Cost‐effectiveness of swab versus tissue sampling for infected diabetic foot ulcers from the CODIFI2 randomised controlled trial

Diabetic Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 27, 2025

Abstract Aims To compare the cost‐effectiveness of wound swabbing versus tissue sampling for infected diabetic foot ulcers. Methods This multi‐centre, Phase III, prospective, unblinded, two‐arm parallel group, randomised controlled trial compared clinical (reported elsewhere) and economic outcomes swab over a 52–104 week period. Resource use was logged using case record forms patient questionnaire at weeks 4, 12, 26, 39, 52 104, costed laboratory published sources from UK NHS perspective, 2021/2022 price‐year. EQ‐5D‐3L questionnaires issued these time points were used to derive quality‐adjusted life‐years (QALYs). account imbalances such as age, regression‐based approach estimate survival, expected costs QALYs between arms. Available analysis (ACA) multiple imputation methods applied self reported missing data, ACA researcher‐collected data (survival, hospitalisations antibiotic use). Probabilistic sensitivity assess uncertainty results. Results We recruited 149 participants (75 swab, 74 tissue) 21 sites, 07 May 2019 28 April 2022 (last follow‐up 2023). Planned sample size 730 participants, 90% power detect 12.5% difference in healing weeks, but stopped early due low recruitment. Expected swab‐sampling arm greater than tissue‐sampling 104. The cost when including antibiotics hospitalisation. Swab had higher lower across 26–52, reducing slightly by Conclusions Because costs, lack evidence benefit, potentially being underpowered, dominated analysis.

Language: Английский

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Impact of the SARS-CoV-2 Pandemic on the Prevalence and Incidence of Enteric Protozoa in a Spanish Tertiary-Care Hospital and a Referral Center for Tropical Diseases, 2019–2023

Medical Sciences, Journal Year: 2025, Volume and Issue: 13(1), P. 23 - 23

Published: March 1, 2025

Objetive: The aim of this study was to describe the impact non-pharmaceutical interventions (NPIs) against SARS-CoV-2 in patients with symptoms enteric protozoa (EP), including Blastocystis spp., Dientamoeba fragilis, Giardia lamblia, Cryptosporidium Entamoeba histolytica, and Cyclospora cayetanensis, overall population who were consulted at a National Referral Center for Imported Tropical Diseases (NRCITD patients) from healthcare area Madrid (Spain). Method: Data on positive RT-PCR results EP collected. periods analyzed prepandemic (P0, 1 April 2019–31 March 2020), first (P1, 2020–31 2021), second (P2, 2021–31 2022), third (P3, 2022–31 2023) pandemic years. We compared prevalence, median age, absolute incidence (EP per 100,000 each period), patient profile vs. non-NRCITD) during using Fisher’s test (p < 0.05) T-test 0.001). Results: During P0, 24.8%, [95% CI: 23.9–25.6] tested positive, 22.6% 21.5–23.7] P1, 20.4%, 19.5–21.3] P2, 20% 19.2–20.9] P3 positive. study, there no difference ages. prevalence showed decreasing trend NRCITD non-NRCITD 0.05). Conclusion: spp. D. fragilis lower decrease P1 > due higher detection colonized pandemic. However, G. lamblia highest P2 because NPIs implemented NTRCID than non-NTRCID every period studied E. histolytica C. cayetanensis homogeneous trend.

Language: Английский

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Study on the diagnostic role of exosome-derived miRNAs in postoperative septic shock and non-septic shock patients

Critical Care, Journal Year: 2025, Volume and Issue: 29(1)

Published: March 3, 2025

Diagnosing septic shock promptly is essential but challenging, especially due to its clinical similarity non-septic shock. Extracellular vesicle-derived miRNAs may serve as biomarkers distinguish from shock, providing a more accurate diagnostic tool for postsurgical patients. This study aims identify extracellular miRNA signatures that differentiate in patients, potentially improving accuracy and decision-making. A multicentre, prospective was conducted on profiles Two cohorts were recruited the Intensive Care Units of two Spanish hospitals: discovery cohort with 109 patients validation 52 Plasma samples collected within 24 h diagnosis subjected sequencing. High-throughput sequencing data analysed differentially expressed miRNAs. These findings validated via qPCR cohort. Thirty identified significantly between Among these, six miRNAs—miR-100-5p, miR-484, miR-10a-5p, miR-148a-3p, miR-342-3p, miR-451a—demonstrated strong capabilities combination miR-100-5p, miR-451a achieved an area under curve 0.894, yielding 0.960. highlights promising differentiating The three-miRNA signature has significant potential enhance diagnosis, thereby aiding timely appropriate treatment

