ABSTRACT
The aim of this study is to develop a scoring platform to be used as a reference for both medical preparedness and research resource allocation in the prioritization of zoonoses. Using a case-control design, a comprehensive analysis of 46 zoonoses was conducted to identify factors influencing disease prioritization. This analysis provides a basis for constructing models and calculating prioritization scores for different diseases. The case group (n = 23) includes diseases that require immediate notification to health authorities within 24 hours of diagnosis. The control group (n = 23) includes diseases that do not require such immediate notification. Two different models were developed for primary disease prioritization: one model incorporated the four most commonly used prioritization criteria identified through an extensive literature review. The second model used the results of multiple logistic regression analysis to identify significant factors (with p-value less than 0.1) associated with 24-hour reporting, allowing for objective determination of disease prioritization criteria. These different modeling approaches may result in different weights and positive or negative effects of relevant factors within each model. Our study results highlight the variability of zoonotic disease information across time and geographic regions. It provides an objective platform to rank zoonoses and highlights the critical need for regular updates in the prioritization process to ensure timely preparedness. This study successfully established an objective framework for assessing the importance of zoonotic diseases. From a government perspective, it advocates applying principles that consider disease characteristics and medical resource preparedness in prioritization. The results of this study also emphasize the need for dynamic prioritization to effectively improve preparedness to prevent and control disease.
Subject(s)
Resource Allocation , Zoonoses , Zoonoses/epidemiology , Zoonoses/prevention & control , Zoonoses/transmission , Animals , Humans , Health Priorities , Case-Control Studies , Logistic ModelsABSTRACT
The first imported case of XDR typhoid fever in Taiwan contracted with a bacterial strain, which was most closely related to the blaCTX-M-15-carrying strains linked to Pakistan. Meropenem, in combination with an antimicrobial with intracellular activity against Salmonella, should be used for the treatment of XDR typhoid fever.
Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Communicable Diseases, Imported/microbiology , Drug Resistance, Multiple, Bacterial , Salmonella typhi/drug effects , Salmonella typhi/pathogenicity , Typhoid Fever/drug therapy , Typhoid Fever/microbiology , Adult , Child , Child, Preschool , Female , Humans , Male , Microbial Sensitivity Tests , Pakistan , Salmonella typhi/classification , Salmonella typhi/genetics , Serogroup , Taiwan , Travel-Related Illness , Typhoid Fever/diagnosis , Young AdultABSTRACT
BACKGROUND/PURPOSE: The susceptibility breakpoints of cephalosporins for Enterobacteriaceae were revised by the Clinical and Laboratory Standards Institute (CLSI) in 2010 and 2011. The clinical outcome and susceptibility data were analyzed to evaluate the impact of revised CLSI cefazolin breakpoints on the treatment of Escherichia coli bacteremia. METHODS: Forty-three bacteremic Escherichia coli isolates from Taichung Veterans General Hospital, Taichung, Taiwan, during the period from January 2013 to December 2013, were selected to analyze the minimum inhibitory concentration (MIC) distributions of cefazolin and the correlated clinical responses to cefazolin therapy. RESULTS: The modal cefazolin MIC among the 43 isolates was 1 µg/mL and accounted for 18 (42%) isolates. The cumulative percentage for MICs ≤ 2 µg/mL was 79%. The conventional dosing regimens achieved clinical cure in 33 (97%) of 34 patients with bacteremia due to E. coli with a cefazolin MIC ≤ 2 µg/mL, in all of the six patients with a cefazolin MIC of 4 µg/mL, and all of the three patients with a cefazolin MIC of 8 µg/mL. CONCLUSION: The microbiological data support the revised CLSI breakpoints of cefazolin. The conventional cefazolin dosing regimens can still achieve satisfactory clinical cure rates for bacteremia of E. coli with a cefazolin MIC ≤ 2 µg/mL in patients without severe septic shock. Before the approval of the efficacy of cefazolin for the treatment of E. coli isolates with a cefazolin MIC of 4 µg/mL, it is prudent to use cefazolin only when a high drug level can be achieved in the infection site, such as the urinary tract.
