Pub Date : 2025-02-06DOI: 10.1016/j.cmi.2025.02.005
Nina Lutz, Vladimir Lazarevic, Nadia Gaïa, Abdessalam Cherkaoui, Jacques Schrenzel
{"title":"Primary meningococcal arthritis by a nonencapsulated Neisseria meningitidis strain.","authors":"Nina Lutz, Vladimir Lazarevic, Nadia Gaïa, Abdessalam Cherkaoui, Jacques Schrenzel","doi":"10.1016/j.cmi.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.02.005","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.cmi.2025.02.001
Fariba Donovan, Mark Bresnik, Belinda Lovelace, Lia Pizzicato, Vamshi Ruthwik Anupindi, Mitchell DeKoven, Craig I Coleman
Objectives: To describe baseline characteristics, antifungal treatment patterns, healthcare utilization, costs, and mortality in patients with central nervous system (CNS) and non-CNS disseminated coccidioidomycosis.
Methods: A retrospective study using IQVIA claims data was conducted to identify adults with disseminated coccidioidomycosis in two mutually exclusive cohorts: those with CNS and those with non-CNS disease. Patients had to have ≥1 medical claim for disseminated coccidioidomycosis from October 2015-November 2022. Antifungal treatment patterns were assessed, as were all-cause healthcare utilization, costs, and mortality during follow-up.
Results: In total, 2,218 patients were identified, 28.2% (626/2,218) with CNS and 71.8% (1,592/2,218) with non-CNS disease. In both cohorts, 70.9% (444/626) and 71.6% (1,140/1,592) of patients initiated first-line antifungal treatment, most with fluconazole (881/1,140, 77.3% to 372/444, 83.8%), followed by an azole+lipid amphotericin B (21/444, 4.7% to 81/1140, 7.1%). Azole monotherapy was used often over subsequent lines of antifungal treatment in both cohorts (1,049/1,140, 92.0% to 122/129, 94.6%). Polyenes peaked in the latter lines of therapy (24/182,13.2% to 79/408, 19.4%), mostly administered with azoles. Median baseline costs in the CNS and non-CNS cohorts were substantial ($9,122 and $8,242, respectively). After diagnosis, 29.7% (186/626) of patients in the CNS cohort experienced a subsequent hospitalization and all-cause cost of $28,664 per person per year. The non-CNS patients experienced a similar proportion of patients requiring hospitalization (469/1,592, 29.5%) and all-cause costs of $21,240 per person per year. Between 5.4% (34/626) and 6.7% (106/1,592) of patients died during follow-up, with death more likely in those with concomitant pulmonary coccidioidomycosis, sepsis, certain immunosuppressive diseases and prior azole use.
Conclusions: Most patients with either CNS or non-CNS disseminated coccidioidomycosis received an azole first-line and demonstrated azole-cycling over subsequent lines. Polyenes were used in the latter lines. Patients utilized substantial healthcare resources and accrued appreciable costs, both prior to and after diagnosis.
