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Article ; Online: Treatment of Mycoplasma genitalium infection in pregnancy: A systematic review of international guidelines.

Drew, Richard J / Eogan, Maeve

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2024

Abstract: Background: Mycoplasma genitalium is an emerging pathogen, which has been linked to cervicitis, urethritis and pelvic inflammatory disease (PID). With the advent of multiplex polymerase chain reaction (PCR) panels for sexually transmitted infections, it ...

Abstract	Background: Mycoplasma genitalium is an emerging pathogen, which has been linked to cervicitis, urethritis and pelvic inflammatory disease (PID). With the advent of multiplex polymerase chain reaction (PCR) panels for sexually transmitted infections, it is increasingly being identified in pregnant women. Objectives: The aim was to review international guidelines, which had explicit recommendations for treatment of M. genitalium infection in pregnancy and breastfeeding. Search strategy: PubMed, EMBASE and Cochrane databases were reviewed with no age, species, language or date restrictions. Selection criteria: Studies were included if they had an explicit recommendation for treatment of M. genitalium in pregnancy. Studies were excluded if there was no recommendation in pregnancy, if they referred to other international guideline recommendations or were historical versions of guidelines. Data collection and analysis: References were manually reviewed and 50 papers were selected for review. Only four guidelines were included in the final analysis and they were from Europe, UK, Australia and Aotearoa New Zealand. Main results: All studies recommended azithromycin as first-line treatment, and advised against moxifloxacin use. The dosing schedule of azithromycin, varied between guidelines, as did the utility/safety of pristinamycin for macrolide resistant infections. Safety data was generally reassuring for azithromycin but inconsistent for pristinamycin. Conclusions: Azithromycin is the first-line treatment for macrolide susceptible or unknown resistance infections, but there is a lack of consistency regarding dosing of azithromycin or the utility/safety of pristinamycin for macrolide resistant infections in pregnancy/lactation.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.15469
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Zs.A 355: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 183: Show issues

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Article ; Online: Predicting community acquired bloodstream infection in infants using full blood count parameters and C-reactive protein; a machine learning study.

Brouwer, Lieke / Cunney, Robert / Drew, Richard J

European journal of pediatrics

2024

Abstract: Early recognition of bloodstream infection (BSI) in infants can be difficult, as symptoms may be non-specific, and culture can take up to 48 h. As a result, many infants receive unneeded antibiotic treatment while awaiting the culture results. In this ... ...

Abstract	Early recognition of bloodstream infection (BSI) in infants can be difficult, as symptoms may be non-specific, and culture can take up to 48 h. As a result, many infants receive unneeded antibiotic treatment while awaiting the culture results. In this study, we aimed to develop a model that can reliably identify infants who do not have positive blood cultures (and, by extension, BSI) based on the full blood count (FBC) and C-reactive protein (CRP) values. Several models (i.e. multivariable logistic regression, linear discriminant analysis, K nearest neighbors, support vector machine, random forest model and decision tree) were trained using FBC and CRP values of 2693 infants aged 7 to 60 days with suspected BSI between 2005 and 2022 in a tertiary paediatric hospital in Dublin, Ireland. All models tested showed similar sensitivities (range 47% - 62%) and specificities (range 85%-95%). A trained decision tree and random forest model were applied to the full dataset and to a dataset containing infants with suspected BSI in 2023 and showed good segregation of a low-risk and high-risk group. Negative predictive values for these two models were high for the full dataset (> 99%) and for the 2023 dataset (> 97%), while positive predictive values were low in both dataset (4%-20%). Conclusion: We identified several models that can predict positive blood cultures in infants with suspected BSI aged 7 to 60 days. Application of these models could prevent administration of antimicrobial treatment and burdensome diagnostics in infants who do not need them. What is Known: • Bloodstream infection (BSI) in infants cause non-specific symptoms and may be difficult to diagnose. • Results of blood cultures can take up to 48 hours. What is New: • Machine learning models can contribute to clinical decision making on BSI in infants while blood culture results are not yet known.
Language	English
Publishing date	2024-04-18
Publishing country	Germany
Document type	Journal Article
ZDB-ID	194196-3
ISSN	1432-1076 ; 0340-6199 ; 0943-9676
ISSN (online)	1432-1076
ISSN	0340-6199 ; 0943-9676
DOI	10.1007/s00431-024-05441-6
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Article ; Online: Enterovirus Central Nervous System Infection in Infancy, the Value of Routine Testing.

