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The impact of the COVID-19 pandemic on antimicrobial usage: an international patient-level cohort study
Get PDFBackground
This study aimed to evaluate the trends in antimicrobial prescription during the first 1.5 years of COVID-19 pandemic.
Methods
This was an observational, retrospective cohort study using patient-level data from Bangladesh, Brazil, India, Italy, Malawi, Nigeria, South Korea, Switzerland and Turkey from patients with pneumonia and/or acute respiratory distress syndrome and/or sepsis, regardless of COVID-19 positivity, who were admitted to critical care units or COVID-19 specialized wards. The changes of antimicrobial prescription between pre-pandemic and pandemic were estimated using logistic or linear regression. Pandemic effects on month-wise antimicrobial usage were evaluated using interrupted time series analyses (ITSAs).
Results
Antimicrobials for which prescriptions significantly increased during the pandemic were as follows: meropenem in Bangladesh (95% CI: 1.94–4.07) with increased prescribed daily dose (PDD) (95% CI: 1.17–1.58) and Turkey (95% CI: 1.09–1.58), moxifloxacin in Bangladesh (95% CI: 4.11–11.87) with increased days of therapy (DOT) (95% CI: 1.14–2.56), piperacillin/tazobactam in Italy (95% CI: 1.07–1.48) with increased DOT (95% CI: 1.01–1.25) and PDD (95% CI: 1.05–1.21) and azithromycin in Bangladesh (95% CI: 3.36–21.77) and Brazil (95% CI: 2.33–8.42). ITSA showed a significant drop in azithromycin usage in India (95% CI: −8.38 to −3.49 g/100 patients) and South Korea (95% CI: −2.83 to −1.89 g/100 patients) after WHO guidelines v1 release and increased meropenem usage (95% CI: 93.40–126.48 g/100 patients) and moxifloxacin (95% CI: 5.40–13.98 g/100 patients) in Bangladesh and sulfamethoxazole/trimethoprim in India (95% CI: 0.92–9.32 g/100 patients) following the Delta variant emergence.
Conclusions
This study reinforces the importance of developing antimicrobial stewardship in the clinical settings during inter-pandemic periods
Residential exposure to road and railway traffic noise and incidence of dementia: The UK Biobank cohort study
Get PDFBackground
Evidence linking noise pollution and brain health, particularly at mid-to-late life, remains scarce. We investigated the associations between long-term exposure to road and railway traffic noise and incident dementia in the UK Biobank cohort.
Methods
Participants with available data for dementia incidence and linked traffic noise exposure during follow-up were included. Residential road traffic noise from both minor and major roads were calculated in accordance with CNOSSOS-EU framework; railway noise estimates were created by Extrium, with the raster datasets representing noise contributions from major railway corridors. Cox regression was used to quantify the associations between transport noise and incident dementia (incl. its subtypes), adjusting for potential confounders, air pollution and greenness.
Results
Of the full cohort (n = 502,416), 7668 participants had incident dementia during a median follow-up period of 9.67 years. No associations were found between all cause dementia incidence and road or railway noise. However, a 10-dB (dB) higher exposure in annual mean road traffic noise (Lden) was significantly associated with incident Alzheimer's disease (HR:1.150, 95 % CI: 1.022–1.294). The effect estimate was slightly higher when participants were exposed to night-time road noise above 45 dB (HR:1.188, 95 % CI:1.012–1.394) and this was mediated by the cardiovascular health profile. Railway noise (Lden) was significantly associated with incident Parkinson's disease related dementia (HR:1.042, 95 % CI:1.005–1.081), however, the effect estimate was slightly reduced after further adjustment of air pollution and residential greenness (HR:1.037, 95 % CI:0.998–1.077).