{"title":"Antifungal therapy patterns, healthcare utilization, costs, and mortality in central nervous system and non-central nervous system disseminated coccidioidomycosis across the continuum-of-care.","authors":"Fariba Donovan, Mark Bresnik, Belinda Lovelace, Lia Pizzicato, Vamshi Ruthwik Anupindi, Mitchell DeKoven, Craig I Coleman","doi":"10.1016/j.cmi.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.02.001","url":null,"abstract":"<p><strong>Objectives: </strong>To describe baseline characteristics, antifungal treatment patterns, healthcare utilization, costs, and mortality in patients with central nervous system (CNS) and non-CNS disseminated coccidioidomycosis.</p><p><strong>Methods: </strong>A retrospective study using IQVIA claims data was conducted to identify adults with disseminated coccidioidomycosis in two mutually exclusive cohorts: those with CNS and those with non-CNS disease. Patients had to have ≥1 medical claim for disseminated coccidioidomycosis from October 2015-November 2022. Antifungal treatment patterns were assessed, as were all-cause healthcare utilization, costs, and mortality during follow-up.</p><p><strong>Results: </strong>In total, 2,218 patients were identified, 28.2% (626/2,218) with CNS and 71.8% (1,592/2,218) with non-CNS disease. In both cohorts, 70.9% (444/626) and 71.6% (1,140/1,592) of patients initiated first-line antifungal treatment, most with fluconazole (881/1,140, 77.3% to 372/444, 83.8%), followed by an azole+lipid amphotericin B (21/444, 4.7% to 81/1140, 7.1%). Azole monotherapy was used often over subsequent lines of antifungal treatment in both cohorts (1,049/1,140, 92.0% to 122/129, 94.6%). Polyenes peaked in the latter lines of therapy (24/182,13.2% to 79/408, 19.4%), mostly administered with azoles. Median baseline costs in the CNS and non-CNS cohorts were substantial ($9,122 and $8,242, respectively). After diagnosis, 29.7% (186/626) of patients in the CNS cohort experienced a subsequent hospitalization and all-cause cost of $28,664 per person per year. The non-CNS patients experienced a similar proportion of patients requiring hospitalization (469/1,592, 29.5%) and all-cause costs of $21,240 per person per year. Between 5.4% (34/626) and 6.7% (106/1,592) of patients died during follow-up, with death more likely in those with concomitant pulmonary coccidioidomycosis, sepsis, certain immunosuppressive diseases and prior azole use.</p><p><strong>Conclusions: </strong>Most patients with either CNS or non-CNS disseminated coccidioidomycosis received an azole first-line and demonstrated azole-cycling over subsequent lines. Polyenes were used in the latter lines. Patients utilized substantial healthcare resources and accrued appreciable costs, both prior to and after diagnosis.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.cmi.2025.02.003
Salam Abbara, Aurélien Dinh
{"title":"Antimicrobial stewardship in primary care telemedicine: the way forward.","authors":"Salam Abbara, Aurélien Dinh","doi":"10.1016/j.cmi.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.02.003","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.cmi.2025.02.004
Tao Chen, Meng Zhang, Qian Liu, Wensi Li, Zhilin Zeng, Chuanwen Chen, Yi Zhou, Tiantong Zhou, Yaping Li, Wei Wang, Quan Ming, Jun Zhu, Zhaohai Zeng, Feng Zhu, Weiming Yan, Peng Wang, Yuxin Niu, Yunhui Liu, Lanyue Huang, Wei Liu, Qiuyu Cheng, Yuzhao Feng, Tingting Liu, Xiaojing Wang, Guang Chen, Di Wu, Qin Ning
Objective: The global incidence of severe fever with thrombocytopenia syndrome (SFTS) has markedly increased over the past decade. There is an urgent need to establish a reliable scoring system for predicting mortality of SFTS patients.
Methods: In this ambispective study, 714 SFTS patients were recruited from 11 sites in China. Among these, 544 patients hospitalized for SFTS from May 2012 to June 2022 were included retrospectively in the training cohort, and 170 were prospectively enrolled between April 2021 and November 2023 in the validation cohort. Logistic regression analysis was performed to identify risk factors for 30-day mortality. A nomogram model (SFTS-logistic model) and a simplified scoring system (SFTS-Wuhan model) were established for predicting mortality. The performance of these models in terms of calibration, discrimination, and clinical utility was evaluated and validated.
Results: The 30-day mortality rate was 12.89% (92/714). The mean age was 65 years old (IQR 57-71), and 322 (45.10%) patients were male. The SFTS-logistic model and SFTS-Wuhan model were developed based on seven independent risk factors, including age (AOR=1.062, 95%CI (1.019-1.106)), temperature at admission (AOR=1.599, 95%CI (1.095-2.336)), white blood cell count (AOR=0.799, 95%CI (0.653-0.978)), platelet count (AOR=0.977, 95%CI (0.959-0.996)), aspartate aminotransferase (AOR=1.001, 95%CI (1.000-1.003)), creatinine (AOR=1.006, 95%CI (1.001-1.011)), and vasopressors use (AOR=6.270, 95%CI (1.397-28.146)). Both models demonstrated good discrimination with areas under the ROC curve above 0.84, satisfactory calibration, and comparable clinical net benefit in the training and validation cohorts.