Giva, Sheiniz / Barry, Rachel / Drew, Richard J / Geoghegan, Sarah

The Pediatric infectious disease journal

2023 Volume 42, Issue 12, Page(s) 1031–1034

Abstract: Background: Human nonpolio enterovirus (EV) is a major cause of infection in neonates and infants; however, the clinical presentation and cerebrospinal fluid findings vary significantly. Infection caused by EV in patients under 1 year of age can present ...

Abstract	Background: Human nonpolio enterovirus (EV) is a major cause of infection in neonates and infants; however, the clinical presentation and cerebrospinal fluid findings vary significantly. Infection caused by EV in patients under 1 year of age can present with a broad clinical spectrum, from fever to severe systemic and/or neurological disease. Methods: Retrospective cohort analysis of infants with EV central nervous system (CNS) infection presenting to a tertiary center between January 2017 and December 2022. We recorded patient demographics, parent-reported symptoms at presentation, and blood and cerebrospinal fluid (CSF) testing at presentation. Results: Seventy-eight patients were included in the final study. Forty-one percent of infants with an EV CNS infection had a normal CSF white blood cell count. Clinical presentation was similar in infants with and without CSF pleocytosis. Median C-reactive protein was higher in cases of EV CNS infection without pleocytosis. Conclusion: EV CNS infection commonly presents without CSF pleocytosis. Testing for EV should be considered in febrile infants with no source regardless of CSF parameters.
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Enterovirus ; Leukocytosis/cerebrospinal fluid ; Retrospective Studies ; Enterovirus Infections ; Central Nervous System Infections/diagnosis
Language	English
Publishing date	2023-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000004072
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Zs.A 1852: Show issues

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Article ; Online: Antenatal pyelonephritis: a three-year retrospective cohort study of two Irish maternity centres.

Barry, Rachel / Houlihan, Elaine / Knowles, Susan J / Eogan, Maeve / Drew, Richard J

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology

2023 Volume 42, Issue 7, Page(s) 827–833

Abstract: Pyelonephritis affects 1-2% of pregnant women, and is associated with significant maternal and fetal morbidity. Antenatal pyelonephritis has been associated with PPROM (preterm premature rupture of membranes), preterm labour, low birth weight (LBW) and ... ...

