Archive for August 24, 2018

Ethics of Infection Control Measures for Carriers of Antimicrobial Drug–Resistant Organisms

Emerging Infectious Diseases September 2018 V.24 N.9

Rump et al.

The Netherlands National Institute for Public Health and the Environment, Bilthoven, the Netherlands (B. Rump, A. Timen); Radboud University Medical Center, Nijmegen, the Netherlands (M. Hulscher); Wageningen University, Wageningen, the Netherlands (M. Verweij)

Many countries have implemented infection control measures directed at carriers of multidrug-resistant organisms. To explore the ethical implications of these measures, we analyzed 227 consultations about multidrug resistance and compared them with the literature on communicable disease in general. We found that control measures aimed at carriers have a range of negative implications. Although moral dilemmas seem similar to those encountered while implementing control measures for other infectious diseases, 4 distinct features stand out for carriage of multidrug-resistant organisms: carriage presents itself as a state of being; carriage has limited relevance for the health of the carrier; carriage has little relevance outside healthcare settings; and antimicrobial resistance is a slowly evolving threat on which individual carriers have limited effect. These features are of ethical relevance because they influence the way we traditionally think about infectious disease control and urge us to pay more attention to the personal experience of the individual carrier.

PDF

https://wwwnc.cdc.gov/eid/article/24/9/pdfs/17-1644.pdf

August 24, 2018 at 6:13 pm

Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada

Emerging Infectious Diseases September 2018 V.24 N.9

P. Kohler et al.

Roberto G. Melano, Samir N. Patel, Shumona Shafinaz, Amna Faheem, Brenda L. Coleman, Karen Green, Irene Armstrong, Huda Almohri, Sergio Borgia, Emily Borgundvaag, Jennie Johnstone, Kevin Katz, Freda Lam, Matthew P. Muller, Jeff Powis, Susan M. Poutanen, David Richardson, Anu Rebbapragada, Alicia Sarabia, Andrew Simor, Allison McGeer, and for the Toronto Invasive Bacterial Diseases Network (TIBDN)

We analyzed population-based surveillance data from the Toronto Invasive Bacterial Diseases Network to describe carbapenemase-producing Enterobacteriaceae (CPE) infections during 2007–2015 in south-central Ontario, Canada. We reviewed patients’ medical records and travel histories, analyzed microbiologic and clinical characteristics of CPE infections, and calculated incidence. Among 291 cases identified, New Delhi metallo-β-lactamase was the predominant carbapenemase (51%). The proportion of CPE-positive patients with prior admission to a hospital in Canada who had not received healthcare abroad or traveled to high-risk areas was 13% for patients with oxacillinase-48, 24% for patients with New Delhi metallo-β-lactamase, 55% for patients with Klebsiella pneumoniae carbapenemase, and 67% for patients with Verona integron-encoded metallo-β-lactamase. Incidence of CPE infection increased, reaching 0.33 cases/100,000 population in 2015. For a substantial proportion of patients, no healthcare abroad or high-risk travel could be established, suggesting CPE acquisition in Canada. Policy and practice changes are needed to mitigate nosocomial CPE transmission in hospitals in Canada.

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https://wwwnc.cdc.gov/eid/article/24/9/pdfs/18-0164.pdf

August 24, 2018 at 6:11 pm

Spread of mcr-1–Driven Colistin Resistance on Hospital Surfaces, Italy

Emerging Infectious Diseases September 2018 V.24 N.9

Caselli et al.

Università Degli Studi di Ferrara, Ferrara, Italy

Plasmid-mediated colistin resistance driven by the mcr-1 gene is of great clinical concern. Its diffusion in the hospital environment is unknown. We detected mcr-1–driven resistance in 8.3% of Enterobacteriaceae isolates from hospital surfaces in Italy, which might represent a reservoir of threatening nosocomial pathogens.

PDF

https://wwwnc.cdc.gov/eid/article/24/9/pdfs/17-1386.pdf

August 24, 2018 at 6:09 pm

Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the U.K. Clinical Research Practice Datalink.

Br J Dermatol. December 2016 V.175 N.6 P.1183-1194.

doi: 10.1111/bjd.14815.

Matthews A1, Turkson M1, Forbes H1, Langan SM1, Smeeth L1, Bhaskaran K1.

Abstract

BACKGROUND:

Statins are commonly prescribed worldwide and recent evidence suggests that they may increase the risk of herpes zoster (HZ).

OBJECTIVES:

To quantify the effect of statin exposure on the risk of HZ in the U.K.

METHODS:

A matched case-control study was conducted using data from U.K. primary care and hospital records. Patients > 18 years with an incident diagnosis of HZ were matched to up to four controls for age, sex and general practice. Patients were included in the statin exposure group if they had ever used a statin, and the daily dosage of the most recent statin prescription and the time since the most recent statin prescription were also recorded. The primary outcome was an incident diagnosis of HZ. Odds ratios (ORs) were estimated from conditional logistic regression and adjusted for potential confounders.

RESULTS:

A total of 144 959 incident cases of HZ were matched to 549 336 controls. Adjusted analysis suggested strong evidence for an increase in the risk of HZ related to statin exposure (OR 1·13, 95% confidence interval 1·11-1·15). There was also an increased risk when dosages were increased for patients who were currently or had recently been receiving statin treatment (Ptrend < 0·001), and we found an attenuation of the increased risk of HZ in previous statin users as the time since last statin exposure increased (Ptrend < 0·001).

