#Host-Protozoan Interactions Protect from Mucosal #Infections through Activation of the Inflammasome
http://www.cell.com/cell/abstract/S0092-8674(16)31174-6?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867416311746%3Fshowall%3Dtrue
Our findings demonstrate a novel mutualistic host-protozoan interaction that increases mucosal host defenses at the cost of an increased risk of inflammatory disease.
http://www.cell.com/cell/abstract/S0092-8674(16)31174-6?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867416311746%3Fshowall%3Dtrue
Our findings demonstrate a novel mutualistic host-protozoan interaction that increases mucosal host defenses at the cost of an increased risk of inflammatory disease.
Vitamin #D supplementation to prevent acute respiratory tract #infections: systematic review and meta-analysis of individual participant data
http://www.bmj.com/content/356/bmj.i6583
Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.
http://www.bmj.com/content/356/bmj.i6583
Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.
The BMJ
Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant…
Objectives To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect.
Design Systematic review and meta-analysis of individual participant data (IPD) from randomised…
Design Systematic review and meta-analysis of individual participant data (IPD) from randomised…
Effect of #procalcitonin-guided antibiotic treatment on mortality in acute respiratory #infections: a patient level meta-analysis
http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30592-3/fulltext
.. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 9% deaths in 3336 procalcitonin-guided patients vs 336 10% in 3372 controls; adjusted odds ratio OR 0·83 95% CI 0·70 to 0·99, p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days 95% CI −2·71 to −2·15, p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 95% CI 0·57 to 0·82, p<0·0001).
Interpretation
Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance
http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30592-3/fulltext
.. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 9% deaths in 3336 procalcitonin-guided patients vs 336 10% in 3372 controls; adjusted odds ratio OR 0·83 95% CI 0·70 to 0·99, p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days 95% CI −2·71 to −2·15, p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 95% CI 0·57 to 0·82, p<0·0001).
Interpretation
Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance
The Lancet Infectious Diseases
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis
Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory
infections reduces antibiotic exposure and side-effects, and improves survival. Widespread
implementation of procalcitonin protocols in patients with acute respiratory infections…
infections reduces antibiotic exposure and side-effects, and improves survival. Widespread
implementation of procalcitonin protocols in patients with acute respiratory infections…
Symptomatic treatment of uncomplicated lower #urinary tract #infections in the ambulatory setting: randomised, double blind trial
http://www.bmj.com/content/359/bmj.j4784
To investigate whether symptomatic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is non-inferior to antibiotics in the treatment of uncomplicated lower urinary tract infection (UTI) in women, thus offering an opportunity to reduce antibiotic use in ambulatory care
72/133 (54%) women assigned to diclofenac and 96/120 (80%) assigned to norfloxacin experienced symptom resolution at day 3 (risk difference 27%, 95% confidence interval 15% to 38%, P=0.98 for non-inferiority, P<0.001 for superiority). The median time until resolution of symptoms was four days in the diclofenac group and two days in the norfloxacin group. A total of 82 (62%) women in the diclofenac group and 118 (98%) in the norfloxacin group used antibiotics up to day 30 (risk difference 37%, 28% to 46%, P<0.001 for superiority). Six women in the diclofenac group (5%) but none in the norfloxacin group received a clinical diagnosis of pyelonephritis (P=0.03).
Conclusion Diclofenac is inferior to norfloxacin for symptom relief of UTI and is likely to be associated with an increased risk of pyelonephritis, even though it reduces antibiotic use in women with uncomplicated lower UTI
http://www.bmj.com/content/359/bmj.j4784
To investigate whether symptomatic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is non-inferior to antibiotics in the treatment of uncomplicated lower urinary tract infection (UTI) in women, thus offering an opportunity to reduce antibiotic use in ambulatory care
72/133 (54%) women assigned to diclofenac and 96/120 (80%) assigned to norfloxacin experienced symptom resolution at day 3 (risk difference 27%, 95% confidence interval 15% to 38%, P=0.98 for non-inferiority, P<0.001 for superiority). The median time until resolution of symptoms was four days in the diclofenac group and two days in the norfloxacin group. A total of 82 (62%) women in the diclofenac group and 118 (98%) in the norfloxacin group used antibiotics up to day 30 (risk difference 37%, 28% to 46%, P<0.001 for superiority). Six women in the diclofenac group (5%) but none in the norfloxacin group received a clinical diagnosis of pyelonephritis (P=0.03).
