Pediococcus pentosaceus Endocarditis in a Patient With Recent Transcatheter Aortic Valve Implantation and Liver Cirrhosis: A Case Report and Review of the Literature.

Transcatheter aortic valve implantation (TAVI) is increasingly being used in the management of severe aortic stenosis, mainly in older and/or medically compromised patients, due to its minimally invasive nature. As in any valve replacement procedure, endocarditis is a recognized complication, more so in TAVI patients, in whom comorbidities are highly prevalent. We report the case of a 70-year-old male with a history of liver cirrhosis and a recent TAVI, who presented with recurrent fever and sustainedPediococcus pentosaceus bacteremia. The diagnosis of endocarditis was delayed, as the microorganism was initially discarded as a contaminant, given that Pediococci are rarely described as human pathogens. However, in cirrhotic patients, microbiota may cause intermittent bacteremia and thereby affect prosthetic valves. Transthoracic echocardiography was not helpful in validating the diagnosis, as is often the case in TAVI patients. Transesophageal echocardiography was deemed perilous, due to esophageal varices complicating the underlying cirrhosis. Therefore, endocarditis diagnosis was based on sustained bacteremia and Duke's criteria, including the presence of high fever, a predisposing cardiac lesion, splenic infarction, and the exclusion of an alternative diagnosis. Moreover, cirrhosis enhanced the side effects of treatment and led to the need for regimen changes and prolonged hospitalization. Given the precariousness of the situation, confirmation of treatment success by 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan was sought. This is the first reported case of Pediococcus TAVI endocarditis in a cirrhotic patient, highlighting the unique challenges in the diagnosis and management of TAVI endocarditis in patients with co-existing conditions.

Tuberculosis incidence in foreign-born people residing in European countries in 2020.

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

Πρόληψη της μικροβιακής αντοχής και προώθηση της ορθολογικής χρήσης αντιμικροβιακών ουσιών στα νοσοκομεία στην Ελλάδα : EVIPNet σύνοψη ερευνητικών δεδομένων, Νούμερο 10

Η παρούσα έκθεση αποτελεί την πρώτη σύνοψη ερευνητικών δεδομένων (Evidence Policy Brief-EBP) που συντάσσεται στην Ελλάδα στο πλαίσιο του World Health Organization (WHO) Evidence-Ιnformed Policy Network (EVIPNet) Europe. Αναπτύχθηκε από τον Εθνικό Οργανισμό Δημόσιας Υγείας (ΕΟΔΥ), τον Οργανισμό Διασφάλισης Ποιότητας στην Υγεία Α.Ε. (ΟΔΙΠΥ) και το Κέντρο Κλινικής Επιδημιολογίας και Έκβασης Νοσημάτων (CLEO). Αυτό το EBP αποτελεί ένα εργαλείο δράσης βασισμένο σε ερευνητικά δεδομένα και έχει ως σκοπό την αντιμετώπιση των ακόλουθων σημαντικών προβλημάτων που αφορούν την παρεχόμενη φροντίδα υγείας: α. τα υψηλότερα από τον μέσο όρο της Ευρωπαϊκης Ένωσης ποσοστά μικροβιακής αντοχής (ΜΑ) των νοσοκομειακών παθογόνων, β. τον υψηλό επιπολασμό των λοιμώξεων που σχετίζονται με την φροντίδα υγείας (Healthcare Associated Infections-HAIs), και γ. την υψηλή κατανάλωση προωθημένων αντιμικροβιακών παραγόντων στα νοσοκομεία. Η ομάδα εργασίας καθόρισε το σκοπό της συστηματικής βιβλιογραφικής ανασκόπηση, διενήργησε την κριτική αξιολόγηση και τον έλεγχο των επιλεγμένων επιστημονικών άρθρων και πραγματοποίησε σειρά συναντήσεων με βασικούς συναρμόδιους φορείς στον τομέα της νοσοκομειακής περίθαλψης και της διοίκησης μονάδων υγείας. Τα δεδομένα, οι πληροφορίες και οι γνώσεις που προέκυψαν κατά τη βιβλιογραφική ανασκόπηση, χρησιμοποιήθηκαν για τη διαμόρφωση τριών προσεγγίσεων, οι οποίες μπορούν να εφαρμοστούν μεμονωμένα ή σε συνδυασμό για την αντιμετώπιση της αυξανόμενης ΜΑ και της υψηλής επίπτωσης των λοιμώξεων που σχετίζονται με την φροντίδα υγείας, στα ελληνικάνοσοκομεία. Οι προτεινόμενες προσεγγίσεις αφορούν: (1) τη δημιουργία ενός διασυνδεδεμένου ηλεκτρονικού συστήματος επιτήρησης της μικροβιακής αντοχής στα νοσοκομεία, (2) την εφαρμογή προγραμμάτων επιμελητείας (ορθολογικής χρήσης) αντιμικροβιακών και πρόληψης & ελέγχου λοιμώξεων σε όλα τα νοσοκομεία και (3) την εφαρμογή εκπαιδευτικών προγραμμάτων για τους επαγγελματίες υγείας σχετικά με την ορθολογική χρήση αντιμικροβιακών και τον έλεγχο των λοιμώξεων στο νοσοκομειακό περιβάλλον.

