RESUMEN
Awareness and uptake of the meningitis vaccine remains low among marginalized groups, such as Latino men who have sex with men (LMSM), potentially due to structural and psychosocial barriers in accessing preventative healthcare. The current study explored awareness and uptake of meningitis vaccines among a group of LMSM (N = 99) living in South Florida. A three-pronged variable selection approach was utilized prior to conducting regression models (linear and logistic). Overall, 48.5% of the participants reported little to no knowledge about meningitis vaccines, and 20.2% reported being vaccinated. Living with HIV (OR = 10.48) and time since outbreak (OR = 1.03) were significant predictors of meningitis vaccine uptake. No significant correlates of meningitis vaccine awareness were identified. More research is needed to identify other important factors associated with meningitis vaccine awareness and uptake among LMSM, a multiple marginalized group.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Meningitis , Vacunas Meningococicas , Humanos , Masculino , Brotes de Enfermedades , Florida , Hispánicos o Latinos/psicología , Homosexualidad Masculina , Meningitis/prevención & control , Vacunación , Vacunas Meningococicas/administración & dosificaciónRESUMEN
BACKGROUND: The RTS,S/AS01E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebral malaria cases in RTS,S recipients, and the possibility of an excess of deaths among girls who received RTS,S than in controls, to inform decisions about wider use. METHODS: In this prospective evaluation, 158 geographical clusters (66 districts in Ghana; 46 sub-counties in Kenya; and 46 groups of immunisation clinic catchment areas in Malawi) were randomly assigned to early or delayed introduction of RTS,S, with three doses to be administered between the ages of 5 months and 9 months and a fourth dose at the age of approximately 2 years. Primary outcomes of the evaluation, planned over 4 years, were mortality from all causes except injury (impact), hospital admission with severe malaria (impact), hospital admission with meningitis or cerebral malaria (safety), deaths in girls compared with boys (safety), and vaccination coverage (feasibility). Mortality was monitored in children aged 1-59 months throughout the pilot areas. Surveillance for meningitis and severe malaria was established in eight sentinel hospitals in Ghana, six in Kenya, and four in Malawi. Vaccine uptake was measured in surveys of children aged 12-23 months about 18 months after vaccine introduction. We estimated that sufficient data would have accrued after 24 months to evaluate each of the safety signals and the impact on severe malaria in a pooled analysis of the data from the three countries. We estimated incidence rate ratios (IRRs) by comparing the ratio of the number of events in children age-eligible to have received at least one dose of the vaccine (for safety outcomes), or age-eligible to have received three doses (for impact outcomes), to that in non-eligible age groups in implementation areas with the equivalent ratio in comparison areas. To establish whether there was evidence of a difference between girls and boys in the vaccine's impact on mortality, the female-to-male mortality ratio in age groups eligible to receive the vaccine (relative to the ratio in non-eligible children) was compared between implementation and comparison areas. Preliminary findings contributed to WHO's recommendation in 2021 for widespread use of RTS,S in areas of moderate-to-high malaria transmission. FINDINGS: By April 30, 2021, 652â673 children had received at least one dose of RTS,S and 494â745 children had received three doses. Coverage of the first dose was 76% in Ghana, 79% in Kenya, and 73% in Malawi, and coverage of the third dose was 66% in Ghana, 62% in Kenya, and 62% in Malawi. 26â285 children aged 1-59 months were admitted to sentinel hospitals and 13â198 deaths were reported through mortality surveillance. Among children eligible to have received at least one dose of RTS,S, there was no evidence of an excess of meningitis or cerebral malaria cases in implementation areas compared with comparison areas (hospital admission with meningitis: IRR 0·63 [95% CI 0·22-1·79]; hospital admission with cerebral malaria: IRR 1·03 [95% CI 0·61-1·74]). The impact of RTS,S introduction on mortality was similar for girls and boys (relative mortality ratio 1·03 [95% CI 0·88-1·21]). Among children eligible for three vaccine doses, RTS,S introduction was associated with a 32% reduction (95% CI 5-51%) in hospital admission with severe malaria, and a 9% reduction (95% CI 0-18%) in all-cause mortality (excluding injury). INTERPRETATION: In the first 2 years of implementation of RTS,S, the three primary doses were effectively deployed through national immunisation programmes. There was no evidence of the safety signals that had been observed in the phase 3 trial, and introduction of the vaccine was associated with substantial reductions in hospital admission with severe malaria. Evaluation continues to assess the impact of four doses of RTS,S. FUNDING: Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.