Conclusions: The prognostic scoring model and its simplified surrogate can serve as robust tools for mortality risk stratification in SFTS, allowing the early identification of high-risk patients.
{"title":"Development and validation of a novel mortality risk stratification simplified scoring scale for severe fever with thrombocytopenia syndrome.","authors":"Tao Chen, Meng Zhang, Qian Liu, Wensi Li, Zhilin Zeng, Chuanwen Chen, Yi Zhou, Tiantong Zhou, Yaping Li, Wei Wang, Quan Ming, Jun Zhu, Zhaohai Zeng, Feng Zhu, Weiming Yan, Peng Wang, Yuxin Niu, Yunhui Liu, Lanyue Huang, Wei Liu, Qiuyu Cheng, Yuzhao Feng, Tingting Liu, Xiaojing Wang, Guang Chen, Di Wu, Qin Ning","doi":"10.1016/j.cmi.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.02.004","url":null,"abstract":"<p><strong>Objective: </strong>The global incidence of severe fever with thrombocytopenia syndrome (SFTS) has markedly increased over the past decade. There is an urgent need to establish a reliable scoring system for predicting mortality of SFTS patients.</p><p><strong>Methods: </strong>In this ambispective study, 714 SFTS patients were recruited from 11 sites in China. Among these, 544 patients hospitalized for SFTS from May 2012 to June 2022 were included retrospectively in the training cohort, and 170 were prospectively enrolled between April 2021 and November 2023 in the validation cohort. Logistic regression analysis was performed to identify risk factors for 30-day mortality. A nomogram model (SFTS-logistic model) and a simplified scoring system (SFTS-Wuhan model) were established for predicting mortality. The performance of these models in terms of calibration, discrimination, and clinical utility was evaluated and validated.</p><p><strong>Results: </strong>The 30-day mortality rate was 12.89% (92/714). The mean age was 65 years old (IQR 57-71), and 322 (45.10%) patients were male. The SFTS-logistic model and SFTS-Wuhan model were developed based on seven independent risk factors, including age (AOR=1.062, 95%CI (1.019-1.106)), temperature at admission (AOR=1.599, 95%CI (1.095-2.336)), white blood cell count (AOR=0.799, 95%CI (0.653-0.978)), platelet count (AOR=0.977, 95%CI (0.959-0.996)), aspartate aminotransferase (AOR=1.001, 95%CI (1.000-1.003)), creatinine (AOR=1.006, 95%CI (1.001-1.011)), and vasopressors use (AOR=6.270, 95%CI (1.397-28.146)). Both models demonstrated good discrimination with areas under the ROC curve above 0.84, satisfactory calibration, and comparable clinical net benefit in the training and validation cohorts.</p><p><strong>Conclusions: </strong>The prognostic scoring model and its simplified surrogate can serve as robust tools for mortality risk stratification in SFTS, allowing the early identification of high-risk patients.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.cmi.2024.08.021
Valentina Galfo, Giusy Tiseo, Niccolò Riccardi, Marco Falcone
Background
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with high mortality rates. Optimal antibiotic dosage plays a crucial role in reducing MRSA burden; thus, the use of therapeutic drug monitoring (TDM) in the clinical practice, especially of new drugs such as ceftobiprole, ceftaroline, dalbavancin, and oritavancin, should be implemented.
Objectives
We aim to examine and summarize the available evidence about TDM of anti-MRSA molecules, with a focus on pneumonia, endocarditis and vascular infections, and bone and joint infections.
Sources
We applied ‘therapeutic drug monitoring’ and ‘Staphylococcus aureus’ as search terms in PubMed, considering a time frame of 24 years (2001–2024). Articles in English language, non-duplicated, evaluating antibiotic therapeutic target, and role of TDM were included in the study.
Content
In this review, available data for therapeutic target and TDM were critically analysed and summarized and suggestions about the use of old and new anti-MRSA antibiotics were provided, focusing on optimal dosages, tissue penetration according to infection types, and toxicity. Limitations to the widespread use of TDM in clinical practice were discussed.
