scholarly journals Protection afforded by the BNT162b2 and mRNA-1273 COVID-19 vaccines in fully vaccinated cohorts with and without prior infection

2021 ◽  
Author(s):  
Laith J Abu-Raddad ◽  
Hiam Chemaitelly ◽  
Houssein H. Ayoub ◽  
HADI M. YASSINE ◽  
Fatiha Benslimane ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Booster Vaccination ◽  
Incidence Rates ◽  
Matched Cohort ◽  
Vaccine Protection ◽  
Dosing Interval ◽  
Prior Infection

Effect of prior SARS-CoV-2 infection on vaccine protection remains poorly understood. Here, we investigated whether persons vaccinated after a prior infection have better protection against future infection than those vaccinated without prior infection. Effect of prior infection was assessed in Qatar population, where the Alpha (B.1.1.7) and Beta (B.1.351) variants dominate incidence, using two national retrospective, matched-cohort studies, one for the BNT162b2 (Pfizer-BioNTech) vaccine, and one for the mRNA-1273 (Moderna) vaccine. Incidence rates of infection among BNT162b2-vaccinated persons, with and without prior infection, were estimated, respectively, at 1.66 (95% CI: 1.26-2.18) and 11.02 (95% CI: 9.90-12.26) per 10,000 person-weeks. The incidence rate ratio was 0.15 (95% CI: 0.11-0.20). Analogous incidence rates among mRNA-1273-vaccinated persons were estimated at 1.55 (95% CI: 0.86-2.80) and 1.83 (95% CI: 1.07-3.16) per 10,000 person-weeks. The incidence rate ratio was 0.85 (95% CI: 0.34-2.05). Prior infection enhanced protection of those BNT162b2-vaccinated, but not those mRNA-1273-vaccinated. These findings may have implications for dosing, interval between doses, and potential need for booster vaccination.

Abstract 3: Impact of Financial Incentives on Variation in Use of Cardiac Imaging Tests

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Vinay Kini ◽  
Fenton McCarthy ◽  
Sheeva Rajaei ◽  
Paul Heidenreich ◽  
Peter Groeneveld
Keyword(s):  
Incidence Rate ◽  
Geographic Variation ◽  
Cardiac Imaging ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Patient Characteristics ◽  
Administrative Claims ◽  
Matched Cohort ◽  
Health Administration ◽  
Local Practice

Background: Rapid growth and geographic variation in the provision of cardiac imaging tests have led to concerns about overuse due to fee-for-service (FFS) incentives. The degree to which FFS incentives may influence rates of cardiac imaging over and above patient characteristics and local practice styles is unknown. Objectives: To examine overall rates, degree of geographic variation, and correlation in use of echocardiography (ECHO) among veterans who primarily use services provided by the Veterans Health Administration (VA - a fixed budget health system without significant FFS incentives), versus veterans who use FFS Medicare. Design: We analyzed administrative claims from VA and Medicare of veterans with heart failure over the age of 65 from 2007-2010. Veterans were assigned to the VA or Medicare cohort according to the volume of services (procedures, hospitalizations, and visits) received within each system. The analysis was restricted to 34 major metropolitan service areas (MSAs). Rates of ECHO in the overall cohort and in a propensity-matched cohort were compared using multilevel mixed effects regression models adjusted for patient-level characteristics. Mean adjusted rates for each MSA according to cohort were tested for correlation and difference in variance. Results: The Medicare cohort included 364,413 veterans (mean age 77 years) and the VA cohort included 15,330 veterans (mean age 76 years). The Medicare cohort had a significantly higher adjusted rate of ECHO use compared to the VA cohort (1.09 versus 0.28 ECHOs per person-year, incidence rate ratio 4.23 [95% CI 4.12 to 4.34], p<.001). The higher rate persisted in the propensity-matched cohort of 14,889 pairs (Medicare incidence rate ratio 1.98 [95% CI 1.92 to 2.04], p<.001). Variance of the mean adjusted use of imaging across MSAs was greater in the Medicare cohort than the VA cohort (0.14 versus 0.02, p<.001). There was modest correlation in geographic variation between cohorts (r = 0.56, p<.001, Figure 1). Conclusions: ECHO rates and degree of variation were significantly higher in the Medicare cohort than the VA cohort in both overall and propensity-matched analyses, with modest regional correlation. ECHO utilization rates may be strongly influenced by payment system despite differences in patient characteristics and local practice styles.