Abstract	Pyelonephritis affects 1-2% of pregnant women, and is associated with significant maternal and fetal morbidity. Antenatal pyelonephritis has been associated with PPROM (preterm premature rupture of membranes), preterm labour, low birth weight (LBW) and prematurity. A three-year retrospective dual-centre cohort study of antenatal pyelonephritis cases was conducted in two neighbouring Irish maternity hospitals - the Rotunda Hospital (RH) and the National Maternity Hospital (NMH). Patient demographics, clinical presentation, investigations, management and maternal/neonatal outcomes were recorded. A total of 47,676 deliveries (24,768 RH; 22,908 NMH) were assessed. 158 cases of antenatal pyelonephritis were identified (n = 88 RH, n = 70 NMH), with an incidence of 0.33%. The median age was 28 years. The median gestation was 27 + 6 weeks, with 51% presenting before 28 weeks' gestation. Risk factors included; obesity (18.4%), diabetes mellitus (13.3%) and self-reported clinical history of recurrent urinary tract infection (28.5%). Rate of relapse with UTI in the same pregnancy was 8.2%. Renal ultrasound was performed in 30.4%. Predominant uropathogens were Escherichia coli (60%), Klebsiella pneumoniae (11%) and Proteus mirabilis (5%). 7.5% of cases had a concurrent bloodstream infection, 13.3% of cases were complicated by sepsis and 1.9% with septic shock. Complications including PPROM (6.3%), preterm delivery < 37 weeks' gestation (11%), LBW < 2,500 g (8.2%) were comparable between sites. Delivery within 72 hours of diagnosis was noted in 7% (n = 11) of patients, of which three were preterm and one had LBW. Appropriate and prompt investigation and management of antenatal pyelonephritis is essential given the associated maternal and neonatal morbidity.
MeSH term(s)	Infant, Newborn ; Female ; Pregnancy ; Humans ; Adult ; Retrospective Studies ; Premature Birth/epidemiology ; Cohort Studies ; Gestational Age ; Sepsis/epidemiology ; Pyelonephritis/epidemiology ; Pyelonephritis/complications ; Pregnancy Outcome/epidemiology
Language	English
Publishing date	2023-05-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	603155-9
ISSN	1435-4373 ; 0934-9723 ; 0722-2211
ISSN (online)	1435-4373
ISSN	0934-9723 ; 0722-2211
DOI	10.1007/s10096-023-04609-6
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Zs.A 1732: Show issues

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Article ; Online: To screen or not to screen for asymptomatic bacteriuria in pregnancy: A comparative three-year retrospective review between two maternity centres.

Houlihan, Elaine / Barry, Rachel / Knowles, Susan J / Eogan, Maeve / Drew, Richard J

European journal of obstetrics, gynecology, and reproductive biology

2023 Volume 288, Page(s) 130–134

Abstract: Background: Current national guidance in Ireland states that asymptomatic bacteriuria (AB) should be screened for at 12-16 weeks' gestation and treated with a seven-day course of antimicrobials, due to the potential risk of preterm birth and low birth ... ...

Abstract	Background: Current national guidance in Ireland states that asymptomatic bacteriuria (AB) should be screened for at 12-16 weeks' gestation and treated with a seven-day course of antimicrobials, due to the potential risk of preterm birth and low birth weight infants (LBWI), however, this is based on low quality evidence. Methods: Over a three-year period (2018-2020), a retrospective review was undertaken in two neighbouring maternity hospitals; one of which screens for AB (Rotunda hospital (RH)) and one which does not (National Maternity Hospital (NMH)). Patients were included on the basis of fulfilling the IDSA definition for pyelonephritis and requiring admission for intravenous antibiotics. Rates of antenatal pyelonephritis were compared between hospitals, and between screened and unscreened populations. Secondary outcomes including rates of preterm births and LBWI were compared across sites. Results: A total of 47,676 deliveries between the two centres (24,768 RH; 22,908 NMH) were assessed, of which 158 patients met inclusion criteria for antenatal pyelonephritis (n = 88 RH, n = 70 NMH). There was no statistically significant difference in the rate of antenatal pyelonephritis (p = 0.34) or preterm births (p = 0.21) across sites. RH had a significantly higher rate of LBWI at 6.45% versus 5.68% of all births in NMH (p=<0.004). Given the screening rate in RH was below 100%, this cohort was further subdivided into 'RH screened' and 'RH unscreened'. There was no statistically significant difference in the rate of antenatal pyelonephritis both between the 'NMH unscreened' group (n = 70) versus the 'RH screened' group (n = 62) (p = 0.53), or in the 'RH screened' group (n = 62) versus the 'RH unscreened' group (n = 26) (p = 0.53). Conclusion: Omission of a screening programme for AB in NMH did not result in higher rates of antenatal pyelonephritis, preterm birth or LBWI. Our findings may inform decision-making on screening protocols and whether selective screening (i.e. screening in high-risk patients only) could be more cost-effective without compromising best quality of care.
MeSH term(s)	Pregnancy ; Female ; Humans ; Infant, Newborn ; Bacteriuria/diagnosis ; Bacteriuria/epidemiology ; Bacteriuria/complications ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/epidemiology ; Premature Birth/epidemiology ; Premature Birth/prevention & control ; Retrospective Studies ; Pyelonephritis/diagnosis ; Pyelonephritis/epidemiology ; Parturition
Language	English
Publishing date	2023-07-25
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2023.07.016
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Zs.A 837: Show issues

