Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings.

Screening for Antimicrobial-Resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review

BACKGROUND

Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) among hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation.

METHODS

We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries.

RESULTS

The search retrieved 11853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection among colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value<0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3).

CONCLUSIONS

While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.

Systematic review on Screening for antimicrobial-resistant Gram-negative bacteria in inpatients

Background

Infections with antimicrobial-resistant Gram-negative bacteria (AMR-GNB) are increasingly being reported worldwide. Early identification of carriage at hospital admission is essential to reduce the risk of onward transmission within the health facility. This systematic review aimed at exploring screening practices for AMR-GNB faecal colonization among patients on admission to hospital in high-income countries and estimating its prevalence.

Methods

We searched on Pubmed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on patients ≥18 years old and hospitalised (excluding long-term care facilities).

Results

The search retrieved 9496 articles, 85 were included after screening: 10 reported screening activities in outbreak situations (not included in the analysis); 75 in non-outbreak situations. Based on the target patient groups and setting we identified four subsets of screening approaches: all admitted (AA) in high risk (HR) wards (36 studies, 48%), HR patients in HR wards (12, 16%), HR patients in low risk wards (LRW) (11; 15%) and AA - LRW (15, 20%). HR patients-based screening targeted patients with certain clinical conditions (mostly oncologic patients, 37%), travellers 29%, previously hospitalised and individuals with multiple risks 34%. HR wards-based screening was performed mostly in ICU (73%), while LRW-based screening in hospital-wide setting (58%). We investigated the overall prevalence rates of AMR-GNB (15.1%; 95%CI: 9.5-21.6), Klebsiella spp (KB) (4.1%; 3.1-5.3), E. coli (9.6%; 7.7-11.7) P. Aeruginosa (7.6%; 1.7-16.8), A. Baumannii (2.1%; 0.5-4.4) and other Enterobacterales (0.8%; 0.59-1.1). Reported KB-prevalence varied according to screening approaches, with statistically significant higher prevalence in HR wards.

Conclusions

According to our data, screening for AMR-GNB mostly followed targeted approaches. Overall prevalence of AMR-GNB carriage at hospital admission was considerable.

Key messages

This systematic review gives un overview on the screening procedures for AMR-GNB faecal colonization among patients on hospital admission in high-income countries. According to our results, overall prevalence of AMR-GNB carriage was considerable (15.1%), varying among specific pathogens but with no significant correlation with screening approaches, except for KB.

Risk of infection in antimicrobial-resistant Gram-negative bacteria carriers: A systematic review

Background

Antimicrobial-resistant Gram-negative bacteria (AMR-GNB) have emerged as important health care-associated pathogens. Infections with AMR-GNB are associated with high patient morbidity and attributable mortality. Colonization is a prerequisite for infection, however the extent to which colonized patients develop infection is unclear. This systematic review explored the risk of developing infection during hospitalisation among AMR-GNB faecal carriers. Also, we investigated the acquisition rate for AMR-GNB colonization among patients not colonized at admission.

Methods

We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on hospitalised patients ≥18 years old in high-income countries (excluding long-term care facilities).

Results

Out of 9496 articles, 55 studies fulfilled our inclusion criteria. Forty-two studies reported data from EU/EEA, 6 from USA and 7 from other regions. Almost all studies (n = 45) were conducted in university hospitals. Most studies (n = 41;74.5%) were performed in high-risk wards (ICU, haematology, burn units and transplant units). Out of 55 studies, 8 examined AMR-GNB, 27 Enterobacteriaceae, while the others investigated specific pathogens: Klebsiella spp. (n = 11), E. Coli (n = 2), A. Baumannii (n = 3) and P. Aeruginosa (n = 4). The rate of AMR-GNB carriage acquisition was 10.5% (n = 40 studies; 95% CI:8.2-13.1). The risk of progression to infection among patients colonized at hospital admission was 13.9% (n = 15; 5.4-24.9), while the infection rate in patients who acquired carriage during hospitalization was 23.0% (n = 7; 5.9-45.2). Patients with an undefined time of colonization presented an infection rate of 16.9% (n = 13; 11.2-23.4). Considering these three populations as a whole, the risk of developing infection was 16.0% (11.0-21.0).

Conclusions

Our results suggest that risk of progression to infection in AMR-GNB colonized patients in hospital setting is high.

Key messages

The aim of our study was to estimate the risk of progression to infection, during hospital stay, in patients colonized by AMR-GNB at hospital admission in high-income countries. Our results suggest that faecal colonization with AMR-GNB poses a 16.0% risk of subsequent AMR-GNB infection. This risk in higher (23.0%) in patients who acquired colonization during hospitalisation.

Liver pathology in Wilson's disease: From copper overload to cirrhosis

Wilson's disease (WD) is a genetic metabolic disease strictly associated with liver cirrhosis. In this review, the genetic bases of the disease are discussed, with emphasis on the role of ATP7B (the Wilson disease protein) dysfunction as a determinant factor of systemic copper overload. Regarding the different multiple mutations described in WD patients, the peculiarity of Sardinian population is highlighted, Sardinians carrying a rare deletion in the promoter (5' UTR) of the WD gene. The role of epigenetic changes in the clinical presentation and evolution of liver disease in WD patients is also discussed, nutrition probably representing a relevantly risk factor in WD patients. The role of transmission electron microscopy in the diagnosis of WD-related liver disease is underlined. Mitochondrial changes, increased peroxisomes fat droplets, lipolysosomes and intranuclear glycogen inclusions are reported as the most frequent ultrastructural changes in the liver of WD carriers. The role of histochemical stains for copper is analyzed, and the Timm's method is suggested as the most sensitive one for revealing hepatic copper overload in all stage of WD. The marked variability of the histological liver changes occurring in WD is underlined simple steatosis may represent the only pathological changes, frequently associated with glycogenated nuclei. Mallory-Denk bodies lipogranulomas alcoholic and non-alcoholic fatty liver disease ending with bridging fibrosis and cirrhosis. Finally, the reversal of fibrosis as a possible therapeutic objective in WD is discussed.