scholarly journals AIDS-related Burkitt lymphoma in the United States: what do age and CD4 lymphocyte patterns tell us about etiology and/or biology?

Blood ◽  
2010 ◽  
Vol 116 (25) ◽  
pp. 5600-5604 ◽  
Author(s):  
Mercy Guech-Ongey ◽  
Edgar P. Simard ◽  
William F. Anderson ◽  
Eric A. Engels ◽  
Kishor Bhatia ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Burkitt Lymphoma ◽  
Rate Ratio ◽  
Hiv Transmission ◽  
Incidence Rate Ratio ◽  
The United States ◽  
Incidence Rates ◽  
Cd4 Lymphocyte ◽  
Cd4 Lymphocytes

Abstract Trimodal or bimodal age-specific incidence rates for Burkitt lymphoma (BL) were observed in the United States general population, but the role of immunosuppression could not be excluded. Incidence rates, rate ratios, and 95% confidence intervals for BL and other non-Hodgkin lymphoma (NHL), by age and CD4 lymphocyte count categories, were estimated using Poisson regression models using data from the United States HIV/AIDS Cancer Match study (1980-2005). BL incidence was 22 cases per 100 000 person-years and 586 for non-BL NHL. Adjusted BL incidence rate ratio among males was 1.6× that among females and among non-Hispanic blacks, 0.4× that among non-Hispanic whites, but unrelated to HIV-transmission category. Non-BL NHL incidence increased from childhood to adulthood; in contrast, 2 age-specific incidence peaks during the pediatric and adult/geriatric years were observed for BL. Non-BL NHL incidence rose steadily with decreasing CD4 lymphocyte counts; in contrast, BL incidence was lowest among people with ≤ 50 CD4 lymphocytes/μL versus those with ≥ 250 CD4 lymphocytes/μL (incidence rate ratio 0.3 [95% confidence interval = 0.2-0.6]). The bimodal peaks for BL, in contrast to non-BL NHL, suggest effects of noncumulative risk factors at different ages. Underascertainment or biological reasons may account for BL deficit at low CD4 lymphocyte counts.

scholarly journals 555. The Burden of Invasive Staphylococcus Aureus Disease Among Native Americans on the Navajo Nation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S263-S263
Author(s):  
Catherine Sutcliffe ◽  
Lindsay Grant ◽  
Angelina Reid ◽  
Grace K Douglass ◽  
Robert Weatherholtz ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Native American ◽  
Native Americans ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Census Data ◽  
Incidence Rate Ratio ◽  
Incidence Rates ◽  
Navajo Nation ◽  
Significant Difference