Asunto(s)
Estudios de Factibilidad , Programas de Inmunización , Vacunas contra la Malaria , Malaria Cerebral , Humanos , Ghana/epidemiología , Malaui/epidemiología , Lactante , Femenino , Kenia/epidemiología , Vacunas contra la Malaria/administración & dosificación , Vacunas contra la Malaria/efectos adversos , Masculino , Preescolar , Malaria Cerebral/epidemiología , Malaria Cerebral/mortalidad , Estudios Prospectivos , Malaria Falciparum/prevención & control , Malaria Falciparum/epidemiología , Meningitis/epidemiología , Meningitis/prevención & controlRESUMEN
BACKGROUND: The choice of prophylactic antibiotics for use in endonasal transsphenoidal surgery (ETSS) lacks universal standards. This study aimed to investigate the effectiveness of cefazolin, ampicillin and third-generation cephalosporins for preventing postoperative meningitis and secondary outcomes (in-hospital death and the combination of pneumonia and urinary tract infection) in patients who have undergone ETSS. METHODS: The study used data from the Diagnosis Procedure Combination database in Japan. Data from 10â688 patients who underwent ETSS between April 2016 and March 2021 were included. Matching weight analysis based on propensity scores was conducted to compare the outcomes of patients receiving cefazolin, ampicillin or third-generation cephalosporins as prophylactic antibiotics. RESULTS: Of the 10â688 patients, 9013, 102 and 1573 received cefazolin, ampicillin and third-generation cephalosporins, respectively. The incidence of postoperative meningitis did not significantly differ between the cefazolin group and the ampicillin group (OR, 1.02; 95% CI, 0.14-7.43) or third-generation cephalosporins group (OR, 0.81; 95% CI, 0.10-6.44). Similarly, in-hospital death and the composite incidence of pneumonia and urinary tract infection did not differ between the cefazolin group and the ampicillin or third-generation cephalosporins group. CONCLUSIONS: Cefazolin, ampicillin and third-generation cephalosporins as perioperative prophylactic antibiotics for ETSS do not differ significantly in terms of preventing meningitis.
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Meningitis , Neumonía , Infecciones Urinarias , Humanos , Cefazolina , Cefalosporinas/uso terapéutico , Pacientes Internos , Japón/epidemiología , Mortalidad Hospitalaria , Profilaxis Antibiótica/métodos , Ampicilina , Infecciones Urinarias/tratamiento farmacológico , Meningitis/epidemiología , Meningitis/prevención & control , Antibacterianos/uso terapéutico , Neumonía/tratamiento farmacológicoRESUMEN
BACKGROUND: An effective, affordable, multivalent meningococcal conjugate vaccine is needed to prevent epidemic meningitis in the African meningitis belt. Data on the safety and immunogenicity of NmCV-5, a pentavalent vaccine targeting the A, C, W, Y, and X serogroups, have been limited. METHODS: We conducted a phase 3, noninferiority trial involving healthy 2-to-29-year-olds in Mali and Gambia. Participants were randomly assigned in a 2:1 ratio to receive a single intramuscular dose of NmCV-5 or the quadrivalent vaccine MenACWY-D. Immunogenicity was assessed at day 28. The noninferiority of NmCV-5 to MenACWY-D was assessed on the basis of the difference in the percentage of participants with a seroresponse (defined as prespecified changes in titer; margin, lower limit of the 96% confidence interval [CI] above -10 percentage points) or geometric mean titer (GMT) ratios (margin, lower limit of the 98.98% CI >0.5). Serogroup X responses in the NmCV-5 group were compared with the lowest response among the MenACWY-D serogroups. Safety was also assessed. RESULTS: A total