Implications
The use of TDM may play an important role for the optimal management of patients with MRSA infections and may impact on patient outcomes by increasing efficacy and reducing the risk of adverse events. TDM may be implemented in clinical practice; however, several limitations such as the wide variability in the methodology and the need for skilled personnel need to be considered.
{"title":"Therapeutic drug monitoring of antibiotics for methicillin-resistant Staphylococcus aureus infections: an updated narrative review for clinicians","authors":"Valentina Galfo, Giusy Tiseo, Niccolò Riccardi, Marco Falcone","doi":"10.1016/j.cmi.2024.08.021","DOIUrl":"10.1016/j.cmi.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><div>Infections caused by methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) are associated with high mortality rates. Optimal antibiotic dosage plays a crucial role in reducing MRSA burden; thus, the use of therapeutic drug monitoring (TDM) in the clinical practice, especially of new drugs such as ceftobiprole, ceftaroline, dalbavancin, and oritavancin, should be implemented.</div></div><div><h3>Objectives</h3><div>We aim to examine and summarize the available evidence about TDM of anti-MRSA molecules, with a focus on pneumonia, endocarditis and vascular infections, and bone and joint infections.</div></div><div><h3>Sources</h3><div>We applied ‘therapeutic drug monitoring’ and ‘<em>Staphylococcus aureus</em>’ as search terms in PubMed, considering a time frame of 24 years (2001–2024). Articles in English language, non-duplicated, evaluating antibiotic therapeutic target, and role of TDM were included in the study.</div></div><div><h3>Content</h3><div>In this review, available data for therapeutic target and TDM were critically analysed and summarized and suggestions about the use of old and new anti-MRSA antibiotics were provided, focusing on optimal dosages, tissue penetration according to infection types, and toxicity. Limitations to the widespread use of TDM in clinical practice were discussed.</div></div><div><h3>Implications</h3><div>The use of TDM may play an important role for the optimal management of patients with MRSA infections and may impact on patient outcomes by increasing efficacy and reducing the risk of adverse events. TDM may be implemented in clinical practice; however, several limitations such as the wide variability in the methodology and the need for skilled personnel need to be considered.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 2","pages":"Pages 194-200"},"PeriodicalIF":10.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.cmi.2024.08.029
Spinello Antinori , Andrea Giacomelli , Giacomo Casalini , Anna Lisa Ridolfo
{"title":"‘How to manage adult patients with malaria in the non-endemic setting’: author's response","authors":"Spinello Antinori , Andrea Giacomelli , Giacomo Casalini , Anna Lisa Ridolfo","doi":"10.1016/j.cmi.2024.08.029","DOIUrl":"10.1016/j.cmi.2024.08.029","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 2","pages":"Pages 300-301"},"PeriodicalIF":10.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Virulence factors of the causative agent, Bordetella pertussis, may be involved in fulminant pertussis, the most severe form of whooping cough (pertussis) in infants. We aimed to assess the association between fulminant pertussis and the status of pertactin (PRN) production of B. pertussis clinical isolates.
Methods
Symptomatic infants aged <6 months with a positive B. pertussis culture from 2008–2019 were included. B. pertussis isolates and clinical data were collected from French hospital laboratories through the national pertussis surveillance network. Fulminant pertussis was defined as a case with a leukocyte count >40 × 109/L and at least one of the following criteria: respiratory failure, pulmonary hypertension, shock, or multiple organ failure. PRN production was assessed by western blotting. Baseline characteristics of infants and microbiological findings were compared between patients with and without fulminant pertussis. To identify patient and microbiological features associated with fulminant pertussis, a multivariable modified Poisson regression model was developed with confounders selected using a directed acyclic graph.
Results
We included 361 infants with pertussis (median age 63 days [interquartile range, 39–86]), of whom 32 (9%) progressed to fulminant pertussis. None of the mothers was vaccinated during pregnancy. Of the 361 implicated B. pertussis isolates, 294 (81%) produced PRN. Patients with fulminant pertussis were more often neonates (adjusted relative risk [aRR]: 3.62, 95% confidence interval [CI]: 1.76–7.44), infants with a history of prematurity (aRR: 7.08, 95% CI: 3.06–16.36), unvaccinated infants (aRR: 4.42, 95% CI: 1.02–19.24), and infants infected by PRN-producing isolates (aRR: 3.76, 95% CI: 1.02–13.83).