Abstract Background Native Americans in the southwestern United States (US) may be at higher risk for invasive infections due to Staphylococcus aureus. The objective of this study was to determine the burden of invasive S. aureus among Native Americans on the Navajo Nation. Methods Prospective population and laboratory-based surveillance for invasive S. aureus infections was conducted from May 2016 through April 2018. A case was defined as a Native American individual living on or around the Navajo Nation with S. aureus isolated from a normally sterile body site. Incidence rates were calculated using the Indian Health Service User Population from 2016 and 2017 as the denominators for Years 1 and 2, respectively. Age-standardized incidence rates were calculated using US Census data from 2015 as the reference group. Results 363 cases were identified (Year 1: 159; Year 2: 204). Most cases were adults (96.9%; median age: 56.0 years) and had ≥1 underlying medical condition (94.5%), of which the most common were diabetes (63.2%), hypertension (39.1%), and obesity (37.2%). 38.0% of cases were categorized as community acquired and 28.7% of infections were methicillin-resistant (MRSA). 83.2% of cases were hospitalized, 10.7% required amputation, and 6.5% died within 30 days of the initial culture. The overall incidence of invasive S. aureus was 74.4 per 100,000 persons (95% confidence interval [CI]: 67.1, 82.4) with a significantly higher incidence in the second year (Year 1: 64.9; Year 2: 84.0; incidence rate ratio: 1.29; 95% CI: 1.05, 1.59). The overall incidence of invasive MRSA was 21.3 per 100,000 persons (95% CI: 17.6, 25.8) with no significant difference by year (Year 1: 21.2; Year 2: 21.4; incidence rate ratio: 1.01; 95% CI: 0.69, 1.48). The incidence of invasive S. aureus and MRSA increased with age and was highest among individuals ≥65 years of age. The overall age-standardized incidence of invasive MRSA was 25.9 per 100,000 persons (Year 1: 26.0; Year 2: 25.7; for comparison US 2015 general population: 18.8 per 100,000 persons). Conclusion The Navajo Nation has a higher burden of invasive MRSA than the general US population. Further research is needed to evaluate trends over time and identify prevention strategies and opportunities for intervention. Disclosures All authors: No reported disclosures.

Pulmonary complications with the use of mTOR inhibitors in targeted cancer therapy: A systematic review and meta-analysis.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 362-362
Author(s):  
Benjamin Adam Gartrell ◽  
Jian Ying ◽  
Shanthi Sivendran ◽  
Neeraj Agarwal ◽  
Kenneth M. Boucher ◽  
...  
Keyword(s):  
Adverse Events ◽  
Incidence Rate ◽  
Solid Tumors ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Meta Analysis ◽  
Mtor Inhibitors ◽  
Incidence Rates ◽  
Pulmonary Complications ◽  
Grade 3

362 Background: mTOR inhibitors are approved in several malignancies including renal cell carcinoma (RCC). While pulmonary toxicities are a recognized adverse effect associated with this drug class, the frequency and risk of these side effects have not been well characterized. Methods: Clinical trials of mTOR inhibitors in solid tumors were identified through a search of PubMed and ASCO abstracts. Prospective studies of temsirolimus, everolimus, and ridaforolimus in solid tumors were evaluated for inclusion. 22 eligible phase II and phase III trials that included 4,242 patients were identified and included in a systematic review and meta-analysis. Adverse event data was extracted for pulmonary complications including pneumonitis, dyspnea, and cough. The incidence rate and the incidence rate ratios were determined for these pulmonary adverse events. Results: Based on our analysis of the 20 trials that reported pneumonitis, the incidence rate of any grade pneumonitis in patients with solid tumors treated with mTOR inhibitors is 0.11 (95% CI, 0.06-0.17). The incidence rate of grade 3 or 4 pneumonitis is 0.03 (95% CI, 0.01-0.04). The incidence rate ratio of any grade pneumonitis with mTOR inhibitors relative to controls is 18.9 (95% CI, 6.5-55.1), and the incidence rate ratio for the development of grade 3 or 4 pneumonitis is 7.9 (95% CI, 2.6-24.0). The incidence rates of any grade cough and dyspnea were found to be 0.23 (95% CI, 0.20-0.27) and 0.15 (95% CI, 0.10-0.21), respectively. The incidence rates of grade 3 or 4 cough and dyspnea are found to be 0.01 (95% CI, 0.00-0.01) and 0.03 (95% CI, 0.02-0.04), respectively. There was a statistically significant, but modest increase in risk of developing any grade cough (incidence rate ratio of 1.9 [95% CI, 1.6-2.4]) and grade 3 or 4 dyspnea (incidence rate ratio of 2.0 [95% CI, 1.2-3.3]) with mTOR inhibitors relative to controls. Conclusions: This study confirms that mTOR inhibitors are associated with pulmonary adverse events and provides a quantitative estimation of the risk of these adverse events in solid tumor patients treated with these drugs. The majority of pulmonary adverse events are low grade.