Conclusion
Distinct associations between different traffic noise exposures and incident dementia subtypes were found in this large UK prospective cohort study
Aneurysm CaRe: a randomized controlled feasibility trial of cardiac rehabilitation versus standard care after aortic aneurysm repair
No full textMaternal vaccination to prevent neonatal infections and combat antimicrobial resistance
Get PDFMaternal vaccination during pregnancy is emerging as a powerful strategy in protecting newborns from infectious diseases, improving neonatal outcomes, and potentially reducing antimicrobial use and resistance. Maternal immunisation works by eliciting protective antibodies in the mother that are transferred to the fetus transplacentally and through breastmilk postnatally to provide the infant with passive immunity during the first vulnerable months of life. There is sufficient evidence to support the role of maternal vaccination in averting many neonatal infections that would otherwise require medical intervention. By preventing infections in mothers and their newborn, maternal vaccination also holds significant potential for reducing antimicrobial use and antimicrobial resistance. Fewer neonatal infections translate to a reduced need for antimicrobial use in the neonatal period and in postpartum women, therefore lowering the selective pressure for drug-resistant bacteria. Routine maternal vaccines (tetanus, diphtheria, acellular pertussis (Tdap), influenza, COVID-19, respiratory syncytial virus) already confer measurable antibiotic-sparing benefits by preventing infections that typically trigger antimicrobial therapy in mothers and neonates. Pipeline candidates (Group B Streptococcus, Klebsiella pneumoniae, Escherichia coli) could further lower neonatal sepsis burden, reducing broad-spectrum antimicrobial use in neonatal intensive care units to help slow antimicrobial resistance. Integrated with antibiotic stewardship and infection-prevention measures, maternal immunisation offers a practical, scalable practice to limit perinatal antibiotic exposure
Current global trends in meningococcal disease control, risk groups and vaccination: Consensus of the Global Meningococcal Initiative
Get PDFThis review outlines recent trends on invasive meningococcal disease (IMD) discussed at the latest meeting of the Global Meningococcal Initiative (GMI). There has been a re-emergence of the Hajj strain sublineage (serogroup W; ST-11 clonal complex), with travel to the Kingdom of Saudi Arabia being a critical factor in transmission. The epidemiology of IMD has also changed following the COVID-19 pandemic, with annual IMD cases increasing in many countries. For example, the highest number of IMD cases since 2014 was reported in the USA in 2023-2024. Atypical presentations of IMD have been prominent irrespective of the pandemic. For instance, an increase in cases of meningococcal epiglottitis has been reported in France in 2022-2023 (serogroups W and Y). When considering vaccination, the GMI has identified a need for broader meningococcal serogroup B (MenB) immunisation owing to the potential impact of the vaccines on reducing IMD incidence caused by other serogroups than MenB. There is also a case for using MenB vaccination to protect against Neisseria gonorrhoeae infection based on initial evidence, albeit further studies will need to be conducted
Body mass index and tuberculosis risk: an updated systematic literature review and dose–response meta-analysis
Get PDFBackground
The relationship between nutritional status and tuberculosis is critically important but poorly understood. We extended a 2009 review characterizing the relationship between body mass index (BMI) and tuberculosis risk.
Methods
We systematically searched for new studies published between 2009 and 2024 investigating BMI and tuberculosis risk in adults. We extracted estimates of risk in BMI categories, used resampling to assign a median BMI ‘dose’ within each category, and included these in one-stage dose–response meta-analyses, stratifying results by population group and country tuberculosis burden. We fitted linear models for comparability with the 2009 review and restricted cubic spline models to investigate nonlinear relationships and piecewise linear models.
Results
Our analyses showed an inverse dose–response relationship between BMI and tuberculosis risk across all populations in the full underweight to obese range (15.0–35.0 kg/m2). The spline and piecewise linear models showed a nonlinear relationship—in 22 general-population cohorts (n = 24 921 531), there was a steep per-unit reduction in risk for BMI of <25.0 kg/m2 [18.0%, 95% confidence interval (CI): 16.4–19.6], which decreased more gradually for BMI of ≥25.0 kg/m2 (6.9%, 95% CI: 4.6–9.2). In 18 cohorts of people with HIV (n = 162 609), the reduction was 15.3% for BMI of <23.0 kg/m2 (95% CI: 13.1–17.5) and 2.6% (95% CI: –3.1–7.9) for BMI of ≥23.0 kg/m2. In three cohorts of people with diabetes (n = 1 118 424), the reduction was 20.5% for BMI of <24.0 kg/m2 (95% CI: 18.4–22.6) and 13.4% (95% CI: 3.9–22.0) for BMI of ≥24.0 kg/m2. Based on the global BMI distribution, we estimated a relative risk of tuberculosis associated with undernutrition (BMI < 18.5 kg/m2) of 5.0 (95% CI: 4.2–5.9).
Conclusion
Our results highlight the independent importance of nutritional status as a driver of the tuberculosis epidemic
Associations of municipality-level income and racial segregation with individual-level tuberculosis treatment outcomes in Brazil: a nationwide cohort study (2010–2019)
Get PDFBackground
Residential segregation is considered a social determinant of health, but there is limited evidence of its impact on tuberculosis (TB). We investigated the associations between municipality-level income and racial segregation and TB treatment outcomes in Brazil.
Methods
We studied nationwide registries of new TB cases between 1 January 2010 and 31 December 2019. TB treatment was dichotomised as unfavourable (ie, loss to follow-up, modification of treatment regimen, treatment failure and death) and favourable (ie, cured/treatment completion). We assessed individuals' municipality-level income and racial segregation (ie, dispersion of household heads earning ≤half versus those earning >half minimum wage; and of household heads identifying as black or brown/mixed race (Pardo/a) versus white). Logistic regression adjusted for sociodemographic and clinical variables was used to estimate the OR of experiencing an unfavourable treatment outcome associated with segregation overall and by self-identified race/ethnicity.