Discussion
PRN-producing B. pertussis was independently associated with an increased risk of fulminant pertussis. In a context where PRN-containing acellular pertussis vaccines favour the emergence of PRN-deficient isolates, our study suggests a positive role for such vaccines in driving the evolution of B. pertussis populations towards reduced virulence.
{"title":"Association between pertactin-producing Bordetella pertussis and fulminant pertussis in infants: a multicentre study in France, 2008–2019","authors":"Pauline Leroux , Soraya Matczak , Valérie Bouchez , Stevenn Volant , Antoine Ouziel , Elise Launay , Albert Faye , Valérie Rabier , Jean Sarlangue , Eric Jeziorski , Zoha Maakaroun-Vermesse , Fouad Madhi , Didier Pinquier , Mathie Lorrot , Marie Pouletty , Aymeric Cantais , Etienne Javouhey , Fatima Aït Belghiti , Sophie Guillot , Carla Rodrigues , Julie Toubiana","doi":"10.1016/j.cmi.2024.09.009","DOIUrl":"10.1016/j.cmi.2024.09.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Virulence factors of the causative agent, <em>Bordetella pertussis</em>, may be involved in fulminant pertussis, the most severe form of whooping cough (pertussis) in infants. We aimed to assess the association between fulminant pertussis and the status of pertactin (PRN) production of <em>B. pertussis</em> clinical isolates.</div></div><div><h3>Methods</h3><div>Symptomatic infants aged <6 months with a positive <em>B. pertussis</em> culture from 2008–2019 were included. <em>B. pertussis</em> isolates and clinical data were collected from French hospital laboratories through the national pertussis surveillance network. Fulminant pertussis was defined as a case with a leukocyte count >40 × 10<sup>9</sup>/L and at least one of the following criteria: respiratory failure, pulmonary hypertension, shock, or multiple organ failure. PRN production was assessed by western blotting. Baseline characteristics of infants and microbiological findings were compared between patients with and without fulminant pertussis. To identify patient and microbiological features associated with fulminant pertussis, a multivariable modified Poisson regression model was developed with confounders selected using a directed acyclic graph.</div></div><div><h3>Results</h3><div>We included 361 infants with pertussis (median age 63 days [interquartile range, 39–86]), of whom 32 (9%) progressed to fulminant pertussis. None of the mothers was vaccinated during pregnancy. Of the 361 implicated <em>B. pertussis</em> isolates, 294 (81%) produced PRN. Patients with fulminant pertussis were more often neonates (adjusted relative risk [aRR]: 3.62, 95% confidence interval [CI]: 1.76–7.44), infants with a history of prematurity (aRR: 7.08, 95% CI: 3.06–16.36), unvaccinated infants (aRR: 4.42, 95% CI: 1.02–19.24), and infants infected by PRN-producing isolates (aRR: 3.76, 95% CI: 1.02–13.83).</div></div><div><h3>Discussion</h3><div>PRN-producing <em>B. pertussis</em> was independently associated with an increased risk of fulminant pertussis. In a context where PRN-containing acellular pertussis vaccines favour the emergence of PRN-deficient isolates, our study suggests a positive role for such vaccines in driving the evolution of <em>B. pertussis</em> populations towards reduced virulence.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 2","pages":"Pages 233-239"},"PeriodicalIF":10.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.cmi.2024.09.028
Pikka Jokelainen , Anne L. Wyllie , Nitin Gupta , Aleksandra Barac , Effrossyni Gkrania-Klotsas , Casandra Bulescu , José Ramón Paño-Pardo , Marta Mora-Rillo , Martin P. Grobusch , F-Xavier Lescure
Pub Date : 2025-02-01DOI: 10.1016/j.cmi.2024.09.027
Syed Mohammad Mazidur Rahman , Pushpita Samina , Tanjina Rahman , Ahammad Shafiq Sikder Adel , Rumana Nasrin , Mohammad Khaja Mafij Uddin , Md Jahid Hasan , Shahriar Ahmed , Paul Daru , Pronab Kumar Modak , Md Abdul Hamid Salim , Sardar Munim Ibna Mohsin , Sayera Banu
Objectives
In high tuberculosis (TB) burden countries such as Bangladesh, research and policy tend to focus on rifampicin (RIF)-resistant TB patients, leaving RIF-sensitive but isoniazid (INH)-resistant (Hr-TB) patients undiagnosed. Our study aims to determine the prevalence of INH resistance among pulmonary TB patients in selected health care facilities in Bangladesh.