scholarly journals 1835. High Burden of Invasive Staphylococcus aureus Disease Among Native Americans on the White Mountain Apache Tribal Lands

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S44-S45
Author(s):  
Catherine Sutcliffe ◽  
Lindsay Grant ◽  
Angelina Reid ◽  
Grace K Douglass ◽  
Laura B Brown ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Native American ◽  
Native Americans ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Rates ◽  
Significant Difference ◽  
White Mountain Apache ◽  
Tribal Lands

Abstract Background Native Americans in the southwestern United States (US) have a higher risk of many infectious diseases than the general US population. The objective of this study was to determine the burden of invasive Staphylococcus aureus disease among Native Americans on the White Mountain Apache (WMA) Tribal lands. Methods Prospective population and laboratory-based surveillance for invasive S. aureus infections was conducted from May 2016 through April 2018. A case was defined as a Native American individual living on or around the WMA Tribal lands with S. aureus isolated from a normally sterile site. Incidence rates were calculated using the Indian Health Service User Population as the denominator. Age-standardized incidence rates were calculated by direct standardization methods using US Census data from 2015 as the reference. Results Fifty-three cases were identified (Year 1: 24; Year 2: 29). Most cases were adults (90.6%; median age: 47.4 years) and had ≥1 underlying medical condition (86.8%), of which the most common were obesity (50.0%) and diabetes (50.0%). 26.4% of cases were categorized as community acquired. Most infections were methicillin-resistant (MRSA; 75.5%). 88.7% of cases were hospitalized, 7.5% required amputation, and 7.7% died within 30 days of the initial culture. The overall incidence of invasive S. aureus was 156.3 per 100,000 persons (95% confidence interval [CI]: 119.4, 204.5) with no significant difference in the incidence by year (Year 1: 141.5; Year 2: 171.1; incidence rate ratio: 1.21; 95% CI: 0.70, 2.08). The overall incidence of invasive MRSA was 118.0 per 100,000 persons (95% CI: 86.5, 160.8) with no significant difference by year (Year 1: 106.1; Year 2: 129.8; incidence rate ratio: 1.22; 95% CI: 0.66, 2.28). The incidence of invasive S. aureus and MRSA increased with age and was highest among individuals 50–64 years of age. The overall age-adjusted incidence of invasive MRSA was 138.2 per 100,000 persons (Year 1: 125.2; Year 2: 150.9, for comparison US 2015 general population: 18.8 per 100,000 persons). Conclusion The WMA community has one of the highest reported incidence rates globally of invasive MRSA. Interventions are urgently needed in this community to reduce the morbidity and mortality associated with these infections. Disclosures All Authors: No reported Disclosures.

scholarly journals Trends in incident acute myocardial infarction in Norway: An updated analysis to 2014 using national data from the CVDNOR project

2018 ◽  
Vol 25 (10) ◽  
pp. 1031-1039 ◽  
Author(s):  
Gerhard Sulo ◽  
Jannicke Igland ◽  
Stein Emil Vollset ◽  
Marta Ebbing ◽  
Grace M Egeland ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Age Groups ◽  
Incidence Rates ◽  
Myocardial Infarctions ◽  
Men And Women

