National hepatitis B and C estimates for 2021: Measuring Canada's progress towards eliminating viral hepatitis as a public health concern.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major causes of morbidity and mortality worldwide. Measuring the epidemiological burden of HCV and HBV in Canada is essential to measure progress towards global elimination targets and to ultimately eliminate viral hepatitis as a public health concern.

Objective: This study aimed to provide the first national estimates of HBV prevalence and unawareness, and to update estimates of HCV incidence, prevalence, and unawareness in the general population and key populations in Canada for 2021.

Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID): protocol for a randomised controlled adaptive platform trial of treatments for acute SARS-CoV-2 infection in community settings.

Introduction: SARS-CoV-2 is now endemic and expected to remain a health threat, with new variants continuing to emerge and the potential for vaccines to become less effective. While effective vaccines and natural immunity have significantly reduced hospitalisations and the need for critical care, outpatient treatment options remain limited, and real-world evidence on their clinical and cost-effectiveness is lacking. In this paper, we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID).

Impact of Adherence With In-Patient Prospective Audit and Feedback Recommendations on Patient and Economic Outcomes.

Introduction: Prospective audit and feedback (PAF) are an antimicrobial stewardship intervention that reduces use of broad-spectrum antimicrobials among in-patients. The objective of this study was to assess the impact of adherence to PAF recommendations on the duration of broad-spectrum antimicrobials and patient outcomes.

Methods: This retrospective cohort study included adult in-patients at two tertiary care hospitals in St.

Machine Learning Accurately Predicts Need for Critical Care Support in Patients Admitted to Hospital for Community-Acquired Pneumonia.

Objectives: Hospitalized community-acquired pneumonia (CAP) patients are admitted for ventilation, vasopressors, and renal replacement therapy (RRT). This study aimed to develop a machine learning (ML) model that predicts the need for such interventions and compare its accuracy to that of logistic regression (LR).

Design: This retrospective observational study trained separate models using random-forest classifier (RFC), support vector machines (SVMs), Extreme Gradient Boosting (XGBoost), and multilayer perceptron (MLP) to predict three endpoints: eventual use of invasive ventilation, vasopressors, and RRT during hospitalization.

Using behavioural science to improve antibiotic stewardship in Canadian long-term care homes: Protocol for a multi-center cluster randomized quality improvement study.

Background: Antimicrobial resistance (AMR) is associated with significant human and financial costs, particularly among vulnerable populations like older adults living in long-term care homes (LTCHs). Urinary tract infection (UTI) is the leading indication for antibiotic use in this population, with some estimates suggesting that up to 70% of these prescriptions may be avoidable.

Objective: The purpose of this study is to develop and test novel behavioural science-informed antimicrobial stewardship (AMS) quality improvement strategies in Canadian LTCHs, which aim to decrease unnecessary testing and treatment for residents who lack the minimum clinical signs and symptoms of UTI.

Community versus academic hospital community-acquired pneumonia patients: a nested cohort study.

Background: Most Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.

Methods: This nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals.

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.

Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.

Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days.

Population-level cascade of care for hepatitis C in Newfoundland and Labrador.

Background: Global elimination of hepatitis C virus (HCV) is feasible using existent tools. Reporting the provincial HCV care cascade will contribute to national and global HCV elimination efforts.

Methods: This observational study was a secondary use of population-level medical record data, including laboratory results for HCV testing and prescription data for HCV treatment in the province of Newfoundland and Labrador (NL).

Characteristics and clinical outcomes of nirmatrelvir/ritonavir (Paxlovid) recipients in Canada, 2022: a descriptive cohort study.

Background: Nirmatrelvir/ritonavir (N/R) (Paxlovid) was introduced in Canada in January 2022. This was the first oral coronavirus disease 2019 (COVID-19) antiviral therapy that was deployed on a large scale in Canada. Since N/R was a new therapeutic option to reduce severe outcomes in high-risk populations, clinical and implementation questions were raised about its real-world utilization and impact.

Partial oral versus full intravenous antibiotic treatment of endocarditis in people who inject drugs: A systematic review.

Background: Prolonged intravenous (IV) antibiotic therapy may not be optimal for people who inject drugs (PWID) with infective endocarditis (IE) due to unique social and medical needs. The role of partial IV antibiotic therapy with continued oral (PO) antibiotic therapy is unclear.

Methods: A systematic review was performed using EMBASE and MEDLINE databases.

Retrospective review of rates of sexually transmitted and blood-borne infection (STBBI) testing in provincial corrections facilities in Newfoundland and Labrador.

Background: Sexually transmitted and blood borne infection (STBBI) testing is recommended for people who are incarcerated (PWAI). We sought to determine the rate of STBBI testing during admissions to provincial correctional institutions in Newfoundland and Labrador (NL).

Methods: This retrospective cohort study collected the identification of all admissions records in provincial correctional facilities in NL between July 1, 2020 and June 31, 2021 using the database.

Population-based outpatient antimicrobial use in Newfoundland and Labrador: a retrospective descriptive study.

