Impact of the SARS-CoV-2 pandemic on the overall respiratory viruses' transmission in a cancer care setting.

INTRODUCTION AND OBJECTIVE: The emergence of the COVID-19 pandemic raised questions about the interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. The objective of this study is to validate the impact of the SARS-CoV-2 pandemic and its interventional measures on the respiratory viruses' transmission/infection rates. METHODS: A retrospective chart review was conducted for cancer patients who underwent laboratory-confirmed respiratory virus polymerase chain reaction (PCR) testing from January 2018 to June 2022. COVID-19 PCR tests from March 2020 to June 2022 were also included. Joinpoint regression analysis was applied to evaluate trends in respiratory virus rates. Statistical analysis was performed using Statistical Package for Social Science software. RESULTS: A total of 6298 respiratory virus PCRs and 40,000 COVID-19 PCRs were performed. Data showed a significant decrease in respiratory viruses' positive cases, total respiratory tests, and respiratory viruses' activity during the pandemic period compared with the pre-pandemic period (p = .0209, .026, and .028, respectively). The joinpoint regression analysis showed a significant decrease of 13.85% in the tested positive cases of respiratory viruses between the years 2018 and 2022. Monthly, the analysis indicated a significant decrease in the positive cases by 13.46% from December 2019 to May 2021. Weekly analysis following lockdown initiation showed a reduction in respiratory virus cases. CONCLUSION: This study provides valuable insights into the interplay between COVID-19 and other respiratory viruses, suggesting that the measures taken for COVID-19 were effective in reducing the spread of viral respiratory infections, aiding future infection control strategies to protect vulnerable populations, including cancer patients, from seasonal respiratory infections.

Needlestick and sharps injuries among healthcare workers in an oncology setting: a retrospective 7-year cross-sectional study.

OBJECTIVE: To assess the prevalence of needlestick and sharps injuries (NSSIs) and associated factors among healthcare workers (HCWs) at King Hussein Cancer Centre (KHCC), Amman, Jordan. METHODS: This retrospective cross-sectional study undertook a chart review of all HCWs that reported an NSSI between January 2015 and December 2021. Data collected included sociodemographic factors including age, sex, qualifications, and predictors of NSSIs such as working hours, work shift, and specific job roles within the oncology setting, work experience in KHCC, overall work experience and occupational category. RESULTS: A total of 355 NSSIs were included in this study with a peak prevalence in 2019 (81 of 355; 22.8%). Nurses (220 of 355; 62.0%), housekeeping staff (59of 355; 16.6%) and physicians (45 of 355; 12.7%) were the most affected occupations. NSSIs were most common in the surgical floor (65 of 355; 18.3%) and operating rooms (56 of 355; 15.8%). Blood collection (94 of 355; 26.5%) and waste collection (65 of 355; 18.3%) were the two primary procedures resulting in NSSIs. The risk of injury was significantly associated with the locations of NSSIs, procedure that caused NSSIs, shift and overall experience. CONCLUSION: NSSIs remain common among HCWs, which highlights the need for targeted education.

Assessing the acceptability of COVID-19 vaccine and its booster dose.

BACKGROUND AND OBJECTIVE: Coronavirus disease of 2019 (COVID-19) vaccinations are essential to control the pandemic and prevent severe COVID-19 infections. This study aims to assess the acceptability of the COVID-19 vaccine and the factors that impact the intention to take the COVID-19 vaccine and its booster dose. METHODS: A cross-sectional study was conducted in Saudi Arabia and Jordan. The study used a self-administered web-based survey (questionnaire) for data collection that was distributed via social media platforms from May 2022 to July 2022. RESULTS: In this study, among 518 participants, 54.4% had already received two doses of the COVID-19 vaccine, and out of the participants who didn't receive the booster dose, 19.9% declared a definite willingness to receive it, while 42% had already taken a booster dose, which indicated good acceptance. After adjustment for significant background characteristics, a significant association between the country and receiving the COVID-19 vaccine, the intention to get the vaccine, and infection with COVID-19 were found, in addition to a significant association between the country and the participants' opinion that electronic applications helped them to follow their vaccine schedule were found (p < .001). Also, the results showed that participants' attitudes were significantly associated with educational level and age groups (p ≤ .001, p = .032, respectively). There was a significant association between the intention to receive the vaccine booster dose and the country (p < .001). The Saudi participants were willing to get the booster dose seven times more than the Jordanians, furthermore, there was a significant association between taking the vaccine booster dose in the country, as well as age group, working in the medical field, previous COVID-19 infection, and the intention to vaccinate the children (p < .001, p = .030, .031, .025, < .001, respectively). CONCLUSION: Overall, our results emphasize a positive response and a positive attitude toward COVID-19 vaccination. In addition, define the groups to be targeted with effective communication regarding the COVID-19 vaccine and its booster dose.

Knowledge, attitudes, concern, behaviors, and barriers associated with the readiness to receive seasonal influenza vaccine among healthcare workers in oncology setting during the COVID-19 pandemic.