Background We updated the information on trends of incident acute myocardial infarction in Norway, focusing on whether the observed trends during 2001–2009 continued throughout 2014. Methods All incident (first) acute myocardial infarctions in Norwegian residents age 25 years and older were identified in the Cardiovascular Disease in Norway 1994–2014 project. We analysed overall and age group-specific (25–64 years, 65–84 years and 85 + years) trends by gender using Poisson regression analyses and report the average annual changes in rates with their 95% confidence intervals. Results During 2001–2014, 221,684 incident acute myocardial infarctions (59.4% men) were identified. Hospitalised cases accounted for 79.9% of all incident acute myocardial infarctions. Overall, incident acute myocardial infarction rates declined on average 2.6% per year (incidence rate ratio 0.974, 95% confidence interval 0.972–0.977) in men and 2.8% per year (incidence rate ratio 0.972, 95% confidence interval 0.971–0.974) in women, contributed by declining rates of hospitalisations (1.8% and 1.9% per year in men and women, respectively) and deaths (6.0% and 5.8% per year in men and women, respectively). Declining rates were observed in all three age groups. The overall acute myocardial infarction incidence rates continued to decline from 2009 onwards, with a steeper decline compared to 2001–2009. During 2009–2014, gender-adjusted acute myocardial infarction incidence among adults age 25–44 years declined 5.3% per year, contributed mostly by declines in hospitalisation rates (5.1% per year). Conclusion Acute myocardial infarction incidence rates continued to decline after 2009 in Norway in both men and women. The decline started to involve individuals aged 25–44 years, marking a turning point in the previously reported stagnation of rates during 2001–2009.

Effect of radium-223 dichloride (Ra-223) on risk for and duration of hospitalization in ALSYMPCA by docetaxel (D) subgroup.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 254-254 ◽  
Author(s):  
Paul Cislo ◽  
Jonathan D. Reuning-Scherer
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
Incidence Rate ◽  
Resource Use ◽  
Day Care ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Rates ◽  
Care Services ◽  
Radium 223

254 Background: In ALSYMPCA, the first-in-class alpha-emitting radiopharmaceutical Ra-223 significantly improved overall survival vs placebo (pbo) and was well tolerated in patients (pts) with castration-resistant prostate cancer (CRPC) with symptomatic bone metastases and no visceral metastases regardless of prior D use. To understand whether treatment (tx) benefit in prior and no prior D subgroups relates to differences in health care resource utilization, hospitalization and other resource use were evaluated. Methods: Hospitalization, nursing home visit, home health care and adult day care services use, and physician visit data were captured. To account for differences in observation time due to differing survival, resource use was annualized for each pt. Mean number and duration of encounters/year were compared using t-tests. To compare tx groups based on rate of use/year, incidence rates and ratios were calculated using a generalized estimating equation regression model with covariates. Results: For prior D pts, hospitalization incidence rates for Ra-223 vs pbo were 1.18 vs 1.70 (incidence rate ratio = 0.69; 95% CI, 0.53-0.90; P = 0.006) and mean hospitalization days/year were 8.53 vs 16.51 (P = 0.001). Among prior D pts with ≥1 hospitalization, mean hospitalization days/year for Ra-223 vs pbo were 19.65 vs 33.02 (P = 0.003). For no prior D pts, hospitalization incidence rates for Ra-223 vs pbo were 1.02 vs 1.10 (incidence rate ratio = 0.92; 95% CI, 0.66-1.29; P = 0.643) and mean hospitalization days/year were 7.53 vs 12.11 (P = 0.027). Among no prior D pts with ≥1 hospitalization, mean hospitalization days/year for Ra-223 vs pbo pts were 19.12 vs 26.61 (P = 0.063). The only other tx differences were nursing home days/year and day care services/year in the no prior D subgroup, but t-test and regression results were inconsistent. Conclusions: In the prior D subgroup, Ra-223 pts experienced 8.0 fewer hospitalization days/pt/year, driven by a 31% reduction in hospitalization and shorter duration among pts hospitalized. In the no prior D subgroup, Ra-223 pts experienced 4.6 fewer hospitalization days/pt/year, primarily driven by a shorter duration among pts hospitalized. Clinical trial information: NCT00699751.

Are temporal trends in colonoscopy among young adults concordant with colorectal cancer incidence?

