/library/oar/handle/123456789/484 2025-12-27T21:15:37Z /library/oar/handle/123456789/141456 Title: The prevalence of tunnelled line-associated MRSA and MSSA bacteraemias in a Maltese haemodialysis patient cohort between 2017 and 2024 Authors: Farrugia, Elena; Sultana, George; De Silva, Peththawadu Thihan Daksitha; Azzopardi, Abigail; Lal, Athira; Farrugia, Emanuel; Borg, Michael Angelo; Scicluna, Elizabeth; Farrugia, Claire; Vassallo, Diana Abstract: Background and Aims: Sepsis is the second most common cause of death in haemodialysis patients and patients dialysing through tunnelled dialysis lines have a 2 to 3-fold increased risk of hospitalization for infection and death compared to patients dialysing through an arteriovenous fistula or graft. This is the first audit looking at the prevalence of catheter-related blood stream infections (CRBSI) in patients receiving haemodialysis via a tunnelled line in Malta. Our aims are to benchmark local data to UK renal registry data and to assess clinical outcomes. 2025-01-01T00:00:00Z /library/oar/handle/123456789/141452 Title: A time series analysis approach to quantify change in antibiotic resistance and antibiotic consumption during COVID-19 epidemics : a multicentre cross-national ecological study on behalf of QUantifying change in antibiotic resistance, ANTibiotic use, and INfection control during COVID-19 epidemics study project Authors: Meschiari, Marianna; López-Lozano, José María; Medioli, Filippo; Bacca, Erica; Sarti, Mario; Cancian, Laura; Bertrand, Xavier; Sauget, Marlène; Rosolen, Béatrice; Conlon-Bingham, Geraldine Mary; McKeating, Cara; Donnelly, Claire; Warnock, Gary; Paul, Mical; Dishon-Benattar, Yael; Abram, Maja; Rubinić, Igor; Palčevsi, Dora; Belančić, Andrej; Skočibušić, Nataša; Vlahović-Palčevski, Vera V.; Yahav, Dafna; Daitch, Vered; Borg, Michael Angelo; Zarb, Peter; Scott, Michael; Farren, David; Magee, Fidelma; Pirš, Mateja; Gregorčič, Sergeja; Beović, Bojana; Mussini, Cristina Abstract: Objectives: We aimed to assess the impact of COVID-19 on antibiotic consumption (AMC) and antimicrobial resistance (AMR) in the new epidemiological scenario from a cross-national perspective.; Methods: A quasi-experimental retrospective multicentre ecological study was conducted to explore the impact of COVID-19 on AMC and AMR using routinely generated retrospective time series data. This study included nine Healthcare University Hospitals from Europe and Israel on behalf QUantifying change in Antibiotic Resistance, ANTibiotic use, and INfection control during COVID-19 Epidemics project. Total effects were defined as the difference between the pre-COVID-19 period (ranging from January 2015 or January 2016 to February 2020) and during the COVID-19 pandemic period (March 2020 to July 2021 or December 2021). The outcomes were incidence density (ID) of carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Klebsiella pneumoniae, extended-spectrum beta-lactamase-producing Escherichia coli, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, carbapenem-resistant Pseudomonas aeruginosa and Clostridioides difficile, as monthly isolates per 1000 patient days and the monthly AMC ranked according to the Access, Watch, and Reserve WHO classification system.; Results: We assessed 15.9 million total hospital bed days, 315 736 COVID-19 bed days, 52 557 monthly bacterial isolates, and 461 739 monthly antimicrobial defined daily doses. The COVID-19 pandemic had a significant impact on the consumption of overall hospital antibiotics combined in all centres except two. Prescriptions for piperacillin/tazobactam, glycopeptides, and ceftazidime/avibactam increased, whereas third-generation cephalosporins, macrolides, and fluoroquinolones returned to pre-pandemic levels after an initial surge, in all centres. A positive relationship between the pandemic intensity and VRE ID was observed in 6 of 9 (66%) centres followed by methicillin-resistant S. aureus-ID and carbapenem-resistant P. aeruginosa-ID 3 of 4 (44%) for both. A negative relationship was found for extended-spectrum beta-lactamase-producing E. coli ID.; Discussion: The COVID-19 pandemic was associated with higher usage of broad-spectrum antibiotics and higher incidence of multidrug-resistant bacteria, with great variability by countries. These results could support international action plans that embed AMR as a priority in the post-COVID-19 era. 2025-01-01T00:00:00Z /library/oar/handle/123456789/140736 