SARS-CoV-2 Secondary Attack Rates in Vaccinated and Unvaccinated Household Contacts during Replacement of Delta with Omicron Variant,Spain

We performed a prospective, cross-sectional study of household contacts of symptomatic index case-patients with SARS-CoV-2 infection during the shift from Delta- to Omicron-dominant variants in Spain. We included 466 household contacts from 227 index cases. The secondary attack rate was 58.2% (95% CI 49.1%–62.6%) during the Delta-dominant period and 80.9% (95% CI 75.0%–86.9%) during the Omicron-dominant period. During the Delta-dominant period, unvaccinated contacts had higher probability of infection than vaccinated contacts (odds ratio 5.42, 95% CI 1.6–18.6), but this effect disappeared at ≈20 weeks after vaccination. Contacts showed a higher relative risk of infection (9.16, 95% CI 3.4–25.0) in the Omicron-dominant than Delta-dominant period when vaccinated within the previous 20 weeks. Our data suggest vaccine evasion might be a cause of rapid spread of the Omicron variant. We recommend a focus on developing vaccines with long-lasting protection against severe disease, rather than only against infectivity.     

Household Secondary Attack Rates of SARS-CoV-2 Omicron Variant,South Korea,February 2022

We studied the effect of booster vaccinations on reducing household transmission of SARS-CoV-2 B.1.1529 (Omicron) variant in a February 2022 sampling of contacts in South Korea. The secondary attack rate was lower for vaccinated versus unvaccinated contacts, and booster vaccination resulted in a lower incidence rate ratio.     

Shigella Infections in Household Contacts of Pediatric Shigellosis Patients in Rural Bangladesh

To examine rates of Shigella infections in household contacts of pediatric shigellosis patients, we followed contacts and controls prospectively for 1 week after the index patient obtained care. Household contacts of patients were 44 times more likely to develop a Shigella infection than were control contacts (odds ratio 44.7, 95% CI 5.5–361.6); 29 (94%) household contacts of shigellosis patients were infected with the same species and serotype as the index patient’s. Pulsed-field gel electrophoresis showed that 14 (88%) of 16 with infected contacts had strains that were indistinguishable from or closely related to the index patient’s strain. Latrine area fly counts were higher in patient households compared with control households, and 2 patient household water samples were positive for Shigella. We show high susceptibility of household contacts of shigellosis patients to Shigella infections and found environmental risk factors to be targeted in future interventions.     

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center,Zurich, Switzerland

Of 1,118 patients with COVID-19 at a university hospital in Switzerland during October 2020–June 2021, we found 83 (7.4%) had probable or definite healthcare-associated COVID-19. After in-hospital exposure, we estimated secondary attack rate at 23.3%. Transmission was associated with longer contact times and with lower cycle threshold values among index patients.     

肝硬化患者院内获得性肺炎临床分析

目的 为探讨肝硬化患者院内获得性肺炎的特点及耐药情况。方法 分析120例肝硬化患者院内获得性肺炎的临床资料。结果 代偿性肝硬化患者的获得性肺炎发生率为42％，失代偿性肝硬化者为31％，其主要诱发因素为应用抗生素及免疫调节剂不合理；主要病菌为G杆菌占78．1％，其中以大肠埃希菌、铜绿假单胞菌为主；真菌感染占13．4％；感染时间多见于人院第2～3周。结论 病原菌对抗生素耐药情况严重，治疗应根据药敏试验和临床经验合理选用抗生素。     

社区获得性金黄色葡萄球菌肺炎的临床研究

目的 研究近年来社区获得性金黄色葡萄球菌肺炎的感染途径、临床特点、病原学治疗。方法总结分析近年来收治我科的10例金黄色葡萄球菌肺炎的临床资料。结果 10例患者中7例因血行感染所致，3例为吸人性感染，主要表现为高热、咳嗽、咯血、呼吸困难及胸痛等，痰、血、骨髓共培养出16株金黄色葡萄球菌，对红霉素、氨苄西林、环丙沙星、青霉素的耐药率＞50％，对苯唑西林尚敏感，对利福平和万古霉素均敏感。结论 社区获得性金黄色葡萄球菌肺炎以血行感染为主，临床表现无特殊性，对常用的抗菌药物如红霉素、青霉素、氨苄西林、环丙沙星的耐药率很高。     

新生儿呼吸机相关肺炎的临床研究

目的分析新生儿呼吸机相关肺炎(VAP)的病原学特点及致病相关因素,提高对VAP的防治水平. 方法总结54例VAP病例的临床资料,比较不同胎龄、出生体重、机械通气时间及是否预防性使用抗菌药物等因素与VAP发生率的关系;对病原学分析采用气道分泌物培养及药物敏感试验. 结果 VAP的发生率为58.7%,VAP组上机时间明显长于非VAP组,胎龄<37周、出生体重≤2.5 kg的患儿VAP发生率明显增高,预防性使用抗菌药物不能降低VAP的发生率;VAP的主要致病菌为肺炎克雷伯菌、铜绿假单胞菌、不动杆菌属、阴沟肠杆菌. 结论 VAP是机械通气治疗失败的重要原因之一,防治VAP应重视消毒和无菌操作以及合理使用抗菌药物.     

