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Peripheral intravenous catheters (PVCs) and central venous catheters (CVCs) are frequently used in hospitalized patients. Estimates from global device sales illustrated that [approximately equal to] 1.2 billion PVCs are used [...]

IntroductionOver half of those hepatitis C virus (HCV)/HIV coinfected live in low-income and middle-income countries, and many remain undiagnosed or untreated. In 2016, Médecins Sans Frontières (MSF) established a direct-acting antiviral (DAA) treatment programme for people HCV/HIV coinfected in Myanmar. The purpose of our study was to evaluate the real-world cost and cost-effectiveness of this programme, and potential cost-effectiveness if implemented by the Ministry of Health (MoH).MethodsCosts (patient-level microcosting) and treatment outcomes were collected from the MSF prospective cohort study in Dawei, Myanmar. A Markov model was used to assess cost-effectiveness of the programme compared with no HCV treatment from a health provider perspective. Estimated lifetime and healthcare costs (in 2017 US$) and health outcomes (in disability-adjusted life-years (DALYs)) were simulated to calculate the incremental cost-effectiveness ratio (ICER), compared with a willingness-to-pay threshold of per capita Gross Domestic Product in Myanmar ($1250). We evaluated cost-effectiveness with updated quality-assured generic DAA prices and potential cost-effectiveness of a proposed simplified treatment protocol with updated DAA prices if implemented by the MoH.ResultsFrom November 2016 to October 2017, 122 with HIV/HCV-coinfected patients were treated with DAAs (46% with cirrhosis), 96% (n=117) achieved sustained virological response. Mean treatment costs were $1229 (without cirrhosis) and $1971 (with cirrhosis), with DAA drugs being the largest contributor to cost. Compared with no treatment, the program was cost-effective (ICER $634/DALY averted); more so with updated prices for quality-assured generic DAAs (ICER $488/DALY averted). A simplified treatment protocol delivered by the MoH could be cost-effective if associated with similar outcomes (ICER $316/DALY averted).ConclusionsUsing MSF programme data, the DAA treatment programme for HCV among HIV-coinfected individuals is cost-effective in Myanmar, and even more so with updated DAA prices. A simplified treatment protocol could enhance cost-effectiveness if further rollout demonstrates it is not associated with worse treatment outcomes.

Background Methods Results Conclusion Bacteremia is a common complication in allogeneic hematopoietic cell transplant recipients (alloHCTr), especially during the pre‐engraftment period. International guidelines recommend antibacterial prophylaxis (ABP), despite potential selection for multidrug‐resistant organisms (MDRO). Limited contemporary data exist on the epidemiology of pre‐engraftment bacteremia in alloHCTr, who do not receive ABP.We performed a retrospective observational single‐center cohort study including all consecutive adult alloHCTr (2015–2021), investigating the incidence, risk factors, and outcomes of bacteremia during the engraftment period. Primary fluoroquinolone (FQ) ABP is not routinely administered in our center.Among 421 patients identified, 124 bacteremia episodes were observed in 121/421 (29%) alloHCTr. The median time to the 1st bacteremia episode was 9 days (IQR 6–11). Most (105/124, 85%) episodes were monomicrobial, while >1 pathogens were identified in 19/124 (15%) episodes. Overall, 152 pathogens were isolated, with a predominance of Gram‐positive (118/152, 78%), including coagulase‐negative staphylococci (n:47), streptococci (n:46), and enterococci (n:15), followed by Gram‐negative bacteria (GNB, 30/152, 20%), and anaerobes (4/152, 3%). There were 2/152 (1%) MDRO (extended‐spectrum beta‐lactamase producing) GNB. Multivariable analyses identified age >40‐year‐old (OR 2.4, P = 0.02), male gender (OR 1.8, P = 0.02), and a haploidentical/mismatched unrelated donor (OR 2.5, P < 0.001) as independent risk factors for bacteremia. All cause 30‐day mortality among alloHCTr with bacteremia was 0.8% (1/121): one patient died due to an HCT‐related complication.Despite lack of primary FQ ABP, low rates of bacteremia were observed during the pre‐engraftment period, with low MDRO prevalence and mortality. Our findings may allow to revisit the need for primary universal FQ ABP in high‐risk neutropenic hematology patients. [ABSTRACT FROM AUTHOR]

