Multicentre evaluation of two multiplex PCR platforms for the rapid microbiological investigation of nosocomial pneumonia in UK ICUs: the INHALE WP1 study

BackgroundCulture-based microbiological investigation of hospital-acquired or ventilator-associated pneumonia (HAP or VAP) is insensitive, with aetiological agents often unidentified. This can lead to excess antimicrobial treatment of patients with susceptible pathogens, while those with resistant bacteria are treated inadequately for prolonged periods. Using PCR to seek pathogens and their resistance genes directly from clinical samples may improve therapy and stewardship.MethodsSurplus routine lower respiratory tract samples were collected from intensive care unit patients about to receive new or changed antibiotics for hospital-onset lower respiratory tract infections at 15 UK hospitals. Testing was performed using the BioFire FilmArray Pneumonia Panel (bioMérieux) and Unyvero Pneumonia Panel (Curetis). Concordance analysis compared machine and routine microbiology results, while Bayesian latent class (BLC) analysis estimated the sensitivity and specificity of each test, incorporating information from both PCR panels and routine microbiology.FindingsIn 652 eligible samples; PCR identified pathogens in considerably more samples compared with routine microbiology: 60.4% and 74.2% for Unyvero and FilmArray respectively vs 44.2% by routine microbiology. PCR tests also detected more pathogens per sample than routine microbiology. For common HAP/VAP pathogens, FilmArray had sensitivity of 91.7%–100.0% and specificity of 87.5%–99.5%; Unyvero had sensitivity of 50.0%–100.0%%, and specificity of 89.4%–99.0%. BLC analysis indicated that, compared with PCR, routine microbiology had low sensitivity, ranging from 27.0% to 69.4%.InterpretationConventional and BLC analysis demonstrated that both platforms performed similarly and were considerably more sensitive than routine microbiology, detecting potential pathogens in patient samples reported as culture negative. The increased sensitivity of detection realised by PCR offers potential for improved antimicrobial prescribing.

Plasma SARS-CoV-2 RNA levels as a biomarker of lower respiratory tract SARS-CoV-2 infection in critically ill patients with COVID-19.

Plasma SARS-CoV-2 viral RNA (vRNA) levels are predictive of COVID-19 outcomes in hospitalized patients, but whether plasma vRNA reflects lower respiratory tract (LRT) vRNA levels is unclear. We compared plasma and LRT vRNA levels in simultaneously collected longitudinal samples from mechanically-ventilated patients with COVID-19. LRT and plasma vRNA levels were strongly correlated at first sampling (r=0.83, p<10-8) and then declined in parallel except in non-survivors who exhibited delayed vRNA clearance in LRT samples. Plasma vRNA measurement may offer a practical surrogate of LRT vRNA burden in critically ill patients, especially early in severe disease.

Prevalence of Human Bocavirus in Children Under 5 Years with Upper and Lower Respiratory Infections in Southeastern Iran

Background: Human Bocavirus (HBoV) is a parvovirus associated with mild to severe upper and lower respiratory tract infections in children. Objectives: This study aimed to detect the virus in the nasopharynx of children under 5-year-old with respiratory infection by polymerase chain reaction (PCR). Methods: Two hundred samples were taken from children referred to pediatric clinics in Kerman, southeastern Iran, with respiratory infections and were positive for virus by PCR. Next, the positive samples were genotyped by real-time PCR. Results: Out of 200 samples, 13 (6.5%) were positive for the Bocavirus gene, and all positive samples were infected by HBoV-1. We observed that 116 patients were male, and there was no difference in the prevalence of the virus based on gender (P = 0.345). The prevalence was significantly higher in infants under 10 months old (P = 0.049). Infection by Bucavirus virus was significantly correlated with symptoms, such as fever (P = 0.035, r = 0.7), otitis media (P = 0.013, r = 0.8), diarrhea, nausea, and vomiting (P = 0.001, r = 0.4). Conclusions: According to our findings, HBoV could be one of the causes of infections in the respiratory system of children, and the only type in the studied region is HBoV-1.