of 1800 participants received NmCV-5 or MenACWY-D. In the NmCV-5 group, the percentage of participants with a seroresponse ranged from 70.5% (95% CI, 67.8 to 73.2) for serogroup A to 98.5% (95% CI, 97.6 to 99.2) for serogroup W; the percentage with a serogroup X response was 97.2% (95% CI, 96.0 to 98.1). The overall difference between the two vaccines in seroresponse for the four shared serogroups ranged from 1.2 percentage points (96% CI, -0.3 to 3.1) for serogroup W to 20.5 percentage points (96% CI, 15.4 to 25.6) for serogroup A. The overall GMT ratios for the four shared serogroups ranged from 1.7 (98.98% CI, 1.5 to 1.9) for serogroup A to 2.8 (98.98% CI, 2.3 to 3.5) for serogroup C. The serogroup X component of the NmCV-5 vaccine generated seroresponses and GMTs that met the prespecified noninferiority criteria. The incidence of systemic adverse events was similar in the two groups (11.1% in the NmCV-5 group and 9.2% in the MenACWY-D group). CONCLUSIONS: For all four serotypes in common with the MenACWY-D vaccine, the NmCV-5 vaccine elicited immune responses that were noninferior to those elicited by the MenACWY-D vaccine. NmCV-5 also elicited immune responses to serogroup X. No safety concerns were evident. (Funded by the U.K. Foreign, Commonwealth, and Development Office and others; ClinicalTrials.gov number, NCT03964012.).
Asunto(s)
Epidemias , Estado de Salud , Meningitis , Vacunas Meningococicas , Vacunas Conjugadas , Humanos , Gambia/epidemiología , Malí/epidemiología , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/efectos adversos , Vacunas Conjugadas/uso terapéutico , Vacunas Meningococicas/administración & dosificación , Vacunas Meningococicas/efectos adversos , Vacunas Meningococicas/uso terapéutico , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Inmunogenicidad Vacunal , Inyecciones Intramusculares , Meningitis/epidemiología , Meningitis/prevención & control , Epidemias/prevención & controlRESUMEN
BACKGROUND: Postoperative cerebrospinal fluid (CSF) leak is one of the most common complications after endoscopic endonasal approach to the skull base. OBJECTIVE: To analyze the effect of leukocyte-rich and platelet-rich fibrin (L-PRF) as part of a standardized endonasal skull base repair protocol on postoperative infection and CSF leak rate. METHODS: One hundred three patients who underwent an endoscopic endonasal approach and were reconstructed using a standard technique (Group A) were compared with 139 patients using the same protocol with the addition of L-PRF (Group B). Postoperative intracranial infection and CSF leak at 6 months were analyzed. RESULTS: In patients with intraoperative CSF leak, postoperative leak occurred in 10.8% in Group A and 2.6% in Group B ( P .024), and in patients with intraoperative high-flow leaks, the incidences were 11.7% and 3.1%, respectively ( P .048). L-PRF reduced postoperative CSF leak by 76% in cases with intraoperative CSF leak (relative risk 0.24, 95% CI 0.06-0.87) and by 73% of patients with high-flow leak (relative risk 0.27, 95% CI 0.07-0.99). In patients undergoing surgery for diagnoses other than adenomas, there were no cases of postoperative leak in Group B, whereas in Group A occurred in 13.4% of those with intraoperative leaks ( P .047) and 15.8% with high-flow intraoperative leaks ( P .033). No significant differences were found in patients with pituitary adenoma. Meningitis occurred in 0.97% in Group A vs 2.16% in Group B ( P .639), without differences between subgroups. CONCLUSION: L-PRF reduced the rate of postoperative CSF leaks in patients with intraoperative leaks, without differences on postoperative meningitis.
