Background.Clostridium difficile infection (CDI) is associated with a 22% recurrence rate.However, few studies have focused on multiple recurrences.In order to evaluate the potential of new treatment options targeting specifically recurrences, we assessed the burden of recurrent Clostridium difficile infections (rCDI).Methods.A retrospective cohort of all adults diagnosed with CDI between 1998 and 2009, identified by a positive cytotoxin assay and ICD-9 CM/10 codes, living in the Sherbrooke area (Quebec, Canada).An rCDI was defined by the reappearance of diarrhea leading to a treatment, with or without a positive toxin assay or an endoscopic evidence of pseudomembranous colitis, within 14 to 60 days following the previous episode.Results.A total of 1311 patients were included (median age = 72.4years; IQR = 54-82).Initial CDI was nosocomial in 35% of cases, followed a previous admission in 22%, and was community-acquired in 44%.The probability of having a first rCDI was 24% (291/1214) excluding deaths and total colectomies within 60 days, a second rCDI 41.3% (105/254), a third 33.3% (31/93), and a fourth or more 24.1% (7/29).
Contexte : Nous avons effectué une étude cas/témoins qui a examiné si l’administration du vaccin antigrippal inactivé au cours de la saison 2019–2020 a eu une incidence sur les risques relatifs à la maladie à coronavirus 2019 (COVID-19), car il y avait une préoccupation à savoir si le vaccin pourrait être préjudiciable par interférence virale. Méthodes : Au total, 920 cas d’infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) (diagnostiquée entre mars et octobre 2020) et 2 123 témoins non infectés ont été recrutés parmi les personnes nées au Québec entre 1956 et 1976 et qui avaient reçu des services de diagnostic dans deux hôpitaux (Montréal et Sherbrooke, Québec). Après avoir obtenu le consentement, un questionnaire a été passé par téléphone. Les données ont été analysées par régression logistique. Résultats : Chez les travailleurs de la santé, le vaccin antigrippal inactivé reçu au cours de la saison grippale précédente n’était pas associé à un risque accru de COVID-19 (rapport de cotes ajusté [RCA] : 0,99, intervalle de confiance [IC] à 95 % : 0,69–1,41). Parmi les participants qui n’étaient pas des travailleurs de la santé, la vaccination antigrippale était associée à des probabilités plus faibles de COVID-19 (RCA : 0,73, IC à 95 % 0,56–0,96). Conclusion : Nous n’avons trouvé aucune preuve que le vaccin contre la grippe saisonnière augmentait le risque de développer la COVID-19.
Background The Canadian National Vaccine Safety (CANVAS) network monitors the safety of seasonal influenza vaccines in Canada. Aim To provide enhanced surveillance for seasonal influenza and pandemic influenza vaccines. Methods In 2017/18 and 2018/19 influenza seasons, adults (≥ 15 years of age) and parents of children vaccinated with the seasonal influenza vaccine participated in an observational study using web-based active surveillance. Participants completed an online survey for health events occurring in the first 7 days after vaccination. Participants who received the influenza vaccine in the previous season, but had not yet been vaccinated for the current season, were unvaccinated controls. Results In 2017/18, 43,751 participants and in 2018/19, 47,798 completed the online safety survey. In total, 957 of 30,173 participants vaccinated in 2017/18 (3.2%; 95% confidence interval (CI): 3.0–3.4) and 857 of 25,799 participants vaccinated in 2018/19 (3.3%; 95% CI: 3.1–3.5) reported a health problem of sufficient intensity to prevent their normal daily activities and/or cause them to seek medical care (including hospitalisation). This compared to 323 of 13,578 (2.4%; 95% CI: 2.1–2.6) and 544 of 21,999 (2.5%; 95% CI: 2.3–2.7) controls in each respective season. The event rate in vaccinated adults and children was higher than the background rate and was associated with specific influenza vaccines. The higher rate of events was associated with systemic symptoms and migraines/headaches. Conclusion In 2017/18 and 2018/19, higher rates of events were reported following seasonal influenza vaccination than in the pre-vaccination period. This signal was associated with several seasonal influenza vaccine products.