Objective To pilot an intervention on the prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) in an antenatal care and maternity unit in Maputo, Mozambique, during 2017-2019. Methods We included HBV in the existing screening programme (for human immunodeficiency virus (HIV) and syphilis) for pregnant women at their first consultation, and followed mother-child dyads until 9 months after delivery. We referred women who tested positive for hepatitis B surface antigen (HBsAg) for further tests, including hepatitis B e antigen (HBeAg) and HBV viral load. According to the results, we proposed tenofovir for their own health or for PMTCT. We administered birth-dose HBV vaccine and assessed infant HBV status at 9 months. Findings Of 6775 screened women, 270 (4.0%) were HBsAg positive; in those for whom data were available, 24/265 (9.1%) were HBeAg positive and 14/267 (5.2%) had a viral load of > 200 000 lU/mL. Ninety-eight (36.3%) HBsAg-positive women were HIV coinfected, 97 of whom were receiving antiretroviral treatment with tenofovir. Among HIV-negative women, four had an indication for tenofovir treatment and four for tenofovir PMTCT. Of 217 exposed liveborn babies, 181 (83.4%) received birth-dose HBV vaccine, 160 (88.4%) of these < 24 hours after birth. At the 9-month follow-up, only one out of the 134 tested infants was HBV positive. Conclusion Our nurse-led intervention highlights the feasibility of integrating PMTCT of HBV into existing antenatal care departments, essential for the implementation of the triple elimination initiative. Universal birth-dose vaccination is key to achieving HBV elimination. Prevenir la transmission du virus de l'hepatite B de la mere a l'enfant dans les soins prenataux et les maternites au Mozambique Objectif Piloter une action de prevention d'une transmission de la mere a l'enfant (PTME) du virus de l'hepatite B (VHB) dans une maternite et unite de soins prenataux a Maputo, au Mozambique, entre 2017 et 2019. Methodes Nous avons inclus le VHB dans le programme existant visant a depister le virus de l'immunodeficience humaine (VIH) et la syphilis chez les femmes enceintes lors de leur premiere consultation. Nous avons egalement suivi les dyades mere-enfant jusqu'a 9 mois apres l'accouchement. Nous avons oriente les femmes positives a la presence de l'antigene de surface (HBsAg) de l'hepatite B vers d'autres tests, dont ceux detectant l'antigene e (HBeAg) et la charge virale du VHB. En fonction des resultats, nous avons propose un traitement au tenofovir pour leur propre sante ou pour la PTME. Enfin, nous avons administre un vaccin contre le VHB a la naissance et evalue le statut serologique du nourrisson a neuf mois. Resultats Sur 6775 femmes depistees, 270 (4,0%) etaient positives au HBsAg; parmi celles pour qui des donnees etaient disponibles, 24/265 (9,1%) etaient positives au HBeAg et 14/267 (5,2%) presentaient une charge virale superieure a 200 000 UI/ml. Le VIH a en outre ete detecte chez 98 (36,3%) femmes positives au HBsAg, 97 d'entre elles faisant l'objet d'un traitement antiretroviral au tenofovir. Parmi les femmes negatives au VIH, quatre avaient recu des indications de traitement au tenofovir et quatre s'etaient vu conseiller le tenofovir dans le cadre d'une PTME. Sur les 217 bebes exposes, 181 (83,4%) ont ete vaccines contre le VHB a la naissance, 160 (88,4%) d'entre eux moins de 24 heures apres leur venue au monde. Lors de la visite de suivi neuf mois apres la naissance, seul un des 134 nourrissons testes etait positif au VHB. Conclusion Notre action dirigee par le personnel infirmier demontre qu'il est possible d'integrer la PTME du VHB dans les departements de soins prenataux existants, une demarche essentielle a la mise en oeuvre de l'initiative de triple elimination. La vaccination universelle a la naissance est cruciale pour eradiquer le VHB. Prevencion de la transmision maternofilial del virus de la hepatitis B en los servicios de asistencia prenatal y de maternidad en Mozambique Objetivo Realizar una intervencion piloto sobre la prevencion de la transmision maternofilial (PTMF) del virus de la hepatitis B (VHB) en una unidad de asistencia prenatal y maternidad en Maputo, Mozambique, entre 2017 y 2019. Metodos Se incluyo el VHB en el programa existente de cribado del virus de la inmunodeficiencia humana (VIH) y de la sifilis para las embarazadas en su primera consulta, y se realizo un seguimiento de las parejas maternofiliales hasta nueve meses despues del parto. Se derivo a las mujeres que dieron positivo en la prueba del antigeno de superficie del virus de la hepatitis B (AgHBs) para que se sometieran a otras pruebas, como el antigeno e del virus de la hepatitis B (AgHBe) y la concentracion virica del VHB. Segun los resultados, se propuso tenofovir como medida sanitaria o para la PTMF. Por ultimo, se administro la vacuna contra el VHB al nacer y se evaluo el estado serologico del VHB en los lactantes a los nueve meses. Resultados De las 6775 mujeres analizadas, 270 (4,0 %) dieron positivo en la prueba del AgHBs; entre las que disponian de datos, 24/265 (9,1 %) eran positivas en la prueba del AgHBe y 14/267 (5,2 %) tenian una concentracion virica superior a 200 000 UI/ml. Noventa y ocho (36,3 %) mujeres con AgHBs positivo estaban coinfectadas por el VIH, 97 de las que recibian tratamiento antirretrovirico con tenofovir. Entre las mujeres con VIH negativo, cuatro tenian indicacion de tratamiento con tenofovir y cuatro con tenofovir para la PTMF. De los 217 bebes nacidos vivos expuestos, 181 (83,4 %) recibieron la vacuna contra el VHB al nacer, 160 (88,4 %) de ellos en las primeras 24 horas de vida. En la visita de seguimiento a los nueve meses, solo uno de los 134 lactantes analizados dio positivo en la prueba del VHB. Conclusion Esta intervencion dirigida por enfermeras demuestra la viabilidad de integrar la PTMF del VHB en los departamentos de asistencia prenatal existentes, lo que es esencial para la aplicacion de la iniciativa de triple eliminacion. La vacunacion universal al nacer es fundamental para lograr la erradicacion del VHB. [phrase omitted], Introduction Hepatitis B virus (HBV) remains a public health threat worldwide, affecting 240 million people and causing an estimated 650 000 deaths per year. (1) The risk of developing chronic [...]

