Publications by authors named "Kevin Schwartz"
Background: Antimicrobial-resistant (AMR) pathogens represent an ongoing global health burden. Colonization is often a prerequisite for infection, but the risk of infection after AMR colonization is not well understood. Using population-level health administrative data, we sought to investigate the risk of infection with the same AMR organism after detection of colonization.
View Article and Find Full Text PDFObjective: To explore the role of local public health organisations in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) surveillance.
Methods: A scoping review was conducted. Peer-reviewed and grey literature from countries within the organisation for economic co-operation and development was searched between 1999 and 2023 using the concepts of local public health, AMR and AMS.
Background: To investigate the prevalence of concomitant bacterial infection across common viral infections.
Methods: This population-based cohort study included patients infected with influenza A and B (FLUA, FLUB) and respiratory syncytial virus (RSV) in Ontario between 2017 and 2019 and patients with SARS-CoV-2 between 2020 and 2021. Specific bacteria present in concomitant infections were identified.
Background: This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness.
Methods: Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.
Background: Understanding how the efficacy of COVID-19 vaccines translates from clinical trials to real-world settings is critical to inform evolving vaccination policies. The objective of this study was to assess COVID-19 vaccine effectiveness (VE) against severe COVID-19-related outcomes in children aged 5-11 years, including COVID-19-related hospital admissions and multisystem inflammatory syndrome in children (MIS-C).
Methods: We conducted a retrospective, population-based cohort study using linked health administrative data in the first year following the emergence of the Omicron variant (January 2 to December 31, 2022) in Ontario, Canada.
Association between maternal mRNA covid-19 vaccination in early pregnancy and major congenital anomalies in offspring: population based cohort study with sibling matched analysis.
BMJ Med
September 2024
Article Synopsis
- A study was conducted to investigate whether maternal vaccination with mRNA COVID-19 vaccines during the first trimester of pregnancy is linked to a higher rate of major congenital anomalies in newborns.
- The research utilized data from over 174,000 live births in Ontario, Canada, comparing infants born to vaccinated mothers with those born to unvaccinated mothers and their older siblings for better analysis.
- Results indicated that the incidence of major congenital anomalies was slightly lower in vaccinated mothers’ infants (24.3 per 1000 live births) compared to unvaccinated mothers’ infants (26.5 per 1000 live births), suggesting no significant increased risk associated with vaccination during early pregnancy.
Article Synopsis
- A study compared the effectiveness of the Toronto Voluntary Isolation Centre (TVIC) and self-isolation guidance in reducing COVID-19 transmission among households during the pandemic.
- Results showed that the 28-day secondary attack rate was significantly lower in TVIC households (5.2%) compared to self-isolation households (8.4%), indicating a 50% reduction in transmission risk.
- The findings suggest that voluntary isolation centres can be beneficial not only for SARS-CoV-2 but may also help control future outbreaks of other infectious diseases, especially for individuals struggling to isolate at home.
Background: Group B (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35-37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.
Methods: Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data.
Article Synopsis
- Late identification of SARS-CoV-2 outbreaks in long-term care homes is linked to higher rates of secondary infections and mortality among residents.
- A study of outbreaks in Ontario from March to November 2020 showed that 36.4% were identified late, leading to significantly increased infection (10.3%) and mortality rates (3.2%) compared to early identified outbreaks (3.3% and 0.9% respectively).
- The findings suggest timely outbreak identification is crucial for better management and response to respiratory infections in LTC homes, helping to reduce adverse effects on residents.
Background: Unnecessary antibiotic prescriptions in primary care are common and contribute to antimicrobial resistance in the population. Audit and feedback (A&F) on antibiotic prescribing to primary care can improve the appropriateness of antibiotic prescribing, but the optimal approach is uncertain. We performed two pragmatic randomized controlled trials of different approaches to audit and feedback.
View Article and Find Full Text PDFArticle Synopsis
- There is a significant need for clinical trials that include infants, children, and adolescents to ensure evidence-based care; this communication discusses three different trial design strategies to address this issue.
- The three strategies include sequential, parallel, and unified adult-pediatric Bayesian adaptive designs, which allow for better integration of pediatric populations into clinical research.
- The unified design, exemplified by the SNAP trial, utilizes Bayesian hierarchical models to share data across age groups, enhancing accuracy in assessing treatment safety and efficacy for both children and adults.
Background: Randomized trials conducted in low- and middle-income settings demonstrated efficacy of influenza vaccination during pregnancy against influenza infection among infants <6 months of age. However, vaccine effectiveness (VE) estimates from settings with different population characteristics and influenza seasonality remain limited.
