Clinical Microbiology and Infection最新文献

英文中文

Re: ‘The effect of antibiotic therapy for Clostridioides difficile infection on mortality and other patient-relevant outcomes’ by Stabholz et al. 关于Stabholz 等人撰写的 "艰难梭菌感染的抗生素治疗对死亡率和其他患者相关结果的影响"。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.01.030

I-Wen Chen , Chia-Li Kao , Kuo-Chuan Hung

引用次数: 0

Efficacy and safety of ZX-7101A, an inhibitor of influenza cap-dependent endonuclease, in adults with uncomplicated influenza: a randomized, double-blind, placebo-controlled phase 2/3 trial 流感帽依赖性内切酶抑制剂 ZX-7101A 对无并发症流感成人患者的疗效和安全性：随机、双盲、安慰剂对照的 2/3 期试验。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.10.020

Hongyu Wang , Gang Wang , Yan Gao , Lihong Qu , Hong Wang , Min Deng , Hainv Gao , Yilin Li , Nan Yang , Baogui Wang , Rongge Liu , Xuzhu Ma , Zhen Tao , Guoqiang Zhang , Qian Wang , Weifeng Zhao , Yunsong Yu , Lin Chen , Lianchun Liang , Shengyu Wang , Wenhong Zhang

Objectives

To evaluate the efficacy and safety of ZX-7101A: an inhibitor of influenza viral cap-dependent endonuclease, in adults with uncomplicated influenza and explore treatment-emergent resistance.

Methods

We conducted a randomized, double-blind, placebo-controlled, adaptive-design phase 2 and phase 3 studies (ZX-7101A-202) in adults with uncomplicated influenza. Eligible patients were randomized 1:1:1 to receive a single dose of 40 or 80 mg ZX-7101A or placebo, stratified by body weight and baseline composite symptom score. The primary efficacy endpoint was time to alleviation of influenza symptoms (TTAS) in intention-to-treat infected population.

Results

The phase 2 trial suggested significantly shorter TTAS for ZX-7101A compared with placebo: the median TTAS of 40 or 80 mg ZX-7101A groups were 34.7 hours (95% CI, 22.8–43.4; p 0.005) and 45.8 hours (95% CI, 32.0–66.3; p 0.020), compared with 63.6 hours (95% CI, 43.9–93.4) in the placebo group. In the phase 3 trial, the TTAS of both ZX-7101A dose groups was significantly shortened relative to the that of placebo group: the median TTAS was shortened to 48.4 hours (95% CI, 40.5–55.6) for 40 mg group and 39.4 hours (95% CI, 35.8–49.3) for 80 mg group, compared with 62.9 hours (95% CI, 56.4–69.3) for placebo group (p 0.003 and p < 0.001, respectively). In the safety population, ZX-7101A treatment was associated with fewer adverse events, with 41.8% (100/239) in the 40 mg group, 44.2% (106/240) in the 80 mg group, and 53.8% (129/240) in the placebo group. The majority of adverse events were mild or moderate. Emergence of resistance to ZX-7101A through I38T amino acid substitution was detected in 5/278 (1.8%) patients.

Discussion

ZX-7101A was an effective treatment for influenza with a single dose of either 40 mg or 80 mg, with more rapid alleviation of influenza symptoms vs. placebo. No safety concerns were identified with single dose treatment of ZX-7101A.

目的评估流感病毒帽依赖性内切酶抑制剂 ZX-7101A 在无并发症流感成人患者中的疗效和安全性，并探索治疗中出现的耐药性：我们在成人无并发症流感患者中开展了一项随机、双盲、安慰剂对照、适应性设计的 2 期和 3 期研究（ZX-7101A-202）。符合条件的患者按照体重和基线综合症状评分，以1:1:1的比例随机接受单剂量40或80毫克ZX-7101A或安慰剂。主要疗效终点是意向治疗感染者（ITTI）的流感症状缓解时间（TTAS）：2期试验表明，与安慰剂相比，ZX-7101A的TTAS明显缩短：40或80毫克ZX-7101A的中位TTAS分别为34.7小时（95%置信区间[CI]，22.8-43.4；p=0.005）和45.8小时（95%CI，32.0-66.3；p=0.020），而安慰剂组为63.6小时（95%CI，43.9-93.4）。在3期试验中，与安慰剂相比，ZX-7101A两个剂量组的TTAS均显著缩短：40毫克组的中位TTAS缩短至48.4小时（95%CI，40.5-55.6），80毫克组缩短至39.4小时（95%CI，35.8-49.3），而安慰剂组为62.9小时（95%CI，56.4-69.3）（p=0.003和p结论：ZX-7101A单次剂量为40毫克或80毫克，与安慰剂相比，能更快地缓解流感症状，是治疗流感的有效药物。单剂量治疗 ZX-7101A 未发现安全问题。

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引用次数: 0

How We Diagnose and Manage Refractory and Resistant Herpes Simplex Virus Mucocutaneous Infection After Hematopoietic Cell Transplantation.