Vocalização como indicativo do bem-estar de suínos submetidos a situações de estresse

Objetivou-se com este trabalho estimar o bem-estar de suínos a partir de registros de sua vocalização, durante alojamento em granja comercial. Foram utilizados 150 suínos machos castrados, distribuídos aleatoriamente em cinco baias. Os suínos foram submetidos a diferentes situações de estresse: sede (sem acesso a água), fome (sem acesso ao alimento), estresse térmico (Índice de temperatura e umidade - ITU >74). Para o tratamento controle, os animais foram mantidos em situação de conforto, com acesso a alimento e água, e ambiente com ITU <70. Foram registrados os sinais acústicos a cada 30 minutos, durante período ininterrupto de três horas, totalizando seis coletas para cada situação de estresse. Os sinais foram digitalizados a uma frequência de até 44.100Hz, por um período de 3 minutos. Posteriormente, os áudios foram analisados pelo software Praat(r) 5.1.19. Os atributos gerados a partir desse software foram a energia do sinal (Pa²*s), amplitude máxima e amplitude mínima (Pa), a frequência de picht (Hz), a intensidade sonora (dB) e quatro níveis de formantes (F1; F2; F3 e F4), também chamados de harmônicas (Hz). Verificou-se que, dependendo do estímulo estressor e de sua duração, os atributos acústicos energia e intensidade do sinal, frequência de pitch e as formantes 2 e 4 apresentaram diferenciação. Os atributos sonoros da vocalização de suínos variam de maneira distinta em função do tipo e duração do estímulo estressante, funcionando, quando associados, como ferramenta eficiente para quantificar o grau de estresse dos animais.

Ambiente térmico y bienestar de los cerdos en el período de descanso previo al sacrificio

Se evaluó la relación entre el ambiente térmico de las pocilgas de descanso en un matadero de cerdos y la temperatura superficial (TS) de los animales, así como el efecto de la pulverización intermitente de agua sobre el confort térmico. Se llevaron a cabo dos visitas a un matadero comercial, y en cada uno de ellos fueron seleccionadas tres pocilgas de descanso, una destinada al tratamiento de control (sin pulverizar durante todo el período) y dos para el tratamiento de pulverización intermitente de agua (sucesivamente 30 minutos con aspersión y 30 minutos sin aspersión). Las evaluaciones se iniciaron en el momento de la descarga de los animales, en la cual se registraron imágenes termográficas de los lotes con una cámara termográfica infrarroja. Después del alojamiento en la porqueriza se registraron imágenes termográficas y la frecuencia respiratoria (FR) de los animales cada cinco minutos durante cuatro horas. También fueron registradas la temperatura y la humedad relativa del aire y se calcularon los índices de temperatura y humedad (ITH). Considerando los valores de (ITH) se observó que los animales se mantuvieron en un estado de confort térmico sólo en el momento de su llegada al matadero. La TS y la FR de los animales mantenidos en la pocilga, sin el sistema de aspersión (control) presentaron una elevación lineal en función de la hora del día, o sea, conforme al aumento de la temperatura ambiental. En el tratamiento con aspersión intermitente de agua se observó un comportamiento sinusoidal del TS y FR, entretanto las mismas se mantuvieron siempre inferiores al tratamiento control, incluso en los momentos que los rociadores de agua se encontraban desconectados. El tiempo de aspersión necesario para la reducción y estabilización de la TS de los animales estuvo condicionado al binomio temperatura-humedad relativa del aire, siendo estimado en 25 minutos en los horarios de mayor ITH. La temperatura ambiente máxima durante las evaluaciones fue de 28,4 ºC.

A model of cost-outcome analysis for assistive technology

During the CERTAIN study (research carried out in 1994-96 within the Technology Initiative for Disabled and Elderly (TIDE) programme of the European Union), a number of real life case studies of provision of assistive technology to disabled persons were investigated in order to assess the applicability of socio-economic principles, methods and techniques already available from Health Care Technology Assessment studies. A retrospective study on cost, effectiveness and utility resulting from the implementation of assistive technology was carried out over a sample of disabled persons who had adopted technical aids before the start of the project. The sample was selected in such a way to include different pathologies (steady or progressive), impairments, ages, technology and social environment. Each case was described by considering all clinical, technical and social aspects; a common structure for case reporting was developed and tested; attempts were carried out to apply and refine concept and tools derived from health technology assessment studies; on the grounds of such experience a decision support model was elaborated for the choice between different alternatives in order to maximize the client's quality of life while making efficient use of scarce resources. A computer implementation of such a model was also developed, along with a mathematical structure of cost analysis. Within a national research programme such findings were further exploited, leading to the development of a prototype cost-outcome instrument designed for use in clinical practice in the provision of assistive technology to individual cases.