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Abstract Innovative testing approaches are needed to meet global targets for the blood-borne viruses (BBVs) HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). We conducted a systematic review of BBV testing in emergency departments (EDs) in Europe to evaluate prevalence, effectiveness of ED testing and linkage to care (LTC). We searched PubMed, Embase and Cochrane Library for articles on ED BBV testing published between January 2012 and July 2022. Studies conducted outside Europe or prior to 2012 were excluded owing to epidemiological and healthcare service variation, together with studies that did not report core parameters. Reference lists from included articles were manually searched. Seventeen original articles met the inclusion criteria. Seven studies reported on HIV testing only. ED prevalence: HIV Ab, 0.0%–1.1%; HBsAg, 0.2%–0.9%; and HCV RNA, 0.2%–3.9%. BBV testing uptake varied by policy and offer methodology: opt-out, provider-initiated: 9.7%–44.2%; electronic health record (EHR) modification: 52.1%–88.9%; and opt-in, provider-initiated: 3.9%–37.7%. LTC rates were 8.1%–100% and varied by BBV, generally highest for HIV and lowest for HCV. There was variable detail in outcome reporting and description of clinical LTC pathways. ED BBV testing in Europe is feasible and identifies high numbers of infections (including, where reported, new diagnoses and disengaged patients), often among marginalized populations who use open-access EDs for healthcare. Factors associated with higher levels of sustained testing uptake included opt-out testing (vs opt-in), EHR (vs provider-initiated) and integration of community services. We propose a toolkit of components necessary for a high-performing ED BBV testing programme.

Background The models that historically have been used to model infectious disease outbreaks are equation-based and statistical models. However, these models do not capture the impact of individual and social factors that affect the spread of common blood-borne viruses (BBVs) such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Agent-based modelling (ABM) is an alternative modelling approach that is gaining popularity in public health and epidemiology. As the field expands, it is important to understand how ABMs have been applied. In this context, we completed a scoping review of research that has been done on the ABM of BBVs. Method The inclusion/exclusion criteria were drafted using the idea of Population, Concept, and Context (PCC). The Preferred Reporting Item for Systematic Reviews and Meta-Analysis, an extension to scoping review (PRISMA-ScR), was employed in retrieving ABM literature that studied BBVs. Three databases (Scopus, Pubmed, and Embase) were systematically searched for article retrieval. 200 articles were retrieved from all the databases, with 10 duplicates. After removing the duplicates, 190 papers were screened for inclusion. After analysing the remaining articles, 70 were excluded during the abstract screening phase, and 32 were excluded during the full-text decision. Eighty-eight were retained for the scoping review analysis. To analyse this corpus of 88 papers, we developed a five-level taxonomy that categorised each paper based first on disease type, then transmission mechanism, then modelled population, then geographic location and finally, model outcome. Results The result of this analysis show significant gaps in the ABM of BBV literature, particularly in the modeling of social and individual factors influencing BBV transmission. Conclusion There is a need for more comprehensive models that address various outcomes across different populations, transmission and intervention mechanisms. Although ABMs are a valuable tool for studying BBVs, further research is needed to address existing gaps and improve our understanding of individual and social factors that influence the spread and control of BBVs. This research can inform researchers, modellers, epidemiologists, and public health practitioners of the ABM research areas that need to be explored to reduce the burden of BBVs globally.

Background In this first national bloodstream infection (BSI) surveillance program in China, we assessed the composition of pathogenic bacteria and the trends for antimicrobial susceptibility over a 6-year period in China. Methods Blood bacterial isolates from patients at hospitals participating in the Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected from January 2014 to December 2019. Only the first isolate of a species per patient was eligible over the full study period. Antibiotic-susceptibility testing was conducted by agar-dilution or broth-dilution methods as recommended by the Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data. Results During the study period, 27,899 bacterial strains were collected. Gram-positive organisms accounted for 29.5% (8244) of the species identified and Gram-negative organisms accounted for 70.5% (19,655). The most-commonly isolated organisms in blood cultures were Escherichia coli , Klebsiella pneumoniae , Staphylococcus aureus , coagulase-negative Staphylococci , and Acinetobacter baumannii . The prevalence of multidrug-resistant organisms, such as E. coli , K. pneumoniae , A. baumannii was higher in tertiary hospitals, whereas extended-spectrum, β-lactamase-producing E. coli (ESBL- E. coli ), carbapenem-resistant A. baumannii were more prevalent in economically-developing areas. The prevalence of methicillin-resistant S. aureus declined from 39.0% (73/187) in 2014 to 25.9% (230/889) in 2019 ( p  < 0.05). The prevalence of ESBL- E. coli dropped from 61.2% (412/673) to 51.0% (1878/3,683) over time ( p  < 0.05), and carbapenem-resistant E. coli remained low prevalence (< 2%; 145/9944; p  = 0.397). In contrast, carbapenem-resistant K. pneumoniae increased markedly from 7.0% (16/229) in 2014 to 19.6% (325/1,655) in 2019 ( p  < 0.05). Conclusion E. coli and K. pneumoniae were the leading causes of BSI during the 6-year study period. The major resistant pathogens declined or remained stable, whereas carbapenem-resistant K. pneumoniae continued to increase, which poses a great therapeutic challenge for BSIs.