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Adenoma , Meningitis , Fibrina Rica en Plaquetas , Humanos , Base del Cráneo/cirugía , Endoscopía/métodos , Nariz , Pérdida de Líquido Cefalorraquídeo/epidemiología , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Adenoma/cirugía , Meningitis/epidemiología , Meningitis/etiología , Meningitis/prevención & controlRESUMEN
In this paper, we have considered a deterministic mathematical model to analyze effective interventions for meningitis and pneumonia coinfection as well as to make a rational recommendation to public healthy, policy or decision makers and programs implementers. We have introduced the epidemiology of infectious diseases, the epidemiology of meningitis, the epidemiology of pneumonia, and the epidemiology of infection of meningitis and pneumonia. The positivity and boundedness of the sated model was shown. Our model elucidate that, the disease free equilibrium points of each model are locally asymptotically stable if the corresponding reproduction numbers are less than one and globally asymptotically stable if the corresponding reproduction numbers are greater than one. Additionally, we have analyzed the existence and uniqueness of the endemic equilibrium point of each sub models, local stability and global stability of the endemic equilibrium points for each model. By using standard values of parameters we have obtained from different studies, we found that the effective reproduction numbers of meningitis [Formula: see text] and effective reproduction numbers of pneumonia [Formula: see text] that lead us to the effective reproduction number of the meningitis and pneumonia co-infected model is [Formula: see text]. Applying sensitivity analysis, we identified the most influential parameters that can change the behavior of the solution of the meningitis pneumonia coinfection dynamical system are [Formula: see text] and [Formula: see text]. Biologically, decrease in [Formula: see text] and increasing in [Formula: see text] is a possible intervention strategy to reduce the infectious from communities. Finally, our numerical simulation has shown that vaccination against those diseases, reducing contact with infectious persons and treatment have the great effect on reduction of these silent killer diseases from the communities.
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Número Básico de Reproducción , Coinfección/epidemiología , Simulación por Computador , Meningitis/epidemiología , Modelos Teóricos , Neumonía/epidemiología , Coinfección/prevención & control , Humanos , Meningitis/prevención & control , Neumonía/prevención & control , Salud PúblicaRESUMEN
BACKGROUND: The internet has made significant contributions towards health education. Analyzing the pattern of online behavior regarding meningitis and vaccinations may be worthwhile. It is hypothesized that the online search patterns in meningitis are correlated with its number of cases and the search patterns of its related vaccines. METHODS: This was an infodemiological study that determined the relationship among online search interest in meningitis, its worldwide number of cases and its associated vaccines. Using Google Trends™ Search Volume Indices (SVIs), we evaluated the search queries "meningitis," "pneumococcal vaccine," "BCG vaccine," "meningococcal vaccine" and "influenza vaccine" in January 2021, covering January 2008 to December 2020. Spearman rank correlation was used to determine correlations between these queries. RESULTS: The worldwide search interest in meningitis from 2008 to 2020 showed an average SVI of 46 ± 8.8. The most searched topics were symptoms, vaccines, and infectious agents with SVIs of 100, 52, and 39, respectively. The top three countries with the highest search interest were Ghana, Kazakhstan, and Kenya. There were weak, but statistically significant correlations between meningitis and the BCG (ρ = 0.369, p < 0.001) and meningococcal (ρ = 0.183, p < 0.05) vaccines. There were no statistically significant associations between the number of cases, influenza vaccine, and pneumococcal vaccine. CONCLUSION: The relationships among the Google SVIs for meningitis and its related vaccines and number of cases data were inconsistent and remained unclear. Future infodemiological studies may expand their scopes to social media, semantics, and big data for more robust conclusions.
