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Preprint accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title and year of publication.
They will be replaced in the appropriate issue by the final typeset articles, which may therefore contain changes.

 

 

 

The history of Gin and Tonic; the infectious disease specialist long drink. When gin and tonic was not ordered but prescribed

Omar Simonetti, Carlo Contini, Mariano Martini

The paper will appear in: Infez Med, December  2022

Published on the journal website: 30 September 2022. Section: Infections in the History of Medicine

Abstract                         

Winston Churchill statement promoting Gin and Tonic as a life saver during British Empire extension hides many truths. As a matter of fact, the modern cocktail is thought to be born in India where it was widely distributed by Royal Navy for its anti-malarial properties. The aim of the present work is to review and unveil the history of Gin and Tonic through the centuries. As a matter of facts, primitive Gin and Tonic protective effects were well understood by physicians far before the advent of the “germ theory” and its fortunate invention is one of the most  fascinating approaches in the history of preventive medicine. Indeed, quinine, a compound with protective effects on the replicative cycle of Plasmodium spp was discovered in 18th Century and since 19th it become the main compound of tonic beverages such as Schweppe's ones. Interestingly, it was administered to British expatriates seamen and soldiers in order to prevent febrile paroxysms. Soon after, British military doctors demonstrated that the addition of lime or lemon peels to tonics was effective in preventing scurvy. While, addition of alcoholic beverages and gin contributed to make more enjoyable the bitter and unpleasant taste of this beverages. Results: The spectacular voyage of Gin and Tonic teaches us that a popular recreational drink of our Century was a powerful prophylaxis which certainly helped British colonial expansion.

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Role of tigecycline in the treatment of urinary tract infections: a systematic review of published case reports

Reema Charles, Shreya Das Adhikari, Ankit Mittal, Souvik Chaudhuri, Mukund Gupta, Wasim Khot, Marco Schito, Heather Stone, Nitin Gupta

The paper will appear in: Infez Med, December  2022


Published on the journal website: 30 September 2022. Section: Reviews

Abstract

Introduction: The emergence of multi-drug resistance has forced clinicians to occasionally use drugs that are not approved to treat urinary tract infections (UTIs). This systematic review aimed to evaluate the utility of tigecycline in patients with UTIs.

Methodology: A systematic review of case studies was used to retrieve articles between 1.1.1999 to 1.1.2021 from two databases, PubMed and Embase. The title-abstract screening was done for 198 articles, out of which 69 articles were included for full-text screening. A total of 18 articles with 27 cases were included for final analysis.

Results: Of the 27 cases, there were 13 cases with complicated UTI and five had catheter-associated UTI. The most common organisms were Klebsiella pneumoniae (n=11), Acinetobacter baumannii (n=9), and Escherichia coli (n=6). Tigecycline was used as monotherapy in 19 patients and as a combination therapy in 8 patients. The median duration of tigecycline was 13 (10-15) days. A favourable clinical or microbiological response at varying intervals was seen in 24/27 (88.9%). Within three months of a favourable response, recurrence of symptoms was seen in four patients.

Conclusion: In a small analysis of published case reports, tigecycline appeared to be a relatively effective treatment in patients with UTIs, caused by multidrug-resistant organisms. Where tigecycline is the only susceptible drug, it can be used for treatment. Further research, such as randomized controlled trials, is needed to fully assess the drug’s efficacy in this context.

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Periodontal disease as a non-traditional risk factor for acute coronary syndrome: a systematic review and meta-analysis

Edinson Dante Meregildo-Rodriguez, Luis Gianmarco Robles-Arce, Eleodoro Vladimir Chunga-Chévez, Martha Genara Asmat-Rubio, Petterson Zavaleta-Alaya, Gustavo Adolfo Vásquez-Tirado 

The paper will appear in: Infez Med, December 2022

Published on the journal website: 30 September 2022. Section: Reviews


Abstract
Objectives: Previous observational studies have suggested an association between periodontal disease (PD) and cardiovascular and cerebrovascular diseases. Nonetheless, evidence linking PD with coronary heart disease (CHD) and acute coronary syndrome (ACS) is still contradictory. We aim to systematically review the role of PD as a risk factor for ACS (myocardial infarction and unstable angina).