Methods
This study was conducted across nine TB Screening and Treatment Centres situated in Bangladesh. Sputum samples from 1084 Xpert-positive pulmonary TB patients were collected between April 2021 and December 2022 and cultured for drug susceptibility testing. Demographic and clinical characteristics of Hr-TB and drug-susceptible TB patients were compared.
Results
Among available drug susceptibility testing results of 998 culture-positive isolates, the resistance rate of any INH regardless of RIF susceptibility was 6.4% (64/998, 95% CI: 4.9–8.2). The rate was significantly higher in previously treated (21.1%, 16/76, 95% CI: 12.0–34.2) compared with newly diagnosed TB patients (5.2%, 48/922, 95% CI: 3.8–6.9) (p < 0.001). The rate of Hr-TB was 4.5% (45/998, 95% CI: 3.3–6.0), which was also higher among previously treated patients (6.6%, 5/76, 95% CI: 1.4–13.5) compared with newly diagnosed TB patients (4.3%; 40/922, 95% CI: 3.1–5.9) (p 0.350). Most importantly, the rate of Hr-TB was more than double compared with MDR-TB (4.5%, 45/998, vs. 1.9%, 19/998) found in the current study.
Discussion
This study reveals a high prevalence of Hr-TB, surpassing even that of the multi-drug-resistant TB in Bangladesh. This emphasizes the urgent need to adopt WHO-recommended molecular tools at the national level for rapid detection of INH resistance so that patients receive timely and appropriate treatment.
{"title":"Isoniazid resistance pattern among pulmonary tuberculosis patients in Bangladesh: An exploratory study","authors":"Syed Mohammad Mazidur Rahman , Pushpita Samina , Tanjina Rahman , Ahammad Shafiq Sikder Adel , Rumana Nasrin , Mohammad Khaja Mafij Uddin , Md Jahid Hasan , Shahriar Ahmed , Paul Daru , Pronab Kumar Modak , Md Abdul Hamid Salim , Sardar Munim Ibna Mohsin , Sayera Banu","doi":"10.1016/j.cmi.2024.09.027","DOIUrl":"10.1016/j.cmi.2024.09.027","url":null,"abstract":"<div><h3>Objectives</h3><div>In high tuberculosis (TB) burden countries such as Bangladesh, research and policy tend to focus on rifampicin (RIF)-resistant TB patients, leaving RIF-sensitive but isoniazid (INH)-resistant (Hr-TB) patients undiagnosed. Our study aims to determine the prevalence of INH resistance among pulmonary TB patients in selected health care facilities in Bangladesh.</div></div><div><h3>Methods</h3><div>This study was conducted across nine TB Screening and Treatment Centres situated in Bangladesh. Sputum samples from 1084 Xpert-positive pulmonary TB patients were collected between April 2021 and December 2022 and cultured for drug susceptibility testing. Demographic and clinical characteristics of Hr-TB and drug-susceptible TB patients were compared.</div></div><div><h3>Results</h3><div>Among available drug susceptibility testing results of 998 culture-positive isolates, the resistance rate of any INH regardless of RIF susceptibility was 6.4% (64/998, 95% CI: 4.9–8.2). The rate was significantly higher in previously treated (21.1%, 16/76, 95% CI: 12.0–34.2) compared with newly diagnosed TB patients (5.2%, 48/922, 95% CI: 3.8–6.9) (p < 0.001). The rate of Hr-TB was 4.5% (45/998, 95% CI: 3.3–6.0), which was also higher among previously treated patients (6.6%, 5/76, 95% CI: 1.4–13.5) compared with newly diagnosed TB patients (4.3%; 40/922, 95% CI: 3.1–5.9) (p 0.350). Most importantly, the rate of Hr-TB was more than double compared with MDR-TB (4.5%, 45/998, vs. 1.9%, 19/998) found in the current study.</div></div><div><h3>Discussion</h3><div>This study reveals a high prevalence of Hr-TB, surpassing even that of the multi-drug-resistant TB in Bangladesh. This emphasizes the urgent need to adopt WHO-recommended molecular tools at the national level for rapid detection of INH resistance so that patients receive timely and appropriate treatment.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 2","pages":"Pages 220-225"},"PeriodicalIF":10.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.cmi.2024.11.016
Susanne Dudman , Arjana Zerja , İmran Hasanoğlu , Simona Ruta , Berend van Welzen , Laura Ambra Nicolini , Paul Yonga , Joakim Øverbø , Sumit Rawat , Selma Habibovic , Tan Bou Kim , Antonio Rivero-Juarez , ESGVH members
Scope
Hepatitis E virus (HEV) is a significant global health issue, impacting both low- and middle-income countries and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in low- and middle-income countries, whereas genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, whereas chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programmes remain limited.