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Bases de Datos Factuales , Servicios de Información/estadística & datos numéricos , Meningitis/patología , Vacunas Meningococicas/administración & dosificación , Vacuna BCG/administración & dosificación , Países Desarrollados , Países en Desarrollo , Carga Global de Enfermedades , Humanos , Servicios de Información/tendencias , Masculino , Meningitis/epidemiología , Meningitis/prevención & controlRESUMEN
BACKGROUND: Escherichia coli K1 (E. coli K1) caused neonatal meningitis remains a problem, which rises the urgent need for an effective vaccine. Previously, we rationally designed and produced the recombinant protein OmpAVac (Vo), which elicited protective immunity against E. coli K1 infection. However, Vo has limited stability, which hinders its future industrial application. METHOD: Chitosan-modified poly (lactic-co-glycolic acid) (PLGA) nanoparticles were prepared and used as carried for the recombinant Vo. And the safety, stability and immunogenicity of Vo delivered by chitosan-modified PLGA nanoparticles were tested in vitro and in a mouse model of bacteremia. RESULTS: We successfully generated chitosan-modified PLGA nanoparticles for the delivery of recombinant Vo (VoNP). In addition, we found that a freeze-drying procedure increases the stability of the VoNPs without changing the shape, size distribution and encapsulation of the Vo protein. Unlike aluminum adjuvant, the nanoparticles that delivered Vo were immunoprotective in mice even after storage for as long as 180 days. CONCLUSIONS: We identified an effective strategy to improve the stability of Vo to maintain its immunogenicity, which will contribute to the future development of vaccines against E. coli K1.
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Quitosano/química , Infecciones por Escherichia coli/prevención & control , Escherichia coli , Meningitis/prevención & control , Nanopartículas/química , Vacunas/química , Vacunas/farmacología , Adyuvantes Inmunológicos , Animales , Modelos Animales de Enfermedad , Sistemas de Liberación de Medicamentos/métodos , Infecciones por Escherichia coli/patología , Femenino , Inmunidad , Ratones , Ratones Endogámicos BALB C , Ratones Desnudos , Proteínas RecombinantesRESUMEN
BACKGROUND: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors. LOCAL PROBLEM: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020. METHODS: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students. RESULTS: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided. CONCLUSION: MI can be an effective part of a strategy to increase vaccination rates.
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Personal de Salud/normas , Entrevista Motivacional/normas , Estudiantes/psicología , Negativa a la Vacunación/psicología , Adolescente , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Humanos , Gripe Humana/tratamiento farmacológico , Gripe Humana/prevención & control , Gripe Humana/psicología , Masculino , Meningitis/tratamiento farmacológico , Meningitis/prevención & control , Meningitis/psicología , Entrevista Motivacional/métodos , Entrevista Motivacional/estadística & datos numéricos , Infecciones por Papillomavirus/tratamiento farmacológico , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/psicología , Mejoramiento de la Calidad , Sudoeste de Estados Unidos , Estudiantes/estadística & datos numéricos , Universidades/organización & administración , Universidades/estadística & datos numéricos , Negativa a la Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: In 2012, the Centers for Disease Control and Prevention (CDC) Advisory Council on Immunization Practice recommended an additional post-splenectomy booster vaccine at 8 weeks following the initial vaccine. The objective of this study was to evaluate our vaccination compliance rate and what sociodemographic factors were associated with noncompliance following this recommendation. MATERIALS AND METHODS: A retrospective review of a performance improvement database of trauma patients eligible for post-splenectomy vaccination (PSV) at a level I trauma center was carried out between 2009 and 2018. Overall and institutional compliance with PSV was compared before and after the addition of booster vaccine recommendation. Factors associated with booster noncompliance were also identified. RESULTS: A total of 257 patients were identified. PSV compliance rate in the pre-booster was 98.4%, while overall and institutional post-booster compliance rate were significantly lower at 66.9% (P ≤ .001) and 50.0% (P ≤ .001), respectively. Compared to booster institutional compliers, institutional noncompliers lived farther from the trauma center (48 vs. 86 miles, P = .02), and though not statistically significant, these patients were generally older (34.9 vs. 40.5, P = .05). DISCUSSION: PSV booster compliance is low even with the current educational materials and recommendations. Additional approaches to improve compliance rates need to be implemented, such as sending letters to the patient and their primary care providers (PCPs), collaborating with rehab/long-term acute care centers, communicating with city and county health departments and city pharmacies, or mirroring other countries and creating a national database for asplenic patients to provide complete information.