Conclusion Diclofenac is inferior to norfloxacin for symptom relief of UTI and is likely to be associated with an increased risk of pyelonephritis, even though it reduces antibiotic use in women with uncomplicated lower UTI
The BMJ
Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial
Objective To investigate whether symptomatic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is non-inferior to antibiotics in the treatment of uncomplicated lower urinary tract infection (UTI) in women, thus offering an opportunity to reduce…
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A Nationwide Study in Denmark of the Association Between Treated #Infections and the Subsequent Risk of Treated #mental Disorders in Children and Adolescents
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2716981
.. Infections requiring hospitalizations were associated with subsequent increased risk of having a diagnosis of any mental disorder (n = 42 462) by an HRR of 1.84 (95% CI, 1.69-1.99) and with increased risk of redeeming a prescription for psychotropic medication (n = 56 847) by an HRR of 1.42 (95% CI, 1.37-1.46). Infection treated with anti-infective agents was associated with increased risk of having a diagnosis of any mental disorder (HRR, 1.40; 95% CI, 1.29-1.51) and with increased risk of redeeming a prescription for psychotropic medication (HRR, 1.22; 95% CI, 1.18-1.26). Antibiotic use was associated with particularly increased risk estimates. The risk of mental disorders after infections increased in a dose-response association and with the temporal proximity of the last infection. In particular, schizophrenia spectrum disorders, obsessive-compulsive disorder, personality and behavior disorders, mental retardation, autistic spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, and tic disorders were associated with the highest risks after infections.
Conclusions and Relevance Although the results cannot prove causality, these findings provide evidence for the involvement of infections and the immune system in the etiology of a wide range of mental disorders in children and adolescents.
A Nationwide Study in Denmark of the Association Between Treated #Infections and the Subsequent Risk of Treated #mental Disorders in Children and Adolescents
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2716981
.. Infections requiring hospitalizations were associated with subsequent increased risk of having a diagnosis of any mental disorder (n = 42 462) by an HRR of 1.84 (95% CI, 1.69-1.99) and with increased risk of redeeming a prescription for psychotropic medication (n = 56 847) by an HRR of 1.42 (95% CI, 1.37-1.46). Infection treated with anti-infective agents was associated with increased risk of having a diagnosis of any mental disorder (HRR, 1.40; 95% CI, 1.29-1.51) and with increased risk of redeeming a prescription for psychotropic medication (HRR, 1.22; 95% CI, 1.18-1.26). Antibiotic use was associated with particularly increased risk estimates. The risk of mental disorders after infections increased in a dose-response association and with the temporal proximity of the last infection. In particular, schizophrenia spectrum disorders, obsessive-compulsive disorder, personality and behavior disorders, mental retardation, autistic spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, and tic disorders were associated with the highest risks after infections.
Conclusions and Relevance Although the results cannot prove causality, these findings provide evidence for the involvement of infections and the immune system in the etiology of a wide range of mental disorders in children and adolescents.
Jamanetwork
A Nationwide Study of Infections and the Subsequent Risk of Mental Disorders in Children and Adolescents
This nationwide register-based cohort study investigates the association between all treated infections since birth and the subsequent risk of development of any treated mental disorder during childhood and adolescence in Denmark.
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Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Severe Urinary Tract #Infections: A Population-Based Cohort Study
https://annals.org/aim/article-abstract/2739786/sodium-glucose-cotransporter-2-inhibitors-risk-severe-urinary-tract-infections
In cohort 1, persons newly receiving SGLT-2 inhibitors had 61 severe UTI events (incidence rate [IR] per 1000 person-years, 1.76), compared with 57 events in the DPP-4 inhibitor group (IR, 1.77) (HR, 0.98 [95% CI, 0.68 to 1.41]). In cohort 2, those receiving #SGLT-2 inhibitors had 73 events (IR, 2.15), compared with 87 events in the GLP-1 agonist group (IR, 2.96) (HR, 0.72 [CI, 0.53 to 0.99]). Findings were robust across sensitivity analyses; within several subgroups of age, sex, and frailty; and for canagliflozin and dapagliflozin individually. In addition, SGLT-2 inhibitors were not associated with increased risk for outpatient UTIs (cohort 1: HR, 0.96 [CI, 0.89 to 1.04]; cohort 2: HR, 0.91 [CI, 0.84 to 0.99])
In a large cohort of patients seen in routine clinical practice, risk for severe and nonsevere UTI events among those initiating SGLT-2 inhibitor therapy was similar to that among patients initiating treatment with other second-line antidiabetic medications.
Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Severe Urinary Tract #Infections: A Population-Based Cohort Study
https://annals.org/aim/article-abstract/2739786/sodium-glucose-cotransporter-2-inhibitors-risk-severe-urinary-tract-infections
In cohort 1, persons newly receiving SGLT-2 inhibitors had 61 severe UTI events (incidence rate [IR] per 1000 person-years, 1.76), compared with 57 events in the DPP-4 inhibitor group (IR, 1.77) (HR, 0.98 [95% CI, 0.68 to 1.41]). In cohort 2, those receiving #SGLT-2 inhibitors had 73 events (IR, 2.15), compared with 87 events in the GLP-1 agonist group (IR, 2.96) (HR, 0.72 [CI, 0.53 to 0.99]). Findings were robust across sensitivity analyses; within several subgroups of age, sex, and frailty; and for canagliflozin and dapagliflozin individually. In addition, SGLT-2 inhibitors were not associated with increased risk for outpatient UTIs (cohort 1: HR, 0.96 [CI, 0.89 to 1.04]; cohort 2: HR, 0.91 [CI, 0.84 to 0.99])
In a large cohort of patients seen in routine clinical practice, risk for severe and nonsevere UTI events among those initiating SGLT-2 inhibitor therapy was similar to that among patients initiating treatment with other second-line antidiabetic medications.