Despite the diagnostic means currently available, fever of unknown origin (FUO) remains a diagnostic challenge for the practitioner, requiring a detailed and systematic approach. The etiologies can be classified into 4 main groups: infectious diseases, systemic inflammatory diseases, neoplasia and various rarer entities such as drug-induced or endocrine fevers. A non-negligible percentage of FUOs remains without a clear etiology, generally with a spontaneously favorable evolution. In this article, we propose an algorithm for a step-by-step diagnostic approach and highlight clues that can lead to a diagnosis. However, clinical judgment remains the main pillar in the proposed approach in order to avoid futile investigations., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

What's new in infectious diseases in 2020 ? This year has been marked by the COVID-19 pandemic, prompting a review of the current knowledge on SARS-CoV-2 and its management in this article. The results of the Swiss project « PIRATE » indicate non-inferiority between CRP-guided antibiotic durations or fixed 7-day durations and 14-day durations for Gram-negative bacteremia. A Mongolian study did not show any benefit of vitamin D substitution in protecting children from tuberculosis. Baloxavir, a new antiviral against the flu, has been approved by Swissmedic. Finally, new American recommendations for therapeutic monitoring of vancomycin and universal screening for hepatitis C virus have been published., Competing Interests: Angela Huttner a mené le projet suisse PIRATE, financé entièrement par une subvention du Fonds national suisse. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Biological treatments are a revolution in the management of many diseases and their development, with the marketing of many new biologics, challenges practitioners in assessing the risk of infectious complications. A rigorous evaluation is required with the introduction of prophylaxis, vaccinations or specific clinical monitoring., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.