Preventing antimicrobial resistance and promoting appropriate antimicrobial use in inpatient health care in Greece: EVIPNet evidence brief for policy, number 10

The present Evidence Brief for Policy (EBP) drawn up in Greece within the framework of the WHO European Evidence-informed Policy Network was prepared by the National Public Health Organization, the Center for Clinical Epidemiology & Outcomes Research (CLEO), The Agency for Quality Assurance in Health S.A. and the WHO Country Office in Greece. This EBP was produced as a research-derived actionable tool, with a view to addressing the following pressing problems in hospital healthcare: a. the higher-than-EU-average rates of antimicrobial resistance (AMR) in hospital-acquired pathogens, b. the high prevalence of healthcare associated infections (HAIs), and c. the high consumption of advanced antimicrobials in hospitals. The working group defined the scope of the literature research, conducted a critical appraisal and review of the selected evidence, and carried out a series of meetings with key stakeholders in the field of clinical healthcare and health administration. The derived data, information and insights were used for the formulation of three options, that may be implemented in isolation or in conjunction to address the rising AMR and high incidence of HAIs in Greek hospitals. The proposed options pertain to: (1) Establishing an interconnected electronic AMR surveillance system in hospitals; (2) Establishing antimicrobial stewardship and IPC programmes in all hospitals; and (3) Implementing post-graduate educational programs for healthcare workers on prudent antimicrobial use and infection control in the hospital setting.

MBL deficiency-causing B allele (rs1800450) as a risk factor for severe COVID-19.

The COVID-19 pandemic represents one of the greatest challenges in modern medicine. The disease is characterized by a variable clinical phenotype, ranging from asymptomatic carriage to severe and/or critical disease, which bears poor prognosis and outcome because of the development of severe acute respiratory distress syndrome (SARS) requiring ICU hospitalization, multi-organ failure and death. Therefore, the determination of risk factors predisposing to disease phenotype is of outmost importance. The aim of our study was to evaluate which predisposing factors, including MBL2 genotyping, affected clinical phenotype in 264 COVID-19 patients. We demonstrated that older age along with underlying comorbidities, primarily obesity, chronic inflammatory disorders and diabetes mellitus, represent the most important risk factors related to hospitalization, the development of pneumonia and SARS. Moreover, we found that the presence of the MBL deficiency-causing B allele (rs1800450) was significantly associated with almost 2-fold increased risk for developing pneumonia and requiring hospitalization, suggesting its usage as a molecular predictor of severe disease in SARS-CoV-2 infected individuals.

COVID-19 Outbreak on a Passenger Ship and Assessment of Response Measures, Greece, 2020.

We describe response measures to an outbreak involving 128 (33.4%) coronavirus disease cases (46.1% asymptomatic) among 383 persons onboard a passenger ship. Multivariate analysis indicated that dining in certain rooms and bar areas, nationality, working department (for crew members), and quarantining onboard the ship were significantly associated with infection.

Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece.

Underdiagnosis of Coxiella burnetii infections in Greece is possible because of lack of awareness by physicians, and most suspected cases are in patients with no bovine contact. We found serologic evidence of C. burnetii infection throughout Greece and identified a new C. burnetii genotype in the aortic valve of a patient with Q fever endocarditis.

Evaluation of Two Chemiluminescent and Three ELISA Immunoassays for the Detection of SARS-CoV-2 IgG Antibodies: Implications for Disease Diagnosis and Patients' Management.

The estimation of anti-SARS-CoV-2 IgG antibodies is possibly the best approach to accurately establish the number of infected individuals and the seroprevalence of COVID-19 within a population. Thus, several commercial immunoassays have recently been developed. The purpose of our study was to assess the performance of five commonly used immunoassays in Greece (3 ELISA, namely Euroimmun SARS-CoV-2, GA GENERIC SARS-CoV-2 and Vircell COVID-19; and 2 chemiluminescent, namely ABBOTT SARS-CoV-2 and ROCHE Elecsys Anti-SARS-CoV-2 test) for the detection of anti-SARS-CoV-2 IgG antibodies. Sera specimens derived from 168 individuals were utilized to assess the specificity and sensitivity score of each assay. Among them, we included 99 COVID-19 patients (29 asymptomatic, 36 with symptom onset 4 to 14 days before serum sampling, and 34 with symptom initiation ≥ 15 days ago), and 69 volunteers with sera specimens collected prior to the SARS-CoV-2 outbreak and maintained at -80°C. We demonstrated that chemiluminescent immunoassays exhibit a significantly higher specificity score but a lower sensitivity, compared to ELISA immunoassays. Moreover, immunoassays detecting IgG antibodies against SARS-CoV-2 N protein instead of S protein alone are more reliable, considering both specificity and sensitivity scores. Interestingly, all asymptomatic patients displayed anti-SARS-CoV-2 IgG antibodies, confirmed by at least two immunoassays. We suggest that chemiluminescent assays could be used as screening methods for the detection of anti-SARS-CoV-2 antibodies to evaluate the possible prevalence of disease in the general population, while ELISA assays would be more reliable to evaluate, and follow-up confirmed COVID-19 patients.

Legal aspects of public health: how law frames communicable disease control in Greece.

We reviewed Greek law (legislation, historic Royal Decrees, and modern Presidential ones, 1833-2010) pertinent to control of communicable diseases and compared this body of Greek law with the revised International Health Regulations. Greece authorizes and regulates communicable disease control commensurate with public health risks, and integrates the principles of equality, objectivity, and respect for human rights. Despite strength at the level of principles, Greek law lacks coherence, clarity, and systematization. An inadequate body of regulations means legislation falls short of adequate implementing authority and guidelines; public health authorities often cannot find or understand the laws, nor are they certain about allocation of jurisdictional authority. We identified areas for improvement.