Household Management of Childhood Diarrhoea: A Population-based Study in Nicaragua

Diarrhoea remains an important cause of mortality and morbidity among children in Nicaragua. As the majority of diarrhoeal cases are treated at home and appropriate household management can lessen severity of diarrhoea, the objective of this study was to examine household management of childhood diarrhoea. A simple random sample of households was selected from the Health and Demographic Surveillance Site-León. Parents or caretakers of children below five years of age, who developed diarrhoea (n=232), were surveyed about household diarrhoea management practices in 2011. Fifty-seven percent of children received oral rehydration therapy (ORT) in the home prior to visiting any health facility. We encountered certain practices in contradiction with WHO recommendations for the management of diarrhoea in communities: 41% of children were offered protein-rich foods less frequently during diarrhoeal episodes, 20% of children were nursed less frequently or not at all during diarrhoeal episodes, and zinc supplementation was recommended at only 39% of visits with healthcare providers. Our findings provide insights for efforts to improve the household management of childhood diarrhoea in Nicaragua.Key words: Child, Diarrhoea, Household management, Nicaragua     

生物过滤器预防呼吸机相关肺炎的临床观察

目的评价生物过滤器预防呼吸机相关肺炎的临床作用.方法需接受呼吸机治疗的病例随机分成生物过滤器组及对照组,选择符合下列条件的病例:入重症监护病房(ICU)前无下呼吸道感染,未使用抗生素,且接受呼吸机治疗时间＞48 h者,生物过滤器组52例,对照组48例,比较两组呼吸机相关肺炎的发生率.结果生物过滤器组其呼吸机相关肺炎的发生率明显下降.结论使用生物过滤器能有效地降低呼吸机相关肺炎的发生率,在机械通气中值得推广应用.     

老年期痴呆患者医院获得性肺炎的临床分析

目的探讨老年期痴呆患者医院获得性肺炎的临床特征和防治措施。方法回顾性分析2003年1月~2008年10月神经内科收治的113例老年期痴呆患者,依据医院获得性肺炎诊断标准进行诊断,诊断明确者31例为感染组,其余82例为对照组,对两组患者进行认知功能[采用简短精神状态量表(MMSE)]和日常生活能力(ADL)评定(Barthel指数),分析感染危险因素,病原菌及其耐药性,并制定防治措施。结果113例老年期痴呆患者中有31例患者合并医院获得性肺炎,该组患者MMSE及ADL评分较对照组明显降低(P0.05),痰培养分离的常见病原菌以革兰阴性杆菌为主,前3位依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌;药敏分析结果显示,常见病原菌对氯霉素耐药性最高,为45.5%~75.8%,对亚胺培南耐药性最低,为0~6.1%。结论认知功能及日常生活能力低下的老年期痴呆患者医院获得性肺炎感染率较高,而控制感染危险因素,监测病原菌,合理选择抗菌药物,有利于其预后。     

呼吸机相关性肺炎胃源致病菌分子流行病学研究

目的从分子水平决定胃内定植菌是否呼吸机相关性肺炎致病菌来源. 方法使用呼吸机24 h内同时留取患者口咽部、气管吸出物、胃液作细菌培养 药敏,然后隔日1次重复以上培养直到患者脱机、可疑VAP发生或死亡;保存菌种,如同一VAP患者胃内细菌定植先于口咽部和呼吸道且常规细菌鉴定为同种细菌则用稀有限制区聚合酶链反应(IRS-PCR)进行细菌同源性鉴定. 结果 IRS-PCR表明:胃内定植菌与VAP致病菌有很高的同源性. 结论胃内定植菌是VAP病原菌的主要来源之一.     

全耐药鲍氏不动杆菌肺部感染的临床分析

目的探讨全耐药鲍氏不动杆菌（PRAB）肺部感染的临床特点以及感染危险因素。方法对2004年6月-2005年8月间，医院住院治疗的83例PRAB肺部感染患者和80例一般鲍氏不动杆菌肺部感染患者的临床特征及其危险因素进行分析比较。结果PRAB肺部感染患者病死率（46．99％）显著高于非PRAB感染者（35．00％），其平均住院（54.53d）和住ICU时间（46．69d）显著大于后者（24．70d和41．87d），且其抗茵药物使用时间（49．02d）与种类（4．75种）也显著大于或多于后者（38．7d和3.45种）。结论PRAB感染已成为严重影响患者预后的难题，积极加强行之有效的预防措施是降低其发生的关键。     

Long-Term Survival After Aspiration Pneumonia in Older Inpatients: A Comparative Study

ObjectivesAspiration pneumonia (AsP), a leading cause of death in older people, remains poorly studied. We aimed to evaluate short- and long-term prognosis after AsP in older inpatients.DesignRetrospective cohort study.Setting and ParticipantsAll consecutive patients aged ≥75 years hospitalized in a 62-bed acute geriatric unit during a 1-year period.MethodsWe compared clinical characteristics and overall 2-year survival between patients with a main diagnosis of AsP, patients with other types of acute pneumonia (non-AsP), and patients hospitalized for another cause.ResultsAmong the 1774 patients hospitalized over 1 year (median age: 87 years, 41% female), 125 (7%) had a primary diagnosis of acute pneumonia, of whom 39 (31%) had AsP and 86 (69%) non-AsP. Patients with AsP were more frequently male, lived more frequently in a nursing home, and had a more frequent history of stroke or neurocognitive disorders. Mortality rates were much higher after AsP, reaching 31% at 30 days (vs 15% after Non-AsP and 11% in the rest of the cohort, P < .001), and 69% 2 years after admission (vs 56% and 49%, P < .001). After adjustment for confounders, AsP was significantly associated with mortality but non-AsP was not [adjusted hazard ratio (95% CI): 3.09 (1.72-5.57) at 30 days and 1.67 (1.13-2.45) at 2 years for AsP; 1.36 (0.77-2.39) and 1.14 (0.85-1.52) for non-AsP]. However, among patients who survived at 30 days, mortality did not significantly differ between the 3 groups (P = .1).Conclusions and ImplicationsIn an unselected cohort of patients hospitalized in an acute geriatric unit, a third of AsP patients died within the first month after admission. However, among those surviving at 30 days, long-term mortality did not significantly differ from the rest of the cohort. These findings underline the importance of optimizing the early management of AsP.