“Good cholesterol” associated with raised risk of infectious diseases, according to Danish researchers

Scientists in Copenhagen have discovered that patients with both low and high rates of HDL, the so-called good cholesterol, had a higher risk of being hospitalised with an infectious disease; they also had an increased risk of dying from an infectious disease.

These findings  were based on analysis of data from 100,000 individuals from the Copenhagen General Population Study who were followed for over 6 years using national Danish health registries. The paper has just been published in the European Heart Journal (via Science Daily).

Abstract

Aims

Preclinical evidence has indicated that HDL may play an important role in the immune system; however, very little is known about the role of HDL in the immune system in humans. We tested the hypothesis that low and high concentrations of HDL cholesterol are associated with risk of infectious disease in the general population.

Methods and results

We included 97 166 individuals from the Copenhagen General Population Study and 9387 from the Copenhagen City Heart Study with measurements of HDL cholesterol at baseline. The primary endpoint was any infectious disease requiring hospital admission, ascertained in the Danish health registries from baseline in 2003–13 or 1991–94 through 2014; 9% and 31% of individuals in the two studies experienced one or more infectious disease events. Using restricted cubic splines, there was a U-shaped association between concentrations of HDL cholesterol and risk of any infection. Following multifactorial adjustment, individuals with HDL cholesterol below 0.8 mmol/L (31 mg/dL) and above 2.6 mmol/L (100 mg/dL) had hazard ratios for any infection of 1.75 (95% confidence interval 1.31–2.34) and 1.43 (1.16–1.76), compared to those with HDL cholesterol of 2.2–2.3 mmol/L (85–95 mg/dL). In the Copenhagen City Heart Study, corresponding hazard ratios for any infection were 2.00 (1.16–3.43) and 1.13 (0.80–1.60).

Conclusion

Low and high HDL cholesterol concentrations found in 21% and 8% of individuals were associated with higher risk of infectious disease in the general population. These findings do not necessarily indicate causality.
Full reference:

Madsen, : C, M.  Varbo, A.,  Tybjærg-Hansen, A., Frikke-Schmidt, R., G Nordestgaard, B, G., |  U-shaped relationship of HDL and risk of infectious disease: two prospective population-based cohort studies |  European Heart Journal |  Vol. 39 | Issue 14 |  7 April 2018 | P. 1181–1190, https://doi.org/10.1093/eurheartj/ehx665

The full article is available for Rotherham NHS staff to request here 

Infectious diseases in pregnancy screening

Public Health England | April 2018 | Infectious diseases in pregnancy screening: programme standards

The Infectious Diseases in Pregnancy Screening (IDPS) Programme aims to support
health professionals and commissioners in providing a high quality screening
programme. This involves the development and regular review of quality standards
against which data is collected and reported annually. The standards provide a defined set
of measures that providers have to meet to ensure local programmes are safe and
effective. 

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The most recent standards apply to data collected from 1 April 2018. They replace previous versions.  Public Health England (PHE) present the national screening standards for the NHS infectious diseases in pregnancy screening (IDPS) programme in the following documents (PHE).

The standards can be downloaded by following the link

 

 

NHS staff who refuse flu vaccine this winter will have to give reasons

NHS staff who refuse to have the flu vaccine this winter will have to give reasons to their employer, as leaders make efforts to improve take-up rates|  BMJ 2017359 

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Image source: Daniel Dionne – Flickr // CC BY-SA 2.0

 NHS leaders are to write to all NHS staff urging them to be vaccinated against flu as soon as possible. The letter will make it clear that staff who refuse the vaccine will have to give reasons to their employing NHS trust, which will then be recorded.

The heads of NHS England, Public Health England, the Department of Health for England, and NHS Improvement said that they were writing to remind staff of their “professional duty to protect their patients.” Trusts are also being urged to make the flu vaccine “readily available” to staff.

Although last year saw record take-up of the vaccine among staff, more than a third of NHS staff members did not take up the offer, with just a fifth being vaccinated in some trusts.

Hospitals and GP surgeries are being warned by NHS England to be prepared for a big increase in cases of flu this winter after a heavy season in the southern hemisphere.

Full story via BMJ 2017359 doi: https://doi.org/10.1136/bmj.j4766

Staff nurses as antimicrobial stewards

An integrative literature review | American Journal of Infection Control

Background: Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored.

Methods: An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis.

Results: Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management.

Discussion: Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce.

Full reference: Monsees, E. et al. (2017) Staff nurses as antimicrobial stewards: An integrative literature review. American Journal of Infection Control. Vol. 45 (no. 8) pp. 917–922

Antibiotics Don’t Work for 1/4 of Adults with Pneumonia

Approximately 1 in 4 (22.1 percent) adults prescribed an antibiotic in an outpatient setting for community-acquired pneumonia does not respond to treatment, according to a new study presented at the 2017 American Thoracic Society International Conference | Infection Control Today

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Image source: Debbie Marshall – Wellcome Images // CC BY 4.0

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae, the species of bacterium that is the commonest cause of pneumonia.

McKinnell and colleagues conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society of America, published in 2007, provide some direction, but large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.

The researchers examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia.  The scientists defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.  The total antibiotic failure rate was 22.1 percent, while patients with certain characteristics — such as older age, or having certain other diseases in addition to pneumonia — had higher rates of drug failure.  After adjusting for patient characteristics, the failure rates by class of antibiotic were:  beta-lactams (25.7 percent), macrolides (22.9 percent), tetracyclines (22.5 percent), and fluoroquinolones (20.8 percent).

Measles: Don’t let your child catch it

This poster highlights the current new campaign to encourage parents to get their child vaccinated | PHE

measles
Image source: PHE

This poster has been revised and updated as part of the measles elimination strategy. The number of young people catching measles is rising. To be protected they need to be immunised with the MMR vaccine. It’s never too late to be vaccinated. It’s time to make measles a disease of the past.

An A3 size downloadable poster is available here

Can vitamin D really stop you getting cold and flu?

New study claims that Vitamin D can reduce the risk of colds and influenza. A new study, published in the British Medical Journal found that daily pills of the vitamin reduced infections by 12%

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Objectives To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect.

Design Systematic review and meta-analysis of individual participant data (IPD) from randomised controlled trials.

Results 25 eligible randomised controlled trials (total 11 321 participants, aged 0 to 95 years) were identified. Vitamin D supplementation reduced the risk of acute respiratory tract infection among all participants.  In subgroup analysis, protective effects were seen in those receiving daily or weekly vitamin D without additional bolus doses but not in those receiving one or more bolus doses.  Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event. The body of evidence contributing to these analyses was assessed as being of high quality.

Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.

Full reference: Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data  | Published 15 February 2017 | BMJ 2017;356:i6583

See also: BBC News: Vitamin D pills ‘could stop colds or flu’