CONCLUSIONS:

These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of HZ.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215701/pdf/BJD-175-1183.pdf

August 24, 2018 at 4:09 pm

Herpes zoster is associated with prior statin use: a population-based case-control study.

PLoS One. October 24, 2014 V.9 N.10 P.:e111268.

doi: 10.1371/journal.pone.0111268.

Chung SD1, Tsai MC2, Liu SP3, Lin HC4, Kang JH5.

Abstract

BACKGROUND:

This study investigated the association between statin use and herpes zoster (HZ) occurrence in a population-based case-control study.

METHODS:

Study subjects were retrieved from the Taiwan Longitudinal Health Insurance Database 2000. This study included 47,359 cases with HZ and 142,077 controls. We performed conditional logistic regression analyses to calculate the odds ratio (OR) to present the association between HZ and having previously been prescribed statin.

RESULTS:

We found that 13.0% of the sampled subjects had used statins, at 15.5% and 12.1% for cases and controls, respectively (p<0.001). A conditional logistic regression analysis suggested that the adjusted OR of being a statin user before the index date for cases was 1.28 (95% confidence interval (CI): 1.24∼1.32) compared to controls. Subjects aged 18∼44 years had the highest adjusted OR for prior statin use among cases compared to controls (OR: 1.69; 95% CI: 1.45∼1.92). Furthermore, we found that the ORs of being a regular and irregular statin user before the index date for cases were 1.32 (95% CI: 1.27∼1.38) and 1.23 (95% CI: 1.181.29), respectively, compared to controls.

CONCLUSIONS:

We concluded that prior statin use was associated with HZ occurrence.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208841/pdf/pone.0111268.pdf

August 24, 2018 at 4:07 pm

Statins increase the risk of herpes zoster: A propensity score-matched analysis.

PLoS One. 2018 June 14, 2018 V.13 N.6 P.e0198263.

doi: 10.1371/journal.pone.0198263.

Kim MC1, Yun SC2, Lee SO3, Choi SH3, Kim YS3, Woo JH3, Kim SH3.

Abstract

OBJECTIVES:

Statins, which are lipid-lowering agents, have anti-inflammatory and immunomodulatory properties that may affect the occurrence of various infectious diseases. We assessed whether statins increase the risk of herpes zoster (HZ) with propensity score-matching.

METHODS:

The study was based on the National Health Insurance database and its subset database of the “medical check-up” population of South Korea. These cohorts consist of about one million and 570,000 people, respectively, representative of the entire population of South Korea. We identified 103,930 statin users and 430,685 non-statin users. After propensity score-matching, 25,726 statin users and the same number of non-statin users were finally analyzed. The development of HZ was monitored in these matched pairs over the 11 years from 2003 to 2013.

RESULTS:

Statin users had a significantly higher risk of HZ than non-statin users: hazard ratio (HR) 1.25 (95% CI, 1.15 to 1.37) (p < .0001). The risk of HZ associated with statins was especially high in the elderly: HR 1.39 (95% CI, 1.12 to 1.73) in the over 70-year-olds (p = 0.003) and HR 1.18 (95% CI, 1.00 to 1.39) in the 60-to-69-year-olds (p = 0.056). Furthermore, there was a significant p for trend in terms of cumulative dose effect between the risk of HZ and the duration of statin use (p < .0001).

CONCLUSIONS:

These epidemiologic findings provide strong evidence for an association between HZ and statin use, and suggest that unnecessary statins should be avoided.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001979/pdf/pone.0198263.pdf

August 24, 2018 at 4:06 pm

Statins and the risk of herpes zoster: a population-based cohort study.

Clin Infect Dis. February 1, 2014 V.58 N.3 P.350-356.

doi: 10.1093/cid/cit745.

Antoniou T1, Zheng H, Singh S, Juurlink DN, Mamdani MM, Gomes T.

Abstract

BACKGROUND:

Statins are widely used lipid-lowering drugs with immunomodulatory properties that may favor reactivation of latent varicella-zoster virus infection. However, whether statins increase the risk of herpes zoster is unknown.

METHODS:

We conducted a population-based retrospective cohort study of Ontario residents aged ≥ 66 years between 1 April 1997 and 31 March 2010 to examine the association between statin use and incidence of herpes zoster. We used propensity score matching to ensure similarity between users and nonusers of statins, and Cox proportional hazard models to assess differences in outcomes between study groups. To test the specificity of our findings, we examined the association between statin exposure and knee arthroplasty.

RESULTS:

During the 13-year study period, we matched 494 651 individuals treated with a statin to an equal number of untreated individuals. In the main analysis, the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10-1.17). The attributable fraction of exposed individuals was 11.6%. In a prespecified analysis, we found a similar risk of herpes zoster among statin users in the subgroup of patients with diabetes (HR, 1.18; 95% CI, 1.09-1.27). As expected, we found no association between statin use and knee arthroplasty (HR, 1.04; 95% CI, .99-1.09).

CONCLUSIONS:

Among older patients, treatment with statins is associated with a small but significantly increased risk of herpes zoster.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954107/pdf/cit745.pdf

August 24, 2018 at 4:05 pm

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