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Article ; Online: Preparing for Group B

Geoghegan, Sarah / Faerber, Jennifer / Stephens, Laura / Gillan, Hannah / Drew, Richard J / Eogan, Maeve / Feemster, Kristen A / Butler, Karina M

Human vaccines & immunotherapeutics

2023 Volume 19, Issue 1, Page(s) 2195331

Abstract: ... Group ... ...

Abstract	Group B
MeSH term(s)	Infant ; Female ; Pregnancy ; Humans ; Pregnant Women ; Pregnancy Complications, Infectious/prevention & control ; Vaccination ; Cross-Sectional Studies ; Streptococcal Vaccines ; Health Knowledge, Attitudes, Practice ; Streptococcus agalactiae ; Streptococcal Infections/prevention & control
Chemical Substances	Streptococcal Vaccines
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2664176-8
ISSN	2164-554X ; 2164-5515
ISSN (online)	2164-554X
ISSN	2164-5515
DOI	10.1080/21645515.2023.2195331
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Article ; Online: Haemophilus influenzae

Reilly, Aoife S / McElligott, Martha / Mac Dermott Casement, Conor / Drew, Richard J

Journal of medical microbiology

2022 Volume 71, Issue 10

Abstract: Since the introduction ... ...

Abstract	Since the introduction of
MeSH term(s)	Humans ; Infant ; Haemophilus influenzae type b/genetics ; Haemophilus Infections/epidemiology ; Haemophilus Infections/prevention & control ; Multilocus Sequence Typing ; Haemophilus Vaccines ; Haemophilus influenzae ; Ampicillin ; Vaccination
Chemical Substances	Haemophilus Vaccines ; Ampicillin (7C782967RD)
Language	English
Publishing date	2022-08-10
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	218356-0
ISSN	1473-5644 ; 0022-2615
ISSN (online)	1473-5644
ISSN	0022-2615
DOI	10.1099/jmm.0.001606
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Article ; Online: Epidemiological typing of methicillin resistant

Broderick, Deirdre / Brennan, Gráinne I / Drew, Richard J / O'Connell, Brian

Infection prevention in practice

2021 Volume 3, Issue 1, Page(s) 100124

Abstract: It has previously been reported that maternity hospitals have lower levels of MRSA compared to other healthcare facilities, due to the patient population - mostly healthy patients with limited healthcare contact. In this epidemiological study, all MRSA ... ...

Abstract	It has previously been reported that maternity hospitals have lower levels of MRSA compared to other healthcare facilities, due to the patient population - mostly healthy patients with limited healthcare contact. In this epidemiological study, all MRSA isolates recovered from patients attending a maternity hospital from 2014 - 2019 were investigated. 171 isolates from adults (n=120) and babies (n=51) from diagnostic and screening investigations were submitted to the National MRSA Reference Laboratory (NMRSARL). Investigations included:
Language	English
Publishing date	2021-01-24
Publishing country	England
Document type	Journal Article
ISSN	2590-0889
ISSN (online)	2590-0889
DOI	10.1016/j.infpip.2021.100124
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Article ; Online: The full blood count in screening asymptomatic infants for early-onset sepsis: A cross-sectional study.

Coveney, John / O'Loughlin, John / Ainle, Fionnuala Ní / Drew, Richard J / Boyle, Michael A

Acta paediatrica (Oslo, Norway : 1992)

2022 Volume 112, Issue 3, Page(s) 385–390

Abstract: Aim: The full blood count (FBC) is commonly measured as part of a partial septic work-up in asymptomatic infants at increased risk of early-onset neonatal sepsis (EOS). To determine the impact of FBC parameters on infants' subsequent management a ... ...