Language: Английский

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Broad-range polymerase chain reaction and sequencing for the diagnosis of infectious diseases

Microbiology Spectrum, Journal Year: 2025, Volume and Issue: unknown

Published: March 5, 2025

Broad-range polymerase chain reaction (BR-PCR) identifies molecular signatures of microorganisms directly from clinical specimens without requiring microbial growth in culture. BR-PCR may be a powerful tool to reveal causes infectious diseases, but the impact on diagnosis and management has yet fully defined. Consequently, aims here were investigate how bacterial, fungal, mycobacterial (AFB) perform compared microbiology culture methods detecting assess utility, defined as ability results change antimicrobial therapy or treatment duration. Between 2018 2021, 348 unique sent 327 patients seen within University Maryland Medical System (UMMS). Patient charts reviewed retrospectively. Organisms identified by bacterial (n = 302), fungal 137), AFB 111) cultures determine concordance evaluated if they led management. Agreement organism(s) reported was considered concordant for calculating performance data. Sensitivity 30.9% bacteria (25/81; 95% CI: 21.8-41.6%), 18.8% fungi (3/16; 5.8-43.8%), 33.3% (1/3; 5.6-79.8%) detection. The negative percent agreement 80.1% (165/206) reflect antibiotic pretreatment detection fastidious organisms. Despite longer turnaround times, changed care 6% cases. Based these findings herein, use would best utilized when organisms are suspected, remain negative, should not replace routine at this time.IMPORTANCEDetermining etiology can challenging with chronic presentation those receiving empiric therapy. In addition standard (microbiology cultures), providers order broad-range sequencing test identify independently While studies have been done individual hospitals systems, there is lack broadly applicable evidence detailing scenarios which utilized. This study adds growing body literature surrounding usage, examining assay utility results. Although had low among identified, it shown complement uncommonly isolated Overall, cases, similar other that include broad representation specimen types.

Language: Английский

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Comparative Analysis of Metagenomic Next-Generation Sequencing, Sanger Sequencing, and Conventional Culture for Detecting Common Pathogens Causing Lower Respiratory Tract Infections in Clinical Samples

Microorganisms, Journal Year: 2025, Volume and Issue: 13(3), P. 682 - 682

Published: March 18, 2025

Background: Metagenomic next-generation sequencing (mNGS) has emerged as a revolutionary tool for infectious disease diagnostics. The necessity of mNGS in real-world clinical practice common Lower Respiratory Tract Infections (LRTI) needs further evaluation. Methods: A total 184 bronchoalveolar lavage fluid (BALF) samples and 322 sputa associated with LRTI were fully examined. detection performance was compared between standard microbiology culture, using Sanger the reference method. Results: 52.05% (165/317) showed identical results all three methods. Compared to sequencing, same obtained by 88.20% (284/322). In 2.80% (9/322) cases, detected more microorganisms, while 9% (29/322) cases. For BALF, 49.41% (85/172) cases 91.30% (168/184) produced both sequencing. species 7.61% (14/184) whereas (2/184) instances, microorganisms than mNGS. BALF samples, 66 identified having co-infections mNGS, 64 cultures 22 samples. Conclusions: Our study demonstrates that offers significant advantage over conventional culture methods detecting co-infections. bacterial pathogens, are sufficient detection. However, provides comprehensive pathogen is particularly useful identifying rare difficult-to-culture pathogens.

Language: Английский

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AUTOMATED URINE CULTURE SYSTEM WITH REDUCED TURNAROUND TIME: A PROSPECTIVE REAL-WORLD EVALUATION

Diagnostic Microbiology and Infectious Disease, Journal Year: 2025, Volume and Issue: unknown, P. 116826 - 116826

Published: March 1, 2025

Language: Английский

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Posicionamiento de la Sociedad Española de Infectología Pediátrica sobre el diagnóstico y tratamiento de la infección por Mycoplasma pneumoniae