This study examines the knowledge, attitudes, concerns, behaviors, and barriers related to seasonal influenza vaccination among healthcare workers (HCWs) in the oncology setting during the COVID-19 pandemic. The objective is to assess the readiness of HCWs to receive the influenza vaccine. A cross-sectional study was conducted at the King Hussein Cancer Center (KHCC) in Amman, Jordan. HCWs were surveyed using a self-administered web-based questionnaire between October 2021 and November 2021. Among 223 participants, the coverage rates for seasonal influenza vaccination ranged from 65% to 81% during the autumns of 2019 and 2020, respectively. These vaccination rates showed a significant increase despite the challenges posed by the COVID-19 pandemic. Furthermore, 89.1% of the participants expressed their intention to receive the vaccine in the autumn of 2021. The analysis revealed a significant association between receiving the influenza vaccine in 2020 and the participants' work experience (P < .001, respectively). Additionally, receiving the influenza vaccination was significantly associated with higher knowledge levels (P = .036, 0.015). Although knowledge about the influenza vaccine was generally high, concerns and barriers were identified. This study demonstrates a high rate of influenza vaccination among HCWs during the COVID-19 pandemic. The participants also expressed a strong willingness to receive the vaccine in the post-pandemic season and exhibited good knowledge about it. However, concerns and barriers related to vaccination remain. These findings emphasize the importance of addressing these concerns and barriers to further enhance influenza vaccination rates among HCWs.

Patterns of microbial growth in urine cultures in a pediatric hematology/oncology unit over a one-year period: a single institution study.

BACKGROUND: Urinary tract infections (UTIs) may present with nonspecific symptoms and without any definitive clinical signs other than fever, hence may be missed without a routine urine analysis. We retrospectively evaluated all cases of culture-positive urine infections in pediatric oncology patients in our center during the year 2015. METHODS: We assessed all positive urine culture incidents for pediatric patients receiving treatment and/or follow-up at our center during 2015. Analysis was performed on patients with regards to clinical, microbiology and pertinent lab findings as well as associated risk factors. RESULTS: There were 151 episodes of documented positive urine cultures among 73 patients. Majority of positive urine cultures were found in solid tumor patients (41%), followed by hematological malignancies (26%). Most organisms detected were gram-negative organisms (84%), with E.coli being the most frequent (51%). Forty percent of bacteria were resistant to standard broad-spectrum antibiotics, with the majority being extended-spectrum beta-lactamase-producing. Most of these infections occurred in patients receiving prophylactic antibiotics (46 out of 50). Approximately two thirds of patients were not febrile on the day of culture (64%) and almost half of the reported episodes were associated with urinary symptoms. Pyuria, leukocyte esterase and nitrites were positive in 39%, 51% and 19% of samples, respectively. CONCLUSIONS: Positive urine culture in children with cancer may not be associated with urinalysis abnormalities, particularly in patients with neutropenia. When selecting empiric treatment for cancer patients with UTIs, one should take into consideration the institutional patterns for resistance and use of prophylactic antibiotics.

Vancomycin pharmacokinetics and predicted dosage requirements in pediatric cancer patients.

PURPOSE: To determine the pharmacokinetic parameters and compare pharmacodynamic target attainment at different dosing strategies of vancomycin in pediatric cancer patients. METHODS: Pediatric patients who received vancomycin and had at least two steady-state concentrations taken within the same dosing interval were identified. Vancomycin minimum inhibitory concentrations (MICs) for methicillin resistant staphylococcus aureus (MRSA) isolates from our institution were determined using E-test. The population-based pharmacokinetic modeling was performed using NONMEM 7.2. A one-compartment model with first-order kinetics was used to estimate clearance (CL) and volume of distribution (Vd). Monte Carlo simulations (N = 9800) were performed to compare area-under-the-curve over 24 h (AUC24)/MIC and trough concentration at different doses. RESULTS: Forty-nine patients, with 120 vancomcyin serum concentrations, were included in the analysis, mean age was 6 ± 2.5 (SD) years, mean weight was 19.6 ± 6.9(SD) kg, mean baseline serum creatinine was 0.4 ± 0.11(SD) mg/dl, and mean initial vancomycin dose was 205 mg/day (range 100-460). Final model pharmacokinetic parameters were: CL (L/h) = 0.381 × weight(0.75) and Vd (L) = 0.663 × weight. Mean baseline (±SD) vancomycin CL was 0.20 ± 0.07 L/h/kg and Vd 0.66 ± 0.001 L/kg. . Renal function, sex, age, stay in the intensive care unit, and co-administration of nephrotoxic medications did not have an effect on the calculated parameters. Using Monte Carlo simulation with reported MICs, a dose of 60 mg/kg/day achieved AUC24/MIC ≥400 and trough concentration ≥15 mcg/mL in only 21.5% and 11% of virtual subjects, respectively. CONCLUSIONS: Higher than usual vancomycin doses may be required to treat serious MRSA infections in pediatric patients. The currently recommended dose of 60 mg/kg/day is unlikely to achieve the targets in most subjects. The optimal vancomycin dosing in pediatric cancer patients requires further investigations.