Methods
This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts to formulate strategies for wider HEV vaccination use.
Questions addressed in the position paper
The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programmes, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally.
Implications
European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake.
范围：戊型肝炎病毒（HEV）是一个重大的全球健康问题，对中低收入国家（LMICs）和工业化国家都有影响。戊型肝炎病毒基因 1 型和 2 型主要通过受污染的水传播，在中低收入国家流行，而基因 3 型和 4 型则在工业化地区通过人畜共患病传播。急性 HEV 感染会带来严重风险，尤其是对孕妇和免疫力低下的人，而慢性 HEV 感染则会导致原有肝病患者和接受移植者出现严重并发症。HEV 疫苗的开发提供了新的预防机会，但其可用性和纳入全球免疫计划的程度仍然有限：本立场文件由欧洲临床微生物学和传染病学会（ESCMID）病毒性肝炎研究小组（ESGVH）通过对 HEV 疫苗的临床数据、安全性、有效性和免疫原性的广泛审查而制定。该研究小组特别关注高危人群和特殊人群，综合了全球健康方面的见解，并采纳了战略专家咨询小组 (SAGE) 的建议，为更广泛地使用 HEV 疫苗制定了战略：该立场文件评估了 HEV 疫苗在普通人群和特殊人群中的有效性和安全性。它指出了将 HEV 疫苗纳入常规免疫计划的主要障碍，包括基础设施限制、成本和疫苗的可及性。本文还提出了克服这些挑战和改善疫苗分配的策略。此外，本文还探讨了如何提高公众意识和加强国际合作，以促进全球范围内的 HEV 疫苗接种工作：ESGVH-ESCMID建议育龄妇女、慢性肝病患者和免疫抑制人群等高危人群接种HEV疫苗。优先投资疫苗物流、整合诊断和教育推广可提高疫苗接种率。
{"title":"Global vaccination against hepatitis E virus: position paper from the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group","authors":"Susanne Dudman , Arjana Zerja , İmran Hasanoğlu , Simona Ruta , Berend van Welzen , Laura Ambra Nicolini , Paul Yonga , Joakim Øverbø , Sumit Rawat , Selma Habibovic , Tan Bou Kim , Antonio Rivero-Juarez , ESGVH members","doi":"10.1016/j.cmi.2024.11.016","DOIUrl":"10.1016/j.cmi.2024.11.016","url":null,"abstract":"<div><h3>Scope</h3><div>Hepatitis E virus (HEV) is a significant global health issue, impacting both low- and middle-income countries and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in low- and middle-income countries, whereas genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, whereas chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programmes remain limited.</div></div><div><h3>Methods</h3><div>This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts to formulate strategies for wider HEV vaccination use.</div></div><div><h3>Questions addressed in the position paper</h3><div>The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programmes, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally.</div></div><div><h3>Implications</h3><div>European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 2","pages":"Pages 201-210"},"PeriodicalIF":10.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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