Anales de Pediatría, Journal Year: 2024, Volume and Issue: 101(1), P. 46 - 57

Published: July 1, 2024

Mycoplasma pneumoniae (MP) es una bacteria con características peculiares que produce un amplio espectro de manifestaciones clínicas, siendo la infección respiratoria más frecuente ellas. Se presenta en epidemias cíclicas, percibiendo los pediatras España incremento casos desde enero del 2024 y poniéndose marcha registros hospitalarios (no enfermedad declaración obligatoria nuestro medio). El diagnóstico por MP se realiza mediante determinación serologías y/o detección material genético reacción cadena polimerasa (PCR). Ambas son incapaces diferenciar colonización activa, lo cual el preciso no posible deben solicitarse solo caso alta sospecha clínica. papel tratamiento antibiótico sus diferentes variantes clínicas está bien definido. La mayoría las infecciones autolimitadas leves, sin evidencia suficiente favor antibioterapia estos casos. estaría justificado pacientes factores riesgo para desarrollo formas graves (síndrome Down, asplenia anatómica o funcional, inmunodepresión), hospitalizados extrapulmonares moderadas graves. Considerando aspectos referentes a optimización uso antimicrobianos, elección sería claritromicina, alternativo azitromicina; reservando doxiciclina levofloxacino resistencias antimicrobianas sistema nervioso central. is bacterium with particular characteristics that give rise to broad clinical spectrum, and respiratory infection the most frequent presentation. Infection by occurs in cyclical epidemics, paediatricians Spain have noticed an increase cases since January 2024, establishing hospital registers collect surveillance data (as it not notifiable disease Spain). The diagnosis of made through serological testing and/or detection genetic means polymerase chain reaction Neither methods can differentiate between colonization active infection, so precise possible should only be requested case high suspicion. role antibiotherapy its different variants well defined. Most infections are self-limiting mild, there insufficient evidence support use these cases. Antibiotic treatment justified patients risk factors for development severe (Down syndrome, anatomical or functional asplenia, immunosuppression), hospitalized moderate extrapulmonary forms. Taking into account aspects concerning rational antimicrobials, choice would clarithromycin, azithromycin as alternative, reserving doxycycline levofloxacin antimicrobial resistance central nervous system.

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Current knowledge of vertebral osteomyelitis: a review

European Journal of Clinical Microbiology & Infectious Diseases, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 26, 2024

Language: Английский

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Performance of 16S rRNA Gene Next-Generation Sequencing and the Culture Method in the Detection of Bacteria in Clinical Specimens

Diagnostics, Journal Year: 2024, Volume and Issue: 14(13), P. 1318 - 1318

Published: June 21, 2024

Effective treatment of infectious diseases requires prompt and accurate bacterial identification tailored antimicrobial treatments. Traditional culture methods are considered the gold standard, but their effectiveness diminishes for fastidious hard-to-grow microorganisms. In recent years, molecular diagnostic tools such as 16S rRNA gene next-generation sequencing (16S NGS) have gained popularity in field. We analysed data from samples submitted NGS between July 2022 2023 at Department Advanced Translational Microbiology Trieste, Italy. The study included both culture-based NGS. Conventional media were used culture, was performed using MALDI-TOF mass spectrometry. V3 region sequenced Ion PGM platform. Among 123 submitted, drainage fluids (38%) blood (23%) most common, with requests predominantly Infectious Diseases (31.7%) Orthopedic (21.13%) Units. collected patients confirmed infections, demonstrated utility over 60% cases, either by confirming results 21% or providing enhanced detection 40% instances. 71 who had received antibiotic therapies before sampling (mean 2.3 prior days), pre-sampling consumption did not significantly affect sensitivity routine microbiology laboratories, combining method enhances microbiological diagnostics, even when is conducted during therapy.

Language: Английский

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The foundation for the microbiology laboratory’s essential role in diagnostic stewardship: an ASM Laboratory Practices Subcommittee report

Journal of Clinical Microbiology, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 30, 2024

ABSTRACT Diagnostic stewardship (DxS) has gained traction in recent years as a cross-disciplinary method to improve the quality of patient care while appropriately managing resources within healthcare system. Clinical microbiology laboratorians have been highly engaged DxS efforts guide best practices with conventional tests and more recently molecular infectious disease diagnostics. Laboratories can experience resistance their role DxS, especially when clinical benefits, motivations for interventions, underlying regulatory requirements are not clearly conveyed stakeholders. laboratories must only ensure ethical but also meet obligatory steward responsibly. In this review, we aim support by providing background that demonstrate laboratory’s essential DxS. The heart review is collate accreditation that, essence, mandate long-standing, core element high-quality laboratory testing deliver possible care. While examples impact plentiful literature, here, focus on operational justification activities.

Language: Английский

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