Results
Individuals living in highly economically and racially segregated municipalities (fifth versus first quintiles) were more likely to have an unfavourable TB treatment outcome (income segregation: adjusted OR 1.34 (95% CI 1.31 to 1.37); racial segregation: 1.13 (0.94 to 1.36)). Living in municipalities of higher income segregation (third, fourth and fifth quintiles) was associated with higher unfavourable TB treatment outcomes in all self-identified racial groups (fifth quintile: white 1.25 (0.96 to 1.64); black 1.42 (1.15 to 1.74); brown/mixed 1.37 (1.20 to 1.56); Asian=1.30 (1.00 to 1.69) and Indigenous 1.37 (1.00 to 1.87)).
Conclusions
Living in highly income and racially segregated environments is associated with unfavourable TB treatment outcomes for all self-identified races in Brazil. TB programmes should account for segregation as a barrier to TB treatment completion
Quality of mental health care for forcibly displaced children and adolescents in the WHO European region: A scoping review of barriers and facilitators
Get PDFForcibly displaced children and adolescents in the World Health Organization (WHO) European Region have high mental health needs, yet few manage to access mental health services, and those who do may encounter inadequate care. This scoping review aimed to identify and synthesize the available evidence on barriers and facilitators to quality mental health care for forcibly displaced children and adolescents in the WHO European Region. We applied the PRISMA guideline extension for scoping reviews, searching five scholarly databases and grey literature published between 2004 and 2025. A total of 7,327 records were screened, with 18 articles included. We used the WHO Quality Standards for Child and Youth Mental Health Services as an analytical framework to map the evidence. The identified studies represented only 7 out of 53 countries in the WHO European Region. Most studies employed qualitative research designs, with a lack of quantitative evidence using quality indicators. Available evidence revealed multiple, intersecting barriers to quality mental health care, including restrictive health care policies, service constraints and a lack of provider competence. Facilitators included the presence of community-based support, networks of interconnected services, task shifting and evidence-based scalable interventions. Major gaps remain in both the data and in the methods used to generate evidence for improving quality of mental health care for forcibly displaced children and adolescents in the WHO European Region. Our review highlighted the discrepancy between the care provided and the recommended WHO Quality Standards for Child and Youth Mental Health Services. There is a need for more targeted efforts to assess and improve the quality of mental health care for forcibly displaced children and adolescents
A Simulated Client Study on Non-Prescription Antibiotic Sales and Counselling Practices in Iraqi Nurse-Led Clinics: Implications for Antimicrobial Resistance
No full textBackground: The inappropriate use of antibiotics is a major contributor to antimicrobial resistance (AMR), which is a critical issue in low and middle-income countries such as Iraq. Nurse-led clinics in Iraq are a common point of care for patients seeking treatment for infectious diseases; however, they are currently poorly regulated. This study aimed to assess the extent and appropriateness of antibiotic dispensing in this setting, including the quality of dispensing. In these clinics, only two antibiotics are legally permitted for dispensing. These are amoxicillin and erythromycin. The findings can be used to provide future guidance to improve antibiotic use in the country and reduce AMR where there are concerns.
Methodology: A cross-sectional study was undertaken using simulated clients among 235 randomly selected nurse-led clinics in Iraq, presenting with a viral upper respiratory tract infection (URTI). The outcomes included the prevalence, type of antibiotics supplied, including their Access, Watch, and Reserve (AWaRe) classification, as well as the extent and quality of patient counselling. Descriptive statistics were used to summarise dispensing patterns and counselling practices. Multivariable logistic regression was also applied to assess associations between provider’s characteristics and inappropriate antibiotic dispensing.
Results: Antibiotics were supplied inappropriately in 60.0% (141/235) of the encounters, with 36.1% (85/235) of them involving antibiotics not legally permitted to be dispensed in these clinics. Amoxicillin/clavulanic acid accounted for 34.0% (48/141) of the antibiotics supplied. Based on their AWaRe classification, 25.5% (36/141) of these were Watch antibiotics. Only 24.8% of providers asked additional clinical questions, and allergy screening occurred in just 7.8% of cases. Clinics with higher-qualified staff were significantly less likely to dispense antibiotics.
Conclusion: Widespread inappropriate and, in many cases, illegal antibiotic dispensing was observed in Iraqi nurse-led clinics, with limited patient assessment. These findings underscore the urgent need for enhanced antimicrobial stewardship, provider education, and regulatory enforcement to address AMR in Iraq
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