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#Stress related disorders and subsequent risk of life threatening #infections: population based sibling controlled cohort study
..144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013
Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios.
Conclusion In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.
https://www.bmj.com/content/367/bmj.l5784
#Stress related disorders and subsequent risk of life threatening #infections: population based sibling controlled cohort study
..144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013
Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios.
Conclusion In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.
https://www.bmj.com/content/367/bmj.l5784
The BMJ
Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study
Objective To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections.
Design Population and sibling matched cohort study.
Setting Swedish population.
Participants 144 919…
Design Population and sibling matched cohort study.
Setting Swedish population.
Participants 144 919…
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Comparing the burdens of opportunistic #infections among patients with systemic #rheumatic diseases: a nationally representative cohort study
The IR of opportunistic infections was highest for PM/DM cases (61.3/1000 person-years, 95% confidence interval [CI] 56.6–66.2), followed by SLE cases (43.1/1000 person-years, 95% CI 41.7–44.5), SSc cases (31.6/1000 person-years, 95% CI 28.3–35.1), RA cases (25.0/1000 person-years, 95% CI 24.4–25.7), and pSS cases (24.1/1000 person-years, 95% CI 23.1–25.2). Multivariable Cox analysis revealed that, relative to SLE, PM/DM was associated with a significantly higher risk of opportunistic infections (hazard ratio 1.18, 95% CI 1.08–1.29). The risk of opportunistic infections was highest during the first year after the diagnosis of all five rheumatic diseases.
Conclusions
The risk of opportunistic infection was highest for PM/DM, followed by SLE, SSc, RA, and pSS. Careful observation and preventive therapy for opportunistic infections may be warranted in selected PM/DM patients, especially during the first year after the diagnosis.
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-019-1997-5
Comparing the burdens of opportunistic #infections among patients with systemic #rheumatic diseases: a nationally representative cohort study
The IR of opportunistic infections was highest for PM/DM cases (61.3/1000 person-years, 95% confidence interval [CI] 56.6–66.2), followed by SLE cases (43.1/1000 person-years, 95% CI 41.7–44.5), SSc cases (31.6/1000 person-years, 95% CI 28.3–35.1), RA cases (25.0/1000 person-years, 95% CI 24.4–25.7), and pSS cases (24.1/1000 person-years, 95% CI 23.1–25.2). Multivariable Cox analysis revealed that, relative to SLE, PM/DM was associated with a significantly higher risk of opportunistic infections (hazard ratio 1.18, 95% CI 1.08–1.29). The risk of opportunistic infections was highest during the first year after the diagnosis of all five rheumatic diseases.
Conclusions
The risk of opportunistic infection was highest for PM/DM, followed by SLE, SSc, RA, and pSS. Careful observation and preventive therapy for opportunistic infections may be warranted in selected PM/DM patients, especially during the first year after the diagnosis.
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-019-1997-5
Arthritis Research & Therapy
Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative…
To estimate and compare the burdens of opportunistic infections and herpes zoster in real-world practice among patients with various systemic rheumatic diseases. This 13-year cohort study used national health insurance data to compare the incidence rates…
Appropriate Use of Short-Course #Antibiotics in Common #Infections: Best Practice Advice From the American College of Physicians
https://2medical.news/2021/04/06/appropriate-use-of-short-course-antibiotics-in-common-infections-best-practice-advice-from-the-american-college-of-physicians/
Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these …
https://2medical.news/2021/04/06/appropriate-use-of-short-course-antibiotics-in-common-infections-best-practice-advice-from-the-american-college-of-physicians/
Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these …
Vitamin #D supplementation to prevent acute respiratory #infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials
https://2medical.news/2021/04/18/vitamin-d-supplementation-to-prevent-acute-respiratory-infections-a-systematic-review-and-meta-analysis-of-aggregate-data-from-randomised-controlled-trials/
A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention. We aimed to examine the link between vitamin D supplementation and prevention of ARIs in an updated meta-analysis. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled …
https://2medical.news/2021/04/18/vitamin-d-supplementation-to-prevent-acute-respiratory-infections-a-systematic-review-and-meta-analysis-of-aggregate-data-from-randomised-controlled-trials/
A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention. We aimed to examine the link between vitamin D supplementation and prevention of ARIs in an updated meta-analysis. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled …