Regina Qu'Appelle Health Region

Background: The molecular and epidemiological landscape of C. difficile infection (CDI) has evolved markedly in the last decade; however, limited information is available contrasting differences between adult and pediatric populations. We describe a multicenter study evaluating healthcare-associated (HA) and community-associated (CA) adult and pediatric-CDI identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) network from 2015 to 2022. Methods: Hospitalized patients with CDI were identified from up to 84 hospitals between 2015–2022 using standardized case definitions. Cases were confirmed by PCR, cultured, and further characterized using ribotyping and E-test. We used two-tailed tests for significance (p≤0.05). Results: Of 30,817 cases reported, 29,245 were adult cases [HA-CDI (73.2%), CA-CDI (26.8%)] and 1,572 were pediatric cases [HA-CDI (77.7%), CA-CDI (22.3%)]. From 2015 to 2022, HA-CDI rates decreased 19.7% (p=0.007) and 29.4% (p=0.004) in adult and pediatric populations, respectively (Figure 1). CA-CDI rates remained relatively stable in the adult population (p=0.797), while decreasing 60.7% in the pediatric population (p=0.013). Median ages of adult and pediatric patients were 70 (interquartile range (IQR), 58–80) and seven (IQR, 3–13) years, respectively. Thirty-day all-cause mortality was significantly higher among adult vs. Pediatric CDI patients (11.0% vs 1.4%, p < 0.0001). No significant differences in other severe outcomes were found. Ribotyping and susceptibility data were available for 4,620 samples: 3,558 adult (77.0%) and 1,062 pediatric (23.0%). The predominant adult and pediatric ribotypes (RT) were 106 (12.2/16.2%), 027 (11.4/3.2%), and 014 (8.8/8.2%). Overall, RT027 prevalence significantly decreased from 17.9% in 2015 to 3.2% in 2022 (p=0.003), while RT106 increased from 8.5% to 14.4%. Resistance rates among adult and pediatric isolates were similar for all antimicrobials tested except moxifloxacin (16.2% vs. 6.2%, p < 0.0001, respectively). Adult moxifloxacin resistance decreased from 30% to 6.3% from 2015 to 2022 (p=0.006). Adults with moxifloxacin-resistant CDI were older (median: 74 vs. 69 years, p < 0.001) and had higher thirty-day all-cause mortality (13% vs. 9.8%, p=0.041) and recurrence (10% vs. 5.7%, p < 0.001) compared to those with moxifloxacin non-resistant CDI, while these trends were not observed in pediatric patients. Among RT027 strains, moxifloxacin resistance decreased from 91.0% in 2015 to 7.1% in 2022. There was one metronidazole-resistant pediatric sample in 2018 and no resistance to vancomycin or tigecycline in either population. Conclusion: We have found differences in the epidemiological and molecular characteristics of adult and pediatric CDI, with higher thirty-day all-cause mortality among adults. Overall, RT106 has replaced RT027 as the predominant ribotype with a concomitant decrease in fluoroquinolone resistance.

BackgroundHepatitis B (HBV) and Human Immunodeficiency Virus (HIV) share common risk factors for exposure. Co-infected patients have an increased liver-related mortality risk and may have accelerated HIV progression. The epidemiology and demographic characteristics of HIV-HBV co-infection in Canada remain poorly defined. We compared the demographic and clinical characteristics and factors associated with advanced hepatic fibrosis between HIV and HIV-HBV co-infected patients.MethodsA retrospective cohort analysis was conducted using data from the Canadian Observational Cohort (CANOC) Collaboration, including eight sites from British Columbia, Quebec, and Ontario. Eligible participants were HIV-infected patients who initiated combination ARV between January 1, 2000 and December 14, 2014. Demographic and clinical characteristics were compared between HIV-HBV co-infected and HIV-infected groups using chi-square or Fisher exact tests for categorical variables, and Wilcoxon’s Rank Sum test for continuous variables. Liver fibrosis was estimated by the AST to Platelet Ratio Index (APRI).ResultsHBV status and APRI values were available for 2419 cohort participants. 199 (8%) were HBV co-infected. Compared to HIV-infected participants, HIV-HBV co-infected participants were more likely to use injection drugs (28% vs. 21%, p = 0.03) and be HCV-positive (31%, vs. 23%, p = 0.02). HIV-HBV co-infected participants had lower baseline CD4 T cell counts (188 cells/mm3, IQR: 120–360) compared to 235 cells/mm3 in HIV-infected participants (IQR: 85–294) (p = 0.0002) and higher baseline median APRI scores (0.50 vs. 0.37, p < 0.0001). This difference in APRI was no longer clinically significant at follow-up (0.32 vs. 0.30, p = 0.03). HIV-HBV co-infected participants had a higher mortality rate compared to HIV-infected participants (11% vs. 7%, p = 0.02).ConclusionThe prevalence, demographic and clinical characteristics of the HIV-HBV co-infected population in Canada is described. HIV-HBV co-infected patients have higher mortality, more advanced CD4 T cell depletion, and liver fibrosis that improves in conjunction with ARV therapy. The high prevalence of unknown HBV status demonstrates a need for increased screening among HIV-infected patients in Canada.

BackgroundWhole genome sequencing (WGS) is a high-resolution approach for tracking the transmission and antimicrobial susceptibility (AMS) of Neisseria gonorrhoeae (Ng). Multiple bioinformatics tools currently used for the analysis of WGS data for Ng complicate their application in clinical settings. We determined the genomic epidemiology and AMS of Ng from Saskatchewan (SK) using our integrated pipeline, Gen2Epi, previously validated on 1484 publicly available Ng genome datasets.MethodsWGS was performed on 99 Ng isolates (2017–2018) from SK submitted to the Roy Romanow Provincial Laboratory. Genomic DNA was isolated using the DNAeasy mini kit (QIAGEN) and sequenced using MiSeq (Illumina). MICs were determined by agar dilution. Gen2Epi includes read assembly, scaffolding, strain typing (ST) by MLST and NG-MAST, plasmid identification, and, identification of mutations in antibiotic resistance genes by NG-STAR.ResultsNine MLST/NG-MAST/NG-STAR (M/M/S) STs comprised 75.6% (75/99) of the isolates; other M/M/S STs (24.3%, 24/99) comprised single isolates. M/M/S ST 1901/10451/90 predominated (21.3%, 21/99), carrying mosaic penA type 34.001 and mutations in mtrR/porB/ponA/gyrA/parC. These isolates were chromosomally resistant to penicillin (38%, 8/21), tetracycline (95.2%, 20/21), and ciprofloxacin (90%, 19/21); they were susceptible to ceftriaxone and 38% (8/21) had cefixime MICs of 0.125 mg/L. The second-most prevalent ST was 1584/7638/160 (18/99); most of these isolates (16/18) were susceptible to all antibiotics. Overall, 57.6% (57/99) of the isolates were tetracycline resistant; 29.8% (17/57) of these were from Regina and carried a tetM gene (M/M/S ST 12462/5985/42). One sporadic isolate was azithromycin resistant (23S rRNA-A2059G), carried tetM and was M/M/S ST 7822/304/515.ConclusionGen2Epi is a one-stop pipeline that both assembles and annotates raw reads and simplifies the analysis of transmission markers and AMS in Ng. We showed the emergence of M/M/S ST 1901/10451/90 as the predominant ST in SK. NG-MAST ST 10451 is similar (≤2bp) to ST 1407 which is implicated in reduced susceptibility to cefixime.DisclosureNo significant relationships.

A 28-year-old man developed fever, night sweats, nausea, headache, reduced appetite, skin rash, and hemoptysis 2 weeks after returning to the United States from Mexico. The patient had fistulizing Crohn disease and had been taking the tumor necrosis factor alpha (TNF-alpha) blocker adalimumab for

ABSTRACTAims: The 10-meter walk test (10 mWT) and Timed Up and Go (TUG) are assessments of speed/time with a ceiling effect in pediatric populations. This study aimed to (1) determine whether collecting spatiotemporal data with inertial sensors (Mobility Lab, APDM Inc.) during these tests improves their discriminative validity, and (2) evaluate the clinical feasibility of Mobility Lab. Methods: Fifteen children with spina bifida (SB) or cerebral palsy (CP) (7.9 ± 3.1 years old) and fifteen age- and sex-matched typically-developing (TD) children completed the 10 mWT and TUG wearing Mobility Lab. Spatiotemporal data were compared between groups. Mobility Lab's potential to distinguish children with SB/CP from TD children was examined using conditional logistic regression. Feasibility was evaluated through participant adherence and a clinical utility scale. Results: For the 10 mWT, group differences (p < 0.01) were found in horizontal and frontal trunk range of motion, horizontal trunk velocity, and swing asymmetry. Children with SB/CP took significantly longer to turn during the TUG. These five variables together distinguished the two groups (p = 0.006). 78% of participants with SB/CP completed the testing protocol. Mobility Lab scored 4/10 on the clinical utility scale. Conclusions: Instrumenting the 10 mWT and TUG improves the tests’ ability to discriminate between children with SB/CP and TD children.

Agencies with overlapping mandates can form partnerships to aid development of effective programming. In 2008, the Dedicated Substance Abuse Treatment Unit (DSATU) opened at Regina Correctional Centre through a tripartite collaboration between the Saskatchewan (SK) Ministry of Justice, Corrections and Policing; Addiction Services, Regina Qu’Appelle Health Region; and the SK Ministry of Health. Stakeholders researched existing best practices in the field and developed an evidence-based substance abuse treatment program for sentenced inmates at high risk to re-offend. An evaluation of the DSATU program completed in 2016 concluded that the DSATU was effective, sustainable, and likely transferable to other correctional facilities wishing to offer this type of programming. The stakeholder partnership was a key ingredient in the program’s success. This paper describes the process by which the partners worked together to develop, implement, and sustain this innovative and evidence-based substance abuse treatment program. The partners’ willingness to compromise, to take a collaborative approach to building the partnership and developing the program, and to put clients ahead of individual organizational mandates all contributed to the success of the partnership.