Abstract	Aim: The full blood count (FBC) is commonly measured as part of a partial septic work-up in asymptomatic infants at increased risk of early-onset neonatal sepsis (EOS). To determine the impact of FBC parameters on infants' subsequent management a retrospective cross-sectional study was performed. Methods: Infants, born at ≥34 weeks gestation, asymptomatic at birth, undergoing a partial septic work-up and receiving prophylactic antibiotics due to increased risk of EOS in a single centre over a 2-year period, were included. The primary outcome measure was frequency of FBC result impacting on duration of antibiotic therapy. Secondary outcome measures included frequency of FBC parameters outside of the reference range and incidental diagnoses. Results: In total, 16 726 live-born infants were delivered during the study period. A total of 802 (4.8%) were included. Thirteen infants (1.6%) received a prolonged course of antibiotics due to suspicion for EOS. Two of these infants had elevated white cell counts. All had normal neutrophil counts. In no case did the FBC result influence the decision to prolong the antibiotic course. Conclusion: In a cohort of 802 infants, asymptomatic at birth and at increased risk of EOS, the FBC result did not impact on the decision to prolong the course of antibiotics for suspicion of EOS.
MeSH term(s)	Infant, Newborn ; Humans ; Infant ; Cross-Sectional Studies ; Retrospective Studies ; Sepsis ; Neonatal Sepsis/diagnosis ; Neonatal Sepsis/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Risk Factors
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-12-02
Publishing country	Norway
Document type	Journal Article
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.16602
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Article ; Online: Evaluation of molecular testing for Mycoplasma genitalium for symptomatic women.

Brehony, Carina / Eogan, Maeve / Lambert, John S / Drew, Richard J

Irish journal of medical science

2021 Volume 191, Issue 4, Page(s) 1771–1775

Abstract: Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STI) with a capacity to rapidly develop antibiotic resistance. The aim of this work was to carry out an evaluation and descriptive analysis of routine molecular testing of M. ... ...

Abstract	Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STI) with a capacity to rapidly develop antibiotic resistance. The aim of this work was to carry out an evaluation and descriptive analysis of routine molecular testing of M. genitalium in symptomatic women at the Rotunda Hospital, Dublin January 2018-December 2019. 1972 specimens were tested from1291 individual symptomatic female patients > 18 years old. The median age was 29 (range 18-71). There were 10 confirmed positive specimens (0.77%); median patient age 26 (range 18-34); seven were obstetrics/gynaecology patients and three were attendees at a sexual assault treatment unit (SATU). The prevalence of positive cases in the ≥ 18 ≤ 30-year-old age group (n = 683) was six times that of the ≥ 30 year-old age group (n = 608) at 1.3% versus 0.2%. Patient symptoms included: discharge in five (50%); pelvic pain on examination in five (50%); abdominal pain in two (20%); pelvic bleeding in two (20%); dyspareunia in two (20%) patients. Co-infections were present in three patients (30%). Macrolide resistance was detected in two positives (28.6%). This initial pilot study prompts the following recommendations which require further study and consideration: 1. promotion of M. genitalium status to notifiable disease; 2 widespread screening of female population not warranted; 3. M. genitalium testing for women symptomatic for STIs; 4. antibiotic resistance testing of all positive cases. 5. Further research into other potential risk groups.
MeSH term(s)	Adolescent ; Adult ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Drug Resistance, Bacterial ; Female ; Humans ; Macrolides ; Molecular Diagnostic Techniques ; Mycoplasma Infections/diagnosis ; Mycoplasma Infections/drug therapy ; Mycoplasma Infections/epidemiology ; Mycoplasma genitalium/genetics ; Pilot Projects ; Prevalence
Chemical Substances	Anti-Bacterial Agents ; Macrolides
Language	English
Publishing date	2021-09-21
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-021-02782-1
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