Title: Increasing platelet concentrate shelf life from 5 to 7 days : a pilot study Abstract: According to current guidelines, platelets are stored at 22°C±2°C with constant agitation in bags that permit proper gaseous exchange for up to 5 days. The need and demand for platelet transfusions is constantly on the rise because of their function in haemostasis, and being a vital part of cancer treatment, as well as prophylactic administration in certain cases. The short shelf life of platelets poses a problem in terms of availability and a costly waste of resources, equipment, and personnel time management. Increasing the shelf life from the current 5-day storage period to 7 days is one way of managing this problem. A 7-day storage shelf life is already implemented by various blood banks worldwide. It is well known that there are certain risks in extending the shelf life of this blood component. Being stored at a temperature of 22±°C makes platelets an optimal medium for bacteria to flourish and may also subject them to what is known as platelet storage lesions, two factors that need to be considered before addressing an extension in shelf life. This study evaluated the impact of extending platelet storage from 5 to 7 days, focusing on key safety and quality parameters. 20 pooled platelet concentrates were monitored at days 1, 5 and 7 for platelet count and indices, pH, glucose, and lactate dehydrogenase, which are established markers of cell viability and function. Cytokine levels of platelet factor 4 (PF4), interleukin-6 (IL-6), interleukin-8 (IL-8), and transforming growth factor-beta (TGF-β) were measured using ELISA to assess cytokine accumulation linked to febrile transfusion reactions. Sterility testing via BacT/ALERT bottles was performed on day 7 to check for microbial contamination. Statistical analysis of the results obtained, revealed no significant differences between days 5 and 7 across all parameters, with p-values all above the 0.05 level of significance. No bacterial growth was detected in any samples. These findings suggest that extending the shelf life of platelets from 5 to 7 days may be feasible without compromising safety or quality, supporting potential implementation by the local blood establishment. Description: M.Sc.(Hons.)(Melit.) 2025-01-01T00:00:00Z /library/oar/handle/123456789/140347 Title: Indefinite anticoagulation with reduced-intensity direct oral anticoagulants in patients with splanchnic vein thrombosis. An international practice survey Authors: Delluc, Aurélien; Carrier, Marc; Lauw, Mandy; Cuker, Adam; Bertoletti, Laurent; Beyer-Westendorf, Jan; Di Nisio, Marcello; Simard, Camille; Roberge, Guillaume; Harrigan, Amye; Shivakumar, Sudeep; Skeith, Leslie; Ageno, Walter; Riva, Nicoletta Abstract: Introduction: Low-dose direct oral anticoagulants (DOACs) could be beneficial for secondary prevention of splanchnic vein thrombosis (SVT) in subgroups of patients at high risk for recurrence. In the absence of direct evidence, we aimed to identify the practice preferences of physicians managing patients with SVT in an international web-based survey. Methods and results: An anonymous questionnaire was sent via E-Mail between April and July 2023 to members of 14 national and international scientific societies. We received 236 responses of which 175 were complete responses. After an initial 3-6 months of SVT treatment, more than 80% of respondents would continue anticoagulation in the presence of cancer, myeloproliferative neoplasms, or in case of unprovoked SVT. If anticoagulation is continued, 45.8-68.6% would use reduced-intensity dosing of DOACs. In case of compensated cirrhosis or controlled inflammatory bowel disease (IBD), 54.3% and 44.4% of respondents would continue anticoagulation and 68.8% and 73.3% would opt for reduced-intensity DOAC dosing, respectively. Gastroenterologists were more likely to discontinue anticoagulation in SVT associated with cancer, controlled IBD, or unprovoked event, and more likely to continue anticoagulation in compensated cirrhosis compared to other specialists. Overall, 96% of respondents supported prospective evaluation of low-dose DOACs for the secondary prevention of SVT. Conclusion: This survey showed that physicians adapt duration and intensity of anticoagulation therapy depending on the patient's specific condition and risk factors even in the absence of high-quality evidence. Prospective evaluation is awaited. 2025-01-01T00:00:00Z