Pathogens threaten the safety of the blood supply, but we have typically relied on a reactive approach to these threats. Having approved three new pathogen-reduction technologies, the FDA could and should mandate treatment of blood components by such technologies. Existing and emerging pathogens including viruses, bacteria, protozoa, and prions continue to threaten the safety of the blood supply. Blood-collecting facilities, including community and hospital blood banks, have typically relied on a reactive approach to these threats, developing and implementing screening tests after potential pathogens are identified. During this often slow and laborious process, pathogen transmission through transfusion is inevitable. The Food and Drug Administration (FDA) recently approved three new pathogen-reduction technologies (see table). These systems are capable of inactivating a wide variety of pathogens in donated blood components, potentially eliminating threats — including some for which no other intervention . . .

Although best known as an animal disease, human babesiosis is attracting increasing attention as a worldwide emerging zoonosis. Humans are commonly infected by the bite of ixodid ticks. Rare ways of transmission are transplacental, perinatal and transfusion-associated. Infection of the human host can cause a very severe host-mediated pathology including fever, and hemolysis leading to anemia, hyperbilirubinuria, hemoglobinuria and possible organ failure. In recent years, apparently owing to increased medical awareness and better diagnostic methods, the number of reported cases in humans is rising steadily worldwide. Hitherto unknown zoonotic Babesia spp. are now being reported from geographic areas where babesiosis was not previously known to occur and the growing numbers of travelers and immunocompromised individuals suggest that the frequency of cases in Europe will also continue to rise. Our review is intended to provide clinicians with practical information on the clinical management of this rare, but potentially life-threatening zoonotic disease. It covers epidemiology, phylogeny, diagnostics and treatment of human babesiosis and the potential risk of transfusion-transmitted disease with a special focus on the European situation.

Leukemic patients are often immunocompromised due to underlying conditions, comorbidities and the effects of chemotherapy and thus at risk for developing systemic infections. Bloodstream infection (BSI) is a severe complication in neutropenic patients and is associated with increased mortality. BSI is routinely diagnosed with blood culture, which only detects culturable pathogens. We analyzed 27 blood samples from 9 patients with acute leukemia and suspected BSI at different time points of their antimicrobial treatment using shotgun metagenomics sequencing in order to detect unculturable and non-bacterial pathogens. Our findings confirm the presence of bacterial, fungal and viral pathogens alongside antimicrobial resistance genes. Decreased white blood cell (WBC) counts were associated with the presence of microbial DNA and was inversely proportional to the number of sequencing reads. This study could indicate the use of high-throughput sequencing for personalized antimicrobial treatments in BSIs.

Using genomic technology to rapidly sequence and analyse pathogens has the potential to deliver a robust, evidence-based approach to the challenge of infectious disease management. The successful implementation of such a response is going to require consideration of the associated ethical, legal and social issues.A genomics-informed response to infectious disease has great potential to improve individual patient treatment as well as public health. This Comment discusses the ethical, legal and social challenges that will need to be overcome if clinical pathogen genomics is to be implemented successfully.

Background Leishmaniosis and other canine vector-borne diseases (CVBDs) pose a major risk for veterinary and public health globally, especially where humans and dogs live in close proximity. Although mosquito and tick vectors are abundant in Hong Kong, surveillance for CVBDs has been limited. Methods A serological and molecular survey of 158 healthy owned ( n  = 64) and free-roaming unowned ( n  = 94) dogs with outdoor access in Hong Kong was performed to determine CVBD prevalence. Point-of-care (POC) immunoassays were used to detect (i) antibodies to Leishmania spp., Ehrlichia spp., and Anaplasma spp., and (ii) Dirofilaria immitis and Angiostrongylus vasorum antigens, in canine sera. Conventional polymerase chain reaction (PCR) was also carried out to detect the molecular prevalence of all five pathogens as well as Hepatazoon canis , Babesia gibsoni , and Trypanosoma evansi . In addition, for Leishmania spp. detection, an immunofluorescence antibody test (IFAT) was performed on all serum samples, followed by real-time PCR of seropositive samples to detect Leishmania spp. DNA. The agreement between tests was assessed by Cohen’s kappa statistic, and logistic regression analysis was applied to identify potential risk factors. Results Overall, 45.6% of dogs tested positive on molecular and/or serological tests for at least one pathogen, with the highest prevalence recorded for Dirofilaria spp. (20.9%), followed by B. gibsoni (15.2%), Leishmania spp. (11.4%), Anaplasma spp. (7.6%), H. canis (4.4%), Ehrlichia spp. (3.8%), and A. vasorum (0.6%). No T. evansi DNA was detected. Co-infections or co-pathogen exposure occurred in 16.5% of samples. Of the 33 Dirofilaria spp.-positive dogs, two were identified by sequencing as Dirofilaria asiatica , and the remaining 31 were D. immitis . No significant risk factors for infection or exposure were identified. Conclusions This is the first epidemiological survey of Leishmania spp. infection in dogs from Hong Kong, highlighting the need for surveillance of competent vectors and further investigation of disease status in dog populations to confirm whether this pathogen is endemic. Given the high prevalence of CVBD, especially of D. immitis, preventive and control measures are advocated in order to mitigate risks to canine health and zoonotic infection. Graphical abstract

