Archive for April 1, 2016
ESCMID Guidelines for the Management of the Infection Control Measures to Reduce Transmission of Multidrug-resistant Gram-negative Bacteria in Hospitalized Patients.
Clinical Microbiology and Infection January 2014 V.20 Supplement s1
Tacconelli, M. A. Cataldo, S. J. Dancer, G. De Angelis, M. Falcone, U. Frank, G. Kahlmeter, A. Pan, N. Petrosillo, J. Rodríguez-Baño, N. Singh, M. Venditti, D. S. Yokoe and B. Cookson
Healthcare-associated infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB) are a leading cause of morbidity and mortality worldwide.
These evidence-based guidelines have been produced after a systematic review of published studies on infection prevention and control interventions aimed at reducing the transmission of MDR-GNB.
The recommendations are stratified by type of infection prevention and control intervention and species of MDR-GNB and are presented in the form of ‘basic’ practices, recommended for all acute care facilities, and ‘additional special approaches’ to be considered when there is still clinical and/or epidemiological and/or molecular evidence of ongoing transmission, despite the application of the basic measures.
The level of evidence for and strength of each recommendation, were defined according to the GRADE approach.
http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12427/epdf
Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands
European Respiratory Journal Nov 2015, 46 (5) 1407-1416
Marie-Josée J. Mangen, Mark H. Rozenbaum, Susanne M. Huijts, Cornelis H. van Werkhoven, Douwe F. Postma, Mark Atwood, Anna M.M. van Deursen, Arie van der Ende, Diederick E. Grobbee, Elisabeth A.M. Sanders, Reiko Sato, Theo J.M. Verheij, Conrad E. Vissink, Marc J.M. Bonten, G. Ardine de Wit
The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects. We examined the cost-effectiveness of PCV13 vaccination in the Netherlands.
Using a Markov-type model, incremental cost-effectiveness ratios (ICER) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective. Estimates of quality-adjusted life-years (QALYs), costs, vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospective studies. The base-case was PCV13 vaccination of adults aged 65–74years compared to no vaccination, assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use. Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted.
The ICER for base-case was €8650 per QALY (95% CI 5750–17100). Vaccination of high-risk individuals aged 65–74years was cost-saving and extension to medium-risk individuals aged 65–74years yielded an ICER of €2900. Further extension to include medium- and high-risk individuals aged ≥18years yielded an ICER of €3100.
PCV13 vaccination is highly cost-effective in the Netherlands. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries.
Effects of PCV7 and PCV13 on invasive pneumococcal disease and carriage in Stockholm, Sweden
European Respiratory Journal April 2016 V.47 N.4 P.1208-1218
Ilias Galanis, Ann Lindstrand, Jessica Darenberg, Sarah Browall, Priyanka Nannapaneni, Karin Sjöström, Eva Morfeldt, Pontus Naucler, Margareta Blennow, Åke Örtqvist, Birgitta Henriques-Normark
The effects of pneumococcal conjugated vaccines (PCVs) need to be investigated. In Stockholm County, Sweden, PCV7 was introduced in the childhood immunisation programme in 2007 and changed to PCV13 in 2010.
Over 90% of all invasive isolates during 2005–2014 (n=2336) and carriage isolates, 260 before and 647 after vaccine introduction, were characterised by serotyping, molecular typing and antibiotic susceptibility, and serotype diversity was calculated. Clinical information was collected for children and adults with invasive pneumococcal disease (IPD).
The IPD incidence decreased post-PCV7, but not post-PCV13, in vaccinated children. Beneficial herd effects were seen in older children and adults, but not in the elderly. The herd protection was more pronounced post-PCV7 than post-PCV13. PCV7 serotypes decreased. IPD caused by PCV13 serotypes 3 and 19A increased post-PCV7. Post-PCV13, serotypes 6A and 19A, but not serotype 3, decreased. The serotype distribution changed in carriage and IPD to nonvaccine types, also in nonvaccinated populations. Expansion of non-PCV13 serotypes was largest following PCV13 introduction. Serotype diversity increased and nonvaccine clones emerged, such as CC433 (serotype 22F) in IPD and CC62 (serotype 11A) in carriage. In young children, meningitis, septicaemia and severe rhinosinusitis, but not bacteraemic pneumonia, decreased.