Methods: The protocol was registered in PROSPERO (CRD42021286278) and we followed the recommendations of the PRISMA and AMSTAR 2 guidelines. We systematically searched for 7 databases and electronic thesis repositories from inception to February 2022. We included articles without language restriction following the PECO strategy (population: “adult participants”; exposure: “periodontal disease”; comparator: “no periodontal disease”; outcome: “acute coronary syndrome” OR “acute myocardial infarction” OR “unstable angina”). Odds ratios (OR) with 95% confidence intervals (95% CI) were pooled using random effects and heterogeneity was quantified by Cochran’s Q and Higgins’ I2 statistics. Subgroup analyses were carried out according to the participants’ sex, type of diagnosis of PD, type of study, and continent of origin of studies.

Results: We included 46 papers (17 cohort, 25 case-control, and 4 cross-sectional studies) that met the inclusion criteria. This meta-analysis includes a total of 6,806,286 participants and at least 68,932 ACS events, mainly myocardial infarction (MI). In accordance with our results, PD is associated with a higher risk of ACS (OR 1.35; 95% CI 1.25–1.45). However, clinical and methodological heterogeneity was significant (I2 = 86%, p < 0.05). In the sensitivity analysis, the exclusion of some studies with "extreme" results (outliers) did not significantly affect the overall estimate or heterogeneity. In subgroup analysis, we found no statistically significant differences between men and women according to subgroup difference tests (I2 = 0%, p = 0.67). Conversely, there were differences according to the type of diagnosis of PD (clinical or self-reported diagnosis), type of study (cohort, case-control, or cross-sectional study), and the continent of origin (North America, South America, Asia, or Europe) of the studies (I² = 79%–96%, p < 0.10). Of the 46 studies, only 4 had a high risk of bias. Additionally, the funnel plot suggested publication bias.

Conclusion: PD may be an important non-traditional risk factor for ACS. Although, this meta-analysis brings together more studies, and therefore more evidence, than any other previous similar study, its results should be interpreted with caution due to the great heterogeneity and the potential presence of bias.

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Pseudomonas infection reduction in the ICU: a successful multidisciplinary quality improvement project

Anwar Khedr, Bijoy M. Mathew, Hisham Mushtaq, Courtney A. Nelson, Jessica L. Poehler, Abbas B. Jama, Jeanine M. Borge, Jennifer L. von Lehe, Eric O. Gomez Urena, Syed Anjum Khan

The paper will appear in: Infez Med, December 2022

Published on the journal website: 30 September 2022. Section: Original articles


Abstract
Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital’s 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.

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The utility of point of care testing of Procalcitonin in pediatric acute assessment

Alasdair PS Munro, Charles Hungwe, Pratisksha Patel, Nick Ward, Simon Struthers, Kordo Saeed

The paper will appear in: Infez Med, December 2022


Published on the journal website: 30 September 2022. Section: Original articles


Abstract
Objective: Febrile illnesses are a common cause of presentation in acute pediatrics, with biomarkers frequently used to help differentiate mild infections from serious bacterial infections (SBI). We aimed to see if a point of care test for procalcitonin could help to reduce antibiotic use and avoid unnecessary admission.

Patients and Methods: A point of care procalcitonin machine which produces results within 20 minutes was introduced to two pediatric assessment units across both sites of a secondary-care hospital trust, alongside guidance for when tested would be appropriate. We performed a prospective, observational, pilot service evaluation, of all children tested during the study period of November 2018 to March 2019. We collected data at the time of testing, including the indication for testing and plan prior to testing, then retrospectively collected outcome data for children tested including diagnosis, treatment and whether the child was admitted to hospital.

Results: 68 tests were performed over 5 months. There are differing denominators due to missing data. Children were predominantly male (40/68, 58.8%) and pre-school age (median age 2.9y, Q1-Q3 1.3-6.7). Severity of illness was low, with 7/54 (11.5%) triggering sepsis tools. The primary indication for testing was febrile illness with no source of infection and some concerning features (31/59, 52.5%). Following testing, 35/67 (52.5%) of patients were admitted and 31/67 (47.1%) had IV antibiotics. A low procalcitonin (<0.5ng/L) was observed in 46/67 (69.1%) of patients, however 21/46 (45.7%) of these children were admitted and 16/46 (34.8%) were given IV antibiotics. Procalcitonin performed poorly at detecting SBIs in this cohort (result >0.5ng/L for 1/5 SBIs).

Conclusion: There was no clear impact of point of care procalcitonin on admission or antibiotic prescribing in this small pilot study. Clinicians often tested for reasons outside the recommended scenarios and often treated “low risk” patients, as determined by low procalcitonin, with antibiotics. These effects may be due to low familiarity with procalcitonin as a biomarker.

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