2019 ◽  
Vol 26 (4) ◽  
pp. 179-185 ◽  
Author(s):  
Stacey A Fedewa ◽  
Rebecca L Siegel ◽  
Ahmedin Jemal
Keyword(s):  
Colorectal Cancer ◽  
Incidence Rate ◽  
Cancer Incidence ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Population Based ◽  
Incidence Rates ◽  
Age Group ◽  
Colorectal Cancer Incidence ◽  
Cancer Incidence Rates

Objective In the United States, colorectal cancer incidence has increased in adults under age 55. Although debate remains about whether this rise is a result of increased detection because of more colonoscopy utilization, population-based trends in colonoscopy among this age group are unknown. We examined changes in colonoscopy rates, as well as colorectal cancer incidence, among adults aged 40–54, using nationally representative data. Methods Recent (past year) colonoscopy rates were computed among 53,175 respondents aged 40–54 in National Health Interview Survey data from 2000 through 2015 by five-year age group. Colorectal cancer incidence rates and incidence rate ratios were estimated from 18 population-based Surveillance Epidemiology and End Result registries during the same period. Results Among respondents aged 40–44, past-year colonoscopy rates were stable during 2000–2015, and ranged from 2.3% to 3.5% ( p-value for trend = 0.771). In contrast, colonoscopy rates increased from 2.5% in 2000 to 5.2% in 2015 among ages 45–49, and from 5.0% to 14.1% in ages 50–54 (test for trend p-values < 0.001). During 2000–2015, colorectal cancer incidence rates increased by 28% in people aged 40–44 (incidence rate ratio = 1.28, 95% CI 1.20, 2.37), 15% in those aged 45–49 (incidence rate ratio = 1.15, 95%CI 1.10, 1.21), and 17% in those aged 50–54 (incidence rate ratio = 1.17, 95%CI 1.13, 1.21), respectively. Conclusion Increases in colonoscopy rates were confined to ages 45–54, whereas colorectal cancer incidence rates rose in those aged 40–44, 45–49, and 50–54. Colonoscopy trends do not fully align with colorectal cancer incidence patterns.

Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

2021 ◽  
Author(s):  
Susanna Scharrer ◽  
Christian Primas ◽  
Sabine Eichinger ◽  
Sebastian Tonko ◽  
Maximilian Kutschera ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Fatal Bleeding ◽  
Adjusted Incidence Rate ◽  
Inflammatory Bowel ◽  
Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

scholarly journals Secrets of the hospital underbelly: abundance of antimicrobial resistance genes in hospital wastewater reflects hospital antimicrobial use and inpatient length of stay

2019 ◽  
Author(s):  
Meghan R. Perry ◽  
Bram van Bunnik ◽  
Luke McNally ◽  
Bryan Wee ◽  
Patrick Munk ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Length Of Stay ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Clinical Activity ◽  
Hospital Wastewater ◽  
Antimicrobial Consumption ◽  
Gene Abundance ◽  
Class Level

ABSTRACTIntroductionHospital wastewater is a potential major source of antimicrobial resistance (AMR). This study uses metagenomics to ask how abundances of AMR genes in hospital wastewater are related to clinical activity.MethodsSewage was collected over a 24-hour period from multiple wastewater collection points representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. AMR gene abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates.FindingsMicrobiota and AMR gene composition varied between each collection point and overall AMR gene abundance was higher in hospital wastewater than in community influent. The composition of AMR genes correlated with microbiota composition (Procrustes analysis, p=0.002). Increased antimicrobial consumption at a class level was associated with higher AMR gene abundance within that class in wastewater (incidence rate ratio 2.80, C.I. 1.2-6.5, p=0.016). Prolonged average patient length of stay was associated with higher total AMR gene abundance in wastewater (incidence rate ratio 2.05, C.I. 1.39-3.01, p=0.0003). AMR gene abundance at a class level within hospital wastewater did not reflect resistance patterns in the 181 clinical isolates grown from hospital inpatients over the time of wastewater sampling.ConclusionsHospital antimicrobial consumption and patient length of stay are important drivers of AMR gene outflow into the environment. Using metagenomics to identify the full range of AMR genes in hospital wastewater could represent a useful surveillance tool to monitor hospital AMR gene outflow and guide environmental policy on AMR.

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