Background and Objectives: Non-viral bloodborne diseases are a group of infections that are a public health problem worldwide. The incidence of diseases such as brucellosis and syphilis is increasing in the Americas and Europe. Chagas disease is an endemic problem in Latin America, the United States and Europe. This study aims to determine the prevalence of non-viral bloodborne diseases in blood donors and to discuss some issues related to federal regulations for the control and prevention of these infectious diseases in Mexico. Material and methods: A cross-sectional study was conducted in the Western National Medical Center Blood Bank, including 228,328 blood donors (2018–2023). Frequencies, percentages, means, standard deviation and confidence intervals (CI) were calculated for demographic data. Prevalences were expressed as rates per 100,000 with 95% CI. Results: Of 3949 seroreactive or undetermined blood donors at the first screening, a total of 682 (0.299%) completed their follow-up test and were positive for Treponema pallidum (478), Trypanosoma cruzi (83), or Brucella spp. (121). The overall prevalence for non-viral bloodborne diseases was 299 per 100,000 blood donors. The prevalence for syphilis, Chagas disease, and Brucella was 209, 36, and 53 per 100,000 respectively. Conclusion: Federal regulations should be reviewed to formulate specific public health policies focused on controlling and preventing nonviral bloodborne diseases.

Background Antimicrobial activity of tigecycline and comparator agents was assessed in vitro against 27857 isolates source from blood samples collected between 2012 and 2016 as part of the Tigecycline Evaluation and Surveillance Trial (TEST). Methods The broth microdilution methods was used to determine  minimum inhibitory concentrations (MIC) of blood-borne isolates according to guildlines of the Clinical and Laboratory Standards Institute (CLSI). Antimicrobial susceptibility breakpoints from CLSI guidelines were used as standards to determine susceptibility against comparator agents, whereas tigecycline breakpoints were provided by the US Food and Drug Administration (FDA). Results More than 91% Enterobacteriaceae isolates, belonging to Escherichia coli , Klebsiella pneumoniae , Enterobacter cloacae and Serratia marcescens , were susceptible to amikacin, meropenem, and tigecycline. Meropenem resistance was observed in 8% of K.pneumoniae isolates worldwide. Extended-spectrum β-lactamase (ESBL) was produced in 15.9 and 20.9% E.coli and  K.pneumoniae isolates, respectively. MIC 90 of tigecycline against Acinetobacter baumannii was 2 μg/ml.  The highest proportion of susceptible A.baumannii isolates was 70.8% for minocycline. Among  P.aeruginose  isolates worldwide, 71.1–94.9% were susceptible to six antibiotics. Almost all Staphylococcus aureus isolates were susceptible to linezolid(100%), vancomycin(100%), and tigecycline (99.9%). The proportion of methicillin-resistant S.aureus (MRSA) was 33.0% among S.aureus isolates worldwide; it was highest in Asia with 46.6%, followed by North America and Latin America with 37.7 and 34.2%, respectively. Vancomycin-resistant (VR) isolates represented 1.4% of Enterococcus faecalis (VR. E.faecalis ) and 27.6% of  Enterococcus faecium (VR. E.faecium ). Highest percentages of VR. E.faecium were found in North America and Latin America, with 61.6 and 58.1% of the isolates, respectively. Production of penicillin-resistant  Streptococcus pneumoniae (PRSP) represented 9.0% of S. pneumoniae isolates worldwide; the PRSP proportion was 25.8% in Asia, 13.0% in Africa, and 11.8% in Latin America. Conclusions In our study, tigecycline was the only antibiotic that was active against over 90% of all major blood-borne pathogens. A global comparison revealed that antimicrobial resistance was higher in Africa, Asia and Latin America than in Europe and North America.