Background: Data that have been reported on antimicrobial use in Newfoundland and Labrador (NL) do not appear to be representative of use at the population level. We sought to use pharmacy network data on prescriptions to describe outpatient antimicrobial use in NL.

Methods: We analyzed all outpatient antimicrobial prescriptions dispensed between June 1, 2017, and June 8, 2021, from the provincial pharmacy network database and translated deidentified data into SPSS.

Population-based evaluation of the effectiveness of nirmatrelvir-ritonavir for reducing hospital admissions and mortality from COVID-19.

Background: A randomized controlled trial involving a high-risk, unvaccinated population that was conducted before the Omicron variant emerged found that nirmatrelvir-ritonavir was effective in preventing progression to severe COVID-19. Our objective was to evaluate the effectiveness of nirmatrelvir-ritonavir in preventing severe COVID-19 while Omicron and its subvariants predominate.

Methods: We conducted a population-based cohort study in Ontario that included all residents who were older than 17 years of age and had a positive polymerase chain reaction test for SARS-CoV-2 between Apr.

Two cases of tularemia in hunters from rural Newfoundland.

Background: Tularemia is a rare zoonosis caused by a small gram-negative intracellular coccobacillus. Transmission occurs through direct contact with small mammals such as hares and rabbits, exposure to ticks, or ingestion or inhalation of aerosolized particles. It is a highly variable disease with six subtypes based on clinical features.

Modified reporting of positive urine cultures to reduce treatment of asymptomatic bacteriuria in long-term care facilities: a randomized controlled trial.

Objectives: We conducted a prospective, randomized, unblinded superiority trial of the safety and efficacy of modified reporting of positive urine cultures to improve the appropriateness of treatment for asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in long-term care facilities (LTCFs).

Methods: Consecutive positive urine cultures collected from LTCF patients were randomized between standard (identification and susceptibility) or modified (without identification and susceptibility) laboratory reports. Exclusion criteria were current antibiotic treatment, neutropenia, or transfer to acute care.

Cost-effectiveness of remdesivir plus usual care versus usual care alone for hospitalized patients with COVID-19: an economic evaluation as part of the Canadian Treatments for COVID-19 (CATCO) randomized clinical trial.

Background: The role of remdesivir in the treatment of hospitalized patients with COVID-19 remains ill-defined. We conducted a cost-effectiveness analysis alongside the Canadian Treatments for COVID-19 (CATCO) open-label, randomized clinical trial evaluating remdesivir.

Methods: Patients with COVID-19 in Canadian hospitals from Aug.

The epidemiology of delayed HIV diagnosis in Ibadan, Nigeria.

Background: Human immunodeficiency virus infection (HIV) is one of the major health burdens in Nigeria. Delayed HIV diagnosis remains a significant driver of HIV transmission. The risk factors of delayed HIV diagnosis have not been widely studied in Nigeria.

Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial.

Background: The role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems.

Streptococcus agalactiae infective endocarditis in Canada: a multicenter retrospective nested case control analysis.

Background: Infective endocarditis (IE) caused by Streptococcus agalactiae (GBS) is increasingly reported and associated with an aggressive course and high mortality rate. Existing literature on GBS IE is limited to case series; we compared the characteristics of patients with GBS IE to patients with GBS bacteremia without IE to identify risk factors for development of IE.

Methods: A nested case-control study in a cohort of adult patients with GBS bacteremia over a 18-year period was conducted across seven centres in three Canadian cities.

The 2018 Global Point Prevalence Survey of antimicrobial consumption and resistance in 47 Canadian hospitals: a cross-sectional survey.

Background: Patient-level surveillance of antimicrobial use (AMU) in Canadian hospitals empowers the reduction of inappropriate AMU and was piloted in 2017 among 14 hospitals in Canada. We aimed to describe AMU on the basis of patient-level data in Canadian hospitals in 2018 in terms of antimicrobial prescribing prevalence and proportions, antimicrobial indications, and agent selection in medical, surgical and intensive care wards.

Methods: Canadian adult, pediatric and neonatal hospitals were invited to participate in the standardized web-based cross-sectional Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) conducted in 2018.

Appropriateness of antibiotic use in community hospitals in rural Newfoundland and Labrador.

Background: Surveillance of the appropriateness of antimicrobial prescribing can identify targets for quality improvement in antimicrobial stewardship. Our objective was to measure antibiotic prescription prevalence, indication, and appropriateness at three rural community hospitals in a 1-day point prevalence study.

Methods: Inpatient antibiotic prescriptions given at three community hospitals on April 24, 2019 were provided by the hospital pharmacies.

Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John's, Canada.

Objectives: Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period.

Modified reporting of positive urine cultures to reduce inappropriate antibiotic treatment of catheter-associated asymptomatic bacteriuria (CA-ASB) among inpatients, a randomized controlled trial.

Objective: To determine whether modified reporting of positive urine cultures collected from indwelling catheters improved treatment decisions without causing harm.

Design: Prospective, unblinded, randomized control trial.

Setting: Two tertiary-care hospitals.