Is SARS-CoV-2 Omicron (B.1.1.529) variant causing different symptoms?

Background: Since preliminary evidence suggests that the new SARS-CoV-2 Omicron (B.1.1.529) variant may cause different symptoms and trigger outbreaks associated with less severe illness compared to previous strains, we conducted and infodemic analysis to verify these suppositions.Methods: We searched Google Trends using the most frequent COVID-19 symptoms, with “United Kingdom” country option and search periods “20-26 December 2020” (predominance of Alpha variant) and “19-25 December 2021” (Omicron prevalence >80%).Results: Seven symptoms (i.e., conjunctivitis, chills, cough, aches, fever, nausea and sore throat) appeared to be more searched in 2021 compared to 2020 (i.e., >15% increase), five symptoms (i.e., anosmia, tiredness, ageusia, sneezing and shortness of breath) were found to be less searched in 2021 compared to 2020 (i.e., >15% decrease), whilst the number of Google searches for headache, diarrhea and runny nose were almost comparable between the two periods (i.e., <15% variation).Conclusion: Actual predominance of Omicron (B.1.1.529) variant in UK is associated with higher number of Google searches for mild symptoms (conjunctivitis, chills, cough, aches and fever), accompanied by considerable lower interest for a severe clinical sign like shortness of breath, which characterizes lower respiratory tract infection.

Clinical sign and biomarker-based algorithm to identify bacterial pneumonia among outpatients with lower respiratory tract infection in Tanzania

Background Inappropriate antibiotics use in lower respiratory tract infections (LRTI) is a major contributor to resistance. We aimed to design an algorithm based on clinical signs and host biomarkers to identify bacterial community-acquired pneumonia (CAP) among patients with LRTI. Methods Participants with LRTI were selected in a prospective cohort of febrile (≥ 38 °C) adults presenting to outpatient clinics in Dar es Salaam. Participants underwent chest X-ray, multiplex PCR for respiratory pathogens, and measurements of 13 biomarkers. We evaluated the predictive accuracy of clinical signs and biomarkers using logistic regression and classification and regression tree analysis. Results Of 110 patients with LRTI, 17 had bacterial CAP. Procalcitonin (PCT), interleukin-6 (IL-6) and soluble triggering receptor expressed by myeloid cells-1 (sTREM-1) showed an excellent predictive accuracy to identify bacterial CAP (AUROC 0.88, 95%CI 0.78–0.98; 0.84, 0.72–0.99; 0.83, 0.74–0.92, respectively). Combining respiratory rate with PCT or IL-6 significantly improved the model compared to respiratory rate alone (p = 0.006, p = 0.033, respectively). An algorithm with respiratory rate (≥ 32/min) and PCT (≥ 0.25 μg/L) had 94% sensitivity and 82% specificity. Conclusions PCT, IL-6 and sTREM-1 had an excellent predictive accuracy in differentiating bacterial CAP from other LRTIs. An algorithm combining respiratory rate and PCT displayed even better performance in this sub-Sahara African setting.

Music For Youth During the Covid 19 Pandemic

SARS-CoV-2 virus was found to be targeted cells may be located in the lower respiratory tract, COVID-19 infection can cause mild, moderate to severe symptoms. The main symptoms that appear are fever (> 38oC), cough and difficulty breathing. Vitamin C treatment has an antiviral effect. Clinical trials have shown that administering high doses of vitamin C has a beneficial effect against colds. As a nurse, one of the roles as an extension agent can be carried out in handling Covid-19 patients, namely providing communication, information, and education about health to the community. The role of nurses in providing education to the community is very necessary because it can make people who are given education understand the information conveyed. In this Community Service activity, the focus is on teenagers as one of the preventive efforts against the transmission of the Covid-19 virus through the provision of Health Education on the importance of consuming vitamin C according to the needs of the adolescent body.