Resume Objectif : L’objectif de cet article consiste a presenter une intervention d’optimisation de l’usage des antimicrobiens articulee autour de l’utilisation d’un systeme expert. Mise en contexte : Au Centre hospitalier universitaire de Sherbrooke, une equipe travaille depuis 2005 a la creation d’un systeme d’aide a la decision pour cibler les prescriptions d’antimicrobiens sous-optimales. Resultats : Apres 53 semaines d’utilisation, 1344 interventions ont ete effectuees, dont 1222 (90,9 %) ont ete acceptees par les differentes equipes medicales. Ceci represente une moyenne de 1,7 interventions acceptees/heure de presence de la pharmacienne. Pour la periode decrite, la consommation totale en antimicrobiens a diminue de 13,5 %, ce qui represente une economie de 305 000 $ (15 %) sur les antimicrobiens du departement de pharmacie. Ceci constitue une economie de 405 $/heure de presence de la pharmacienne. Discussion : Les resultats observes s’expliquent par l’evaluation exhaustive de toutes les nouvelles prescriptions et de toutes les modifications subsequentes d’antimicrobiens par le logiciel. De plus, la surveillance hebdomadaire permet egalement de detecter des pratiques en emergence. Conclusion : La collaboration medicale, pharmaceutique et informatique ont permis de developper un outil adapte a la realite quebecoise afin d’optimiser l’utilisation des antimicrobiens et de diminuer les couts lies a l’antibiotherapie. Abstract Objective: The purpose of this article is to discuss an intervention optimizing the use of antimicrobials using experts in the field. Context: At the Centre hospitalier universitaire de Sherbrooke , a team has been working since 2005 to create a decisionmaking support system targeting sub-optimal prescriptions for antimicrobials. Results: After 53 weeks of use, 1344 interventions were made of which 1222 (90.0%) were accepted by the different medical teams. This represents, on average, 1.7% of interventions being accepted per hour of pharmacist presence. For this period, total antimicrobial consumption decreased by 13.5%, representing savings of 305 00$ (15%) with respect to the pharmacy department’s antimicrobial agents. This constitutes savings of 405$ per hour of pharmacist presence. Discussion: The observed results can be explained by the exhaustive review that was done of all new prescriptions and of all subsequent modifications to antimicrobial therapy by the software. In addition, emergent practice habits were detected through weekly surveillance. Conclusion: The collaboration between the medical, pharmacy and information technology fields allowed the development of a tool adapted to the Quebec reality to optimize antimicrobial use and to decrease costs related to antimicrobial therapy. Key words: Antimicrobials, pharmacist, software, surveillance
Klebsiella oxytoca is a gram-negative bacterium found in fecal microbiota and known to cause several infections in humans, including antibiotic-associated hemorrhagic colitis. We present here a case of colitis caused by K. oxytoca toxin-producing strains that evolved in chronic diarrhea successfully treated by fecal microbiota transplant.
Background.Pneumococcal community acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) cause significant morbidity and mortality worldwide.Although childhood immunization programs have reduced the burden of pneumococcal disease, there is insufficient data in Canada to advise immunization policy in adults.This study aimed to describe clinical outcomes of pneumococcal CAP and IPD in hospitalized Canadian adults, and determine the proportion of patients with vaccine-preventable disease.Methods.To establish the burden of pneumococcal disease, active surveillance for CAP and IPD in hospitalized adults was performed in five Canadian provinces from December 2010 to 2013.The serotype distribution was characterized using the Quellung reaction, PCR-based serotyping, and urine antigen detection (UAD).Results.Of 4769 cases of all-cause CAP, a laboratory test for pneumococci was performed in 3703.Of these, 516 (13.9%) were pneumococcal CAP (CAP Spn ) and 238 (6.4%) were bacteremic CAP Spn .In addition to CAP, 80 cases of IPD (non-CAP) were identified.The burden of CAP Spn , bacteremic CAP Spn , and IPD was evident in terms of intensive care unit admission, mechanical ventilation, and 30-day mortality.Overall, the proportion of all-cause CAP with laboratory testing identifying a 13valent pneumococcal conjugate vaccine (PCV13) or 23-valent pneumococcal polysaccharide vaccine (PPV23) serotype was 6.2% and 7.1%, respectively.However, these values are underestimated; 41.9% of the CAP Spn case isolates were not viable upon reculturing, non-typeable, or unavailable for serotyping.Of the available serotypes, PCV13-and PPV23-serotypes represented 76.0% and 87.7% in CAP Spn , respectively.If these proportions are extrapolated to the overall contribution of CAP Spn to all-cause CAP of 13.9%, PCV13-and PPV23-serotypes would represent 10.6% and 12.2% of allcause CAP, respectively.The results of a PCV13-specific UAD were consistent with this estimation at 197/1907 (10.3%).Conclusion.This study demonstrated that pneumococcal CAP and IPD are significant causes of morbidity and mortality in hospitalized Canadian adults, with a large proportion of available S. pneumoniae serotypes being vaccinepreventable.
Background The Canadian National Vaccine Safety (CANVAS) network conducted a multi-center, prospective vaccine safety study to collect safety data after dose 1 and 2 of COVID-19 vaccines and follow up safety information 7 months after dose 1. Objective This study aimed to describe and evaluate the recruitment methods used by CANVAS and the retention of participants by each modality. Methods CANVAS deployed a multi-pronged recruitment approach to reach a larger sample, without in-person recruitment. Three primary recruitment strategies were used: passive recruitment, technology-assisted electronic invitation through the vaccine booking system (auto-invitation), or auto-registration through the vaccine registries (auto-enrollment). Results Between December 2020 and April 2022, approximately 1.3 million vaccinated adults either self-enrolled or were auto-enrolled in CANVAS, representing about 5% of the vaccinated adult Canadian population. Approximately 1 million participants were auto-enrolled, 300,000 were recruited by auto-invitation, and 5,000 via passive recruitment. Overall survey completion rates for dose 1, dose 2 and the 7-month follow-up surveys were 51.7% (681,198 of 1,318,838), 54.3% (369,552 of 681,198), and 66.4% (452,076 of 681,198), respectively. Completion rates were lower among auto-enrolled participants compared to passively recruited or auto-invited participants who self-enrolled. However, auto-enrolled samples were much larger, which offset the lower completion rates. Conclusion Our data suggest that auto-enrollment provided an opportunity to reach and retain a larger number of individuals in the study compared to other recruitment modalities.