Characteristics and Outcomes of Acinetobacter baumannii Infections in Critically Ill Patients with Cancer: A Matched Case-Control Study.

AIM: To describe the characteristics and outcomes of Acinetobacter baumannii (AB) infections in critically ill cancer patients and to evaluate the impact of AB on mortality and length of stay (LOS). RESULTS: In a 4-year case-control study of critically ill cancer patients, we identified 161 patients with AB infections and 232 matched patients who were treated in the intensive care unit (ICU) during the same time period, but had no AB cultures. The case and control groups were matched for APACHE II, age, gender, type of malignancy, and mechanical ventilation. Most AB isolates were carbapenem-resistant (n=142, 88.2%). The majority of positive cultures were collected from the respiratory tract (58%) and blood (21.8%). The median ICU LOS and mortality rate for patients with AB infections were higher than those for the control group (12 days [IQR 6-23] vs. 3 days [IQR 1-7], p<0.0001 and 73.3% vs. 61.5%, p=0.015, respectively). AB infection was independently associated with ICU LOS and mortality: OR 1.108 (95% CI, 1.077-1.139), OR 1.658 (95% CI, 1.017-2.703), respectively. CONCLUSION: AB infections in critically ill cancer patients were independently associated with increased mortality and increased ICU LOS. Measures to improve the outcomes of critically ill cancer patients infected with AB are necessary.

Clinical presentations and outcomes of influenza infection among hematology/oncology patients from a single cancer center: pandemic and post-pandemic seasons.

BACKGROUND: Influenza can cause severe infection in hematology/oncology patients. The occurrence of the 2009 pandemic represented an opportunity to study the impact of influenza on such patients in pandemic and post-pandemic seasons. METHODS: We retrospectively reviewed medical records of hematology/oncology patients who had laboratory-confirmed influenza infection during the 2009 pandemic and the first post-pandemic seasons. We assessed influenza-related outcomes in both seasons with emphasis on the development of pneumonia and mortality. We also analyzed factors associated with poor outcomes. RESULTS: We included 350 patients; 207 were diagnosed in the pandemic and 143 in the post-pandemic seasons. Influenza severity was similar in both seasons with no significant differences in the development of pneumonia or death. Infection with the pH1N1 virus was associated with the development of pneumonia (24.7% vs 14.9%, p = 0.029) but did not affect mortality. A multivariate analysis showed that initiation of antiviral treatment after > 48 h, healthcare acquisition of influenza, and low albumin were independent risk factors for the development of pneumonia (p values 0.022, 0.003, and < 0.0001, respectively). A log-rank test showed increased mortality in patients who received therapy > 48 h after onset of symptoms (p = 0.001). CONCLUSIONS: In hematology/oncology patients, influenza was as severe in the post-pandemic as in the pandemic season. Pneumonia developed more commonly in patients infected with pH1N1 virus. Healthcare acquisition of infection and low albumin were associated with the development of pneumonia. Delayed initiation of antiviral treatment was associated with both pneumonia and mortality.

A multicenter study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries: early therapy improves outcomes.

BACKGROUND: Pandemic influenza A (hereafter 2009/H1N1) caused significant morbidity and mortality during the 2009 pandemia. Patients with chronic medical conditions and immunosuppressive diseases had a greater risk of complications. However, data regarding the characteristics and outcome of 2009/H1N1 infection in patients with solid tumors are nonexistent. Herein, the authors describe a series of influenza 2009/H1N1 in patients with solid malignancies at 3 major cancer hospitals worldwide. METHODS: The authors retrospectively reviewed the records of patients with solid organ malignancies and 2009/H1N1 from The University of Texas M. D. Anderson Cancer Center in Houston, Texas; the Mexican National Cancer Institute, Federal District of Mexico; and King Hussein Cancer Center in Amman, Jordan from the period of the 2009 H1N1 pandemia. Data on demographics, disease characteristics, and outcome were extracted. RESULTS: In total, 115 cases were identified during the pandemic influenza among the 3 institutions. High rates of hospitalization (50%), pneumonia (23%), and death (9.5%) were reported. Patients who developed pneumonia and those who died were moderately to severely immunocompromised (P = .001 and P = .006, respectively). A multivariate competing risk analysis demonstrated that a delay >48 hours in starting antiviral therapy was associated significantly with an increased risk of developing pneumonia (P = .013). CONCLUSIONS: The 2009/H1N1 pandemic caused severe illness in immunocompromised patients with cancer who had solid tumors, and heavily immunosuppressed patients were at greater risk of developing pneumonia and death. Early initiation of antiviral therapy is crucial in this patient population to decrease morbidity and probably mortality.