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Inmunización Secundaria/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/estadística & datos numéricos , Complicaciones Posoperatorias/prevención & control , Bazo/lesiones , Esplenectomía , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Meningitis/etiología , Meningitis/prevención & control , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Sepsis/etiología , Sepsis/prevención & control , Bazo/cirugía , Heridas y Lesiones/cirugía , Adulto JovenRESUMEN
Objective: Early permanent cerebrospinal fluid (CSF) diversion for hydrocephalus during the first 2 weeks after aneurysmal subarachnoid hemorrhage (aSAH) shortens the duration of external ventricular drainage (EVD) and reduces EVD-associated infections (EVDAI). The objective of this study was to detect any association with symptomatic delayed cerebral vasospasm (DCVS), or delayed cerebral ischemia (DCI) by the time of hospital discharge. Methods: We used a single-center dataset of aSAH patients who had received a permanent CSF diversion. We compared an 'early group' in which the procedure was performed up to 14 days after the ictus, to a 'late group' in which it was performed from the 15th day onward. Results: Among 274 consecutive aSAH patients, 39 (14%) had a permanent CSF diversion procedure with a silver-coated EVD. While the blood clot burden was similarly distributed, patients with early permanent CSF diversion (20 out of 39; 51%) had higher levels of consciousness on admission. Early permanent CSF diversion was associated with less colonized catheter, a shorter duration of extracorporeal CSF diversion (OR 0.73, 95%CI 0.58-0.92 per EVD day), and a lower rate of EVDAI (OR 0.08, 95%CI 0.01-0.80). The occurrence of CSF diversion device obstruction, the rate of symptomatic DCVS or detected DCI on computed tomography and the likelihood of a poor outcome at discharge did not differ between the two groups. Discussion: Early permanent CSF diversion lowers the occurrence of catheter colonization and infectious complication without affecting DCVS-related morbidity in good-grade aSAH patients. These findings need confirmation in larger prospective multicenter cohorts. Abbreviations: aSAH: aneurysmal subarachnoid hemorrhage; BNI: Barrow Neurological Institute Scale; CSF: Cerebrospinal fluid; DCVS: Delayed Cerebral Vasospasm; DCI: Delayed Cortical Ischemia; EKNZ: Ethik-Kommission Nordwest Schweiz; EVD: External ventricular drain; EVDAI: External ventricular drain-associated infections; GCS: Glasgow Coma Scale; IRB: Institutional Review Board; IVH: Inraventricular hemorrhage; mRS: Modified Rankin Scale; SOS: Swiss Study of Subarachnoid Hemorrhage Registry; WFNS: World Federation Neurological-Surgeon Scale.
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Derivaciones del Líquido Cefalorraquídeo/métodos , Infección Hospitalaria/prevención & control , Drenaje/efectos adversos , Hemorragia Subaracnoidea/complicaciones , Vasoespasmo Intracraneal/etiología , Adulto , Anciano , Infecciones Relacionadas con Catéteres/prevención & control , Estudios de Cohortes , Infección Hospitalaria/etiología , Drenaje/métodos , Femenino , Humanos , Hidrocefalia/etiología , Hidrocefalia/cirugía , Masculino , Meningitis/etiología , Meningitis/prevención & control , Persona de Mediana Edad , Estudios Retrospectivos , Tiempo de Tratamiento , Vasoespasmo Intracraneal/epidemiologíaRESUMEN
PURPOSE: Endoscopic endonasal skull base surgery (EESBS) is a clean-contaminated procedure. Guidelines regarding the antibiotic prophylaxis in EESBS have not been developed yet, and today, there are no universally accepted protocols. In this article, we investigated the efficacy of our new ultra-short antibiotic prophylaxis protocol for EESBS guided by the cultural results of preoperative microbiological nasal swabs. METHODS: We defined as "nasal swab-related antibiotic protocol" the administration of a first-generation cephalosporin (cefazolin 2 g) in patients whose nasal swabs revealed the presence of normal nasal flora or methicillin-sensitive Staphylococcus aureus (MSSA), and the administration of vancomycin 1 g intravenously in patients whose nasal swabs revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA) or with reported cephalosporin/penicillin allergy. This case-control study included 120 patients who underwent EESBS. The case group included 60 cases who received the "nasal swab-related antibiotic protocol," while the control group included 60 cases who received the "standard hospital antibiotic protocol" used in neurosurgery (cefazolin 2 g plus metronidazole 500 mg at induction, and 2 g of cefazolin repeated after 180 min). RESULTS: The preoperative microbiological nasal swabs showed normal nasal flora in 42 patients (70%), MSSA in 17 patients (28.3%), and MRSA in 1 patient (1.6%). During the study period, no cases of meningitis or sinusitis