Methods: We conducted a test-negative study in Ontario, Canada.
Article Synopsis
- The study analyzed the risk factors and outcomes for patients with Gram-negative bloodstream infections (GN-BSI) who experience persistent bacteraemia, which is when bacteria remain in the bloodstream after initial treatment.
- Out of 8807 hospitalized patients, 600 (6.8%) exhibited persistent bacteraemia, linked to factors like having a permanent catheter, antimicrobial resistance, ICU admission, and specific types of infections.
- The research found that patients with persistent bacteraemia had significantly higher mortality rates within 30 days (17.2%) and 90 days (25.5%) compared to those without, suggesting the need for better risk assessment tools for these patients.
Objectives: To determine COVID-19 vaccine uptake among physicians in Ontario, Canada from 14 December 2020 to 13 February 2022.
Design: Population-based retrospective cohort study.
Setting: All registered physicians in Ontario, Canada using data from linked provincial administrative healthcare databases.
Article Synopsis
- The study aimed to determine if giving family physicians feedback on their antibiotic prescribing practices compared to their peers would help reduce unnecessary prescriptions, particularly for patients aged 65 and older.
- It was a randomized controlled trial conducted among primary care physicians in Ontario, Canada, where eligible doctors either received feedback letters or were placed in a control group without feedback.
- Results showed that, after six months, physicians who received feedback had a slightly lower mean antibiotic prescribing rate compared to the control group, indicating some effectiveness of the intervention in reducing unnecessary prescriptions.
Objectives: Data supporting routine infectious diseases (ID) consultation in gram-negative bloodstream infection (GN-BSI) are limited. We evaluated the association between ID consultation and mortality in patients with GN-BSI in a retrospective population-wide cohort study in Ontario using linked health administrative databases.
Methods: Hospitalized adult patients with GN-BSI between April 2017 and December 2021 were included.
Background: Coronavirus disease 2019 (COVID-19) vaccination has been associated with reduced outpatient antibiotic prescribing among older adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the impact of COVID-19 vaccination on outpatient antibiotic prescribing in the broader population of older adults, regardless of SARS-CoV-2 infection status.
Methods: We included adults aged ≥65 years who received their first, second, and/or third COVID-19 vaccine dose from December 2020 to December 2022.
Background: Antibiotic overuse and misuse in primary care are common, highlighting the importance of antimicrobial stewardship (AMS) efforts in this setting. Audit and feedback (A&F) interventions can improve professional practice and performance in some settings.
Objectives And Methods: To leverage the expertise from international members of the Joint Programming Initiative on Antimicrobial Resistance - Primary care Antibiotic Audit and feedback Network (JPIAMR-PAAN).
Article Synopsis
- A study investigated the effectiveness of follow-up blood cultures (FUBCs) on mortality rates in patients with Gram-negative bloodstream infections (GN-BSI) in Ontario, Canada, determining that their utility is controversial due to previous observational studies' limitations.
- The analysis included over 34,000 hospitalized adults, revealing that 25.8% received FUBCs, with no significant difference in 30-day mortality rates between those who did and those who did not (10.1% vs. 8.9%).
- Results also indicated that patients receiving FUBCs had longer hospital stays (11 days vs. 7 days) and fewer days alive outside the hospital, suggesting that while FUBCs
Objective: To compare myocarditis/pericarditis risk after COVID-19 mRNA vaccination versus SARS-CoV-2 infection, and to assess if myocarditis/pericarditis risk varies by vaccine dosing interval.
Methods: In this retrospective cohort study, we used linked databases in Quebec, Ontario, and British Columbia between January 26, 2020, and September 9, 2021. We included individuals aged 12 or above who received an mRNA vaccine as the second dose or were SARS-CoV-2-positive by RT-PCR.
BackgroundWaning immunity from seasonal influenza vaccination can cause suboptimal protection during peak influenza activity. However, vaccine effectiveness studies assessing waning immunity using vaccinated and unvaccinated individuals are subject to biases.AimWe examined the association between time since vaccination and laboratory-confirmed influenza to assess the change in influenza vaccine protection over time.
View Article and Find Full Text PDFBackground: Overuse of antimicrobials in residents of long-term care homes is common and can result in harm. Antimicrobial stewardship interventions are needed in the long-term care (LTC) homes setting to improve the appropriate use of antimicrobials. Previous literature has highlighted the importance of documenting antimicrobial indication as a strategy that contributes to improve antimicrobial use; however, there is a lack of evidence in LTC homes.
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