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It is not well investigated whether exposure to specific drug classes is associated with COVID-19. We investigated the risk of SARS-CoV-2 infection and severe COVID-19 among healthcare workers according to prescription drug use. We conducted an observational study among Danish healthcare workers. SARS-CoV-2 positivity was defined as a positive PCR/ELISA test throughout 2020 and severe COVID-19 as any above 48-hour hospitalization within 14 days after infection. Patient characteristics came from online surveys while data on SARS-CoV-2, drugs and hospitalizations came from Danish Health Registers. Infected individuals were matched with uninfected controls based on age, sex, and chronic diseases. Drug exposure was defined as any prescription redemption in the past six and one month(s) before infection for each drug class. Models assessing the risk of infection (conditional logistic regression) and severe COVID-19 (logistic regressions) versus drug usage were adjusted for BMI, smoking, alcohol, education, region, and patient contact when possible. We matched 5,710 SARS-CoV-2-infected cases with 57,021 controls. The odds of infection were reduced by calcium channel blocker (adjusted odds ratio (aOR) 0.81, 95% Confidence Interval (CI): 0.66-1.00) and vasoprotective drug (aOR 0.77, CI: 0.62-0.95) usage during the six months before infection compared to no usage. Exposure to antibacterials in the past month increased the odds of infection (aOR 1.27, CI: 1.09-1.48). Among infected participants, the odds of severe COVID-19 were higher with usage of almost any investigated drug, especially, diuretics (crude odds radio (OR) 4.82, CI:2.15-10.83), obstructive airway disease drugs (OR 4.49, CI: 2.49-8.08), and antibacterials (OR 2.74 CI:1.62-4.61). In conclusion, antibacterials were associated with more SARS-CoV-2 infections and calcium channel blockers with less. Once infected, users of prescription drugs had higher odds of developing severe COVID-19. These findings suggest a need for studies to clarify interactions between specific drug groups, behaviour, known risk factors, and disease susceptibility/severity.

Background: Radicular pain is the most predominant symptom among adults with Lyme neuroborreliosis (LNB) but the duration preceding and following diagnosis remains unknown. We aimed to investigate whether patients with LNB have increased obtainment of analgesics before and after diagnosis and for how long. Methods: We performed a nationwide, population-based, matched cohort study (2009–2021). all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis) were included. To form a comparison cohort, individuals from the general population were randomly extracted and matched 10:1 to patients with LNB on age and sex. Outcomes were obtainment of simple analgesics, antiepileptics, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, tramadol, and other opioids. We calculated monthly and six-monthly proportions of individuals with obtainment of analgesics and absolute risk differences. Results: 1,056 patients with LNB and 10,560 comparison cohort members were included. An increased proportion of patients with LNB obtained analgesics from 3 months before study inclusion, especially simple analgesics, tramadol, and other opioids. Within the 0–1-month period after study inclusion, patients with LNB most frequently obtained simple analgesics (15 %), antiepileptics (11 %), and tramadol (10 %). Thereafter, obtainment of analgesics declined within a few months. A slightly larger proportion of patients with LNB obtained antiepileptics up to 2.5 years after diagnosis. Conclusions: Up to 3 months preceding diagnosis, LNB was preceded by increased obtainment of analgesics, which suggests diagnostic delay. Importantly, most patients with LNB did not obtain analgesics after the immediate disease course, although obtainment remained more frequent up to 2.5 years after.

Background: Lyme borreliosis is a tick-borne disease caused by the bacterium Borrelia burgdorferi (Bb) sensu lato complex. Previous studies have suggested an association between Lyme borreliosis and heart failure, which have been suggested to be a possible manifestation of Lyme carditis. We aimed to investigate the risk of heart failure among individuals tested for serum Bb antibodies, and serum Bb seropositive individuals. Methods: We performed a matched nationwide cohort study (Denmark, 1993–2020) and included 52,200 Bb seropositive individuals, and two age- and sex-matched comparison cohorts: 1) 104,400 Bb seronegative comparison cohort members, and 2) 261,000 population controls. We investigated the risk associated with 1) being tested for serum Bb antibodies, and 2) being Bb seropositive. Outcomes were: 1) a composite of heart failure, cardiomyopathy, and/or myocarditis diagnosis, and 2) redemption of cardiovascular medicine used for treatment of heart failure. We calculated short-term odds ratios (aOR) (within 1 month) and long-term hazard rates (aHR) (after 1 month) adjusted for age, sex, diabetes, pre-existing heart failure, and kidney disease. Results: Compared with the population controls, individuals tested for Bb antibodies, regardless of the test result, had increased short-term risk of heart failure, cardiomyopathy, and myocarditis (aOR 8.3, 95 %CI: 6.7–10.2), and both increased short- and long-term risk of redemption of cardiovascular medicine (aOR 4.3, 95 %CI: 3.8–4.8, aHR 1.13, 95 % CI: 1.11–1.15). The Bb seropositive individuals had no increased short- or long-term risk of any outcome compared with Bb seronegative comparison cohort members. Conclusions: In conclusion, Bb antibody tests seemed to be performed in the diagnostic work-up of heart failure, but Bb seropositivity was not associated with heart failure.

ObjectivesAn increasing incidence of positive blood cultures has been reported in several countries. This represents an important challenge for public health due to the large number of hospital admissions with high mortality among these patients. This study aims to characterize the epidemiology and mortality associated with positive blood cultures.Study design and methodsWe performed a nationwide cohort study, identifying all individuals with a blood culture drawn in Denmark from 2010 to 2022. We estimated the incidence of positive blood cultures and 30-day mortality per 100,000 individuals and modeled the case fatality rate (CFR) and population incidences with regression techniques.ResultsWe identified almost 4 million blood cultures drawn during the study period, increasing 64% from 220,757 in 2010 to 362,239 in 2022. During this period, the underlying population increased only 10%, whereas the population of older adults above 85 years increased 3.3 times. The positivity rate was 9.8%, and the most common pathogens were Escherichia coli (29%) and other pathogens associated with urinary tract infection, whereas Staphylococcus aureus accounted for 12%, and Enterococcus faecium for 4.1%. The 30-day CFR was 17% with a small reduction during the study period, with notable differences according to species.ConclusionWe found a substantial rise in blood culture activity and the incidence of positive cultures. This rise is driven by an increasing number of older citizens, which is expected to increase further in the coming years. Considering the high risk of mortality and increasing incidence, a national surveillance of bacteremia is warranted.

Except for a few countries, comprehensive all-cause surveillance for bacteremia is not part of mandatory routine public health surveillance. We argue that time has come to include automated surveillance for bacteremia in the national surveillance systems, and explore diverse approaches and challenges in establishing bacteremia monitoring. Assessed against proposed criteria, surveillance for bacteremia should be given high priority. This is based on severity, burden of illness, health gains obtained by improved treatment and prevention, risk of outbreaks (including health care associated infections), the emergence of antimicrobial drug resistance as well as the changing epidemiology of bacteremia which is seen along with an aging population and advances in medical care. The establishment of comprehensive surveillance for bacteremia was until recently conceived as an insurmountable task. With computerized systems in clinical microbiology, surveillance by real-time data capture has become achievable. This calls for re-addressing the question of including bacteremia among the conditions under mandatory surveillance. Experiences from several countries, including Denmark, show that this is feasible. We propose enhanced international collaboration, legislative action, and funding to address the challenges and opportunities.