occurred in the case group ("nasal swab-related antibiotic protocol"), while two infections (3.3%, 1 sinusitis and 1 meningitis) were reported in the control group ("standard hospital antibiotic protocol"). Mean length of hospitalization was 6.5 days for the case group and 8.5 days in the control group. "Standard hospital antibiotic protocol" is less expensive (range, 2.88-5.42 euros) compared with our new "nasal swab-related antibiotic protocol" (range, 10.02-32.56 euros), but in line with other antibiotic prophylaxis protocols reported in literature. DISCUSSION: The low complication rates of our case series (0%) is comparable to complication rates reported in literature (1.6% for meningitis and 8% for sinusitis). Compared with other perioperative antibiotic regimens reported in literature, the "nasal swab-related antibiotic protocol" is cheap and at least equally effective. We discuss the rationale on which we based the choice of chemoprophylaxis, the timing, and the length of our regimen. CONCLUSIONS: Our study confirmed the safety and efficacy of our easily applicable and low-cost antibiotic prophylaxis protocol.
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Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Cefazolina/administración & dosificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Procedimientos Neuroquirúrgicos , Cuidados Preoperatorios/métodos , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/administración & dosificación , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Endoscopía , Femenino , Humanos , Masculino , Meningitis/prevención & control , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Nariz , Sinusitis/prevención & control , Base del Cráneo/cirugía , Adulto JovenAsunto(s)
Antibacterianos/uso terapéutico , Cultivo de Sangre/métodos , Meningitis , Insuficiencia Multiorgánica , Sepsis Neonatal , Diagnóstico Diferencial , Progresión de la Enfermedad , Diagnóstico Precoz , Servicios Médicos de Urgencia/métodos , Humanos , Recién Nacido , Meningitis/diagnóstico , Meningitis/etiología , Meningitis/prevención & control , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/prevención & control , Sepsis Neonatal/complicaciones , Sepsis Neonatal/mortalidad , Sepsis Neonatal/fisiopatología , Sepsis Neonatal/terapia , Uso Excesivo de Medicamentos Recetados/prevención & control , Factores de Riesgo , Evaluación de Síntomas/métodosRESUMEN
Managing a deadly pandemic in low- and middle-income countries (LMIC) is challenging. The task becomes tougher when there is an outbreak of an equally deadly disease. This is the present situation of Ghana, a low-resource country, that is confronted with the coronavirus disease 2019 (COVID-19) pandemic and cerebrospinal meningitis (CSM) outbreak. Apart from the resource constraint at both governmental and individual levels, such a situation affects the overall wellbeing of ordinary citizens as well as healthcare professionals, particularly those in high-risk areas. Perhaps, more than ever, we have to ensure equitable distribution of scarce healthcare resources in our effort to manage this 'twin disaster' of COVID-19 and CSM. We evaluated Ghana's situation (outbreak response) and recommended measures to help us navigate this conundrum of a public health crisis.
Asunto(s)
Infecciones por Coronavirus/prevención & control , Desastres/prevención & control , Brotes de Enfermedades/prevención & control , Meningitis/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , COVID-19 , Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Ghana/epidemiología , Asignación de Recursos para la Atención de Salud , Recursos en Salud/provisión & distribución , Humanos , Meningitis/epidemiología , Neumonía Viral/epidemiologíaRESUMEN
AIM: To investigate if adult cochlear implant (CI) recipients have received the recommended immunisations as compared to current guidelines and to report instances of meningitis within this population. METHODS: Telephone interview of CI recipient's general practitioner (GP) surgeries for details regarding immunisations received. Subsequent reporting of immunisation rates of adult patients, under the care of the Northern Cochlear Implant Programme (NCIP) in New Zealand, when compared to the recommended guidelines from the Immunisation Advisory Centre (IMAC) and rates of meningitis of CI recipients are presented. RESULTS: It is recommended to immunise against the most common organisms causing meningitis, Streptococcus pneumoniae and Haemophilus influenzae type b (HiB), as well as influenza. Data for 135 CI recipients over the last five years was complete. 14.8% of patients had received a full pneumococcal immunisation schedule. 11.9% had received a HiB immunisation and 62.2% an influenza vaccination. No patient had developed meningitis following CI insertion. CONCLUSION: This paper highlights clear issues with the immunisation of adult CI recipients.
