situation. Conclusions This study analyses neutralizing antibodies, which should prevent the virus from binding to target cells via spike protein. According to literature, immunological response to vaccine presents a great variability of antibodies level in the study population. However, no significantly correlations were found between the available variables. Preliminary data show the presence of a very intense antibody response after active vaccine immunization both in subjects with previous infection and in the rest of the study population. Key messages Covid-19 vaccine response in a population at risk. Differences between subjects with or without a confirmed previous infection.