Asunto(s)
Implantación Coclear , Adhesión a Directriz , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/uso terapéutico , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Meningitis Neumocócica/prevención & control , Vacunas Neumococicas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Implantes Cocleares , Femenino , Humanos , Esquemas de Inmunización , Masculino , Meningitis/prevención & control , Persona de Mediana Edad , Nueva Zelanda , Guías de Práctica Clínica como Asunto , Vacunas Conjugadas/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: Health care-associated meningitis or ventriculitis (HCAMV) is a serious complication in different neurosurgical procedures and is associated with significant morbidity and mortality. We aimed to investigate whether an educational intervention program could reduce the HCAMV incidence in patients undergoing postsurgery external ventricular drainage and wound management. METHODS: We enrolled 2,904 patients from the neurosurgery intensive care unit between January 1, 2016 and December 31, 2018. The medical staff undertook an educational program developed by a multidisciplinary team on correct external ventricular drainage insertion and maintenance. The program included a 9-page self-learning module on the HCAMV risk factors and operational improvements. Each participant completed a pre- and posttest on their HCAMV knowledge. RESULTS: We found that 38 of 693 (5.48%) patients presented with infection in the preintervention 9-month period. In the 27-month postintervention period, the proportion of HCAMV incidence dropped by 52.19% (P < .0001) to 58 of 2,211 (2.62%) patients. CONCLUSIONS: Educational intervention aimed at the neurosurgery intensive care unit staff could significantly reduce the HCAMV rate, leading to a significant decline in the cost, morbidity, and mortality caused by neurosurgical procedures.
Asunto(s)
Ventriculitis Cerebral , Infección Hospitalaria , Meningitis , Ventriculitis Cerebral/epidemiología , Ventriculitis Cerebral/prevención & control , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Atención a la Salud , Humanos , Unidades de Cuidados Intensivos , Meningitis/epidemiología , Meningitis/prevención & control , Procedimientos Neuroquirúrgicos/efectos adversosRESUMEN
BACKGROUND: Spontaneous skull base defects can result in life-threatening intracranial complications (ICCs), including meningitis and pneumocephalus. Endoscopic skull base reconstruction (ESBR) has traditionally been the treatment of choice, but its impact upon ICCs is not known. In this study, we aimed to describe the incidence rate of preoperative ICCs in patients with spontaneous skull base defects, risk factors associated with ICC development, and the impact of surgical repair on the incidence rate of ICCs. METHODS: A retrospective review was performed of all spontaneous skull base defects undergoing ESBR from 2005 to 2019 at 2 academic tertiary care medical centers. The incidence rate of ICCs and the demographics information and risk factors were collected. RESULTS: In 222 spontaneous skull base defects, preoperative ICCs occurred in 46 subjects (20.7%) with an incidence rate of 22.7 per 100 person-years. Factors significantly associated with preoperative ICCs included symptom duration, reduced body mass index (BMI), resolved cerebrospinal fluid rhinorrhea, and location in the frontal or lateral sphenoid sinuses. Endoscopic repair was successful in 97.2% of subjects and the postoperative ICC incidence rate was significantly reduced at 0.8 per 100 person-years (p < 0.001). CONCLUSION: Spontaneous skull base defects pose significant risk for life-threatening ICCs. Our findings reveal significantly elevated odds of ICC development associated with resolved CSF rhinorrhea, lower BMI, longer duration of symptoms, and defect location. Endoscopic repair is highly successful with low morbidity and significantly reduces the incidence rate of intracranial complications.