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2025.01.033

Tali Shafat, Ella J Ariza Heredia, Marilyne Daher, Roy F Chemaly

Background: Herpes simplex virus (HSV) infection is a clinically significant complication in hematopoietic cell transplant (HCT) recipients. Refractory and resistant (R/R) HSV infections may occur in this patient population, particularly after prolonged exposure to anti-HSV agents.

Objectives: To provide a comprehensive review of the diagnostic approach and the treatment options for R/R HSV mucocutaneous infections in HCT recipients and to highlight future treatment strategies.

Sources: We searched the PubMed Central Database and Embase to identify published studies on R/R HSV infections in HCT recipients. We used the search terms "herpes simplex virus," "resistant*," OR "refractory," "immunocompromised," "immunosuppress*," and "immunodeficien*," and screened the results for articles reporting R/R HSV infections among HCT recipients. We chose an HCT recipient with a complicated refractory HSV infection as a representative clinical case.

Content: A clear clinical definition of refractory HSV infection is currently not available, which can lead to delays in diagnosis and treatment, negatively impacting patient care. Apart from two small randomized controlled trials in the 1990s that looked at treatment with systemic foscarnet and topical cidofovir in patients living with human immunodeficiency virus, all treatment recommendations for R/R HSV infections are based on observational studies and case reports. The use of alternative treatment options often comes with serious side effects, such as kidney toxicity. This underscores the urgent need for safer and effective treatment options. Pritelivir, a new oral antiviral medication, is currently being studied in a phase 3 trial for R/R HSV infections in immunocompromised patients. Limited data from the Early Access Program, which allows compassionate use, suggests that pritelivir holds promise as a treatment option for HCT recipients with R/R HSV infections.

Implications: The proposed R/R HSV mucocutaneous infection diagnostic and treatment algorithm guides the appropriate management of these difficult-to-treat infections, potentially improving patient outcomes.

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引用次数: 0

Re: Impact of C-reactive protein point-of-care testing on antibiotic prescriptions for children and adults with suspected respiratory tract infections in primary care by Jung et al. 关于Jung 等人撰写的 "C 反应蛋白床旁检测对基层医疗机构为疑似呼吸道感染的儿童和成人开具抗生素处方的影响"。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.09.008

Lars Bjerrum , Ivan Gentile , Oliver van Hecke , Jan Y. Verbakel , Carl Llor

引用次数: 0

Clinical Microbiology and Infection will recognize excellent research by early-career scientists CMI 将表彰早期科学家的杰出研究。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.11.015

Katharina Last, Jacob Bodilsen, Inmaculada Lopez Montesinos, Leonard Leibovici

引用次数: 0

Methicilin-resistant Staphylococcus aureus in the community—time to take action 社区中的 MRSA，是时候采取行动了。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.11.010

Anna L. Goodman , Gerard Lina , Ed J. Kuijper

引用次数: 0

Pitfalls in generating robust malaria molecular evidence for SP-resistance 生成抗 SP 的可靠疟疾分子证据的陷阱。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.09.026

Nimita Deora , Abhinav Sinha

引用次数: 0

Agreement between Mycobacterium tuberculosis antigen-based skin test and interferon-gamma release assay in elderly individuals aged ≥65 years in China 中国≥65 岁老年人结核分枝杆菌抗原皮试与干扰素-γ 释放测定之间的一致性。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.10.016

Yijun He , Lingyu Shen , Jiang Du , Xuefang Cao , Bin Zhang , Dakuan Wang , Boxuan Feng , Zihan Li , Yuanzhi Di , Juanjuan Huang , Tonglei Guo , Jianguo Liang , Jiaoxia Yan , Zisen Liu , Qi Jin , Weitao Duan , Henan Xin , Lei Gao

Objectives

To determine the agreement of Mycobacterium tuberculosis (MTB) antigen-based skin test (TBST) with interferon-gamma release assay (IGRA) in the elderly individuals aged ≥65 years beyond instruction for use in China.

Methods

Based on the baseline survey of a randomized controlled trial with the objective of exploring suitable regimens for tuberculosis(TB) preventive treatment, MTB infection was tested using TBST and IGRA in parallel in rural residents aged 50–70 years using a cross-sectional study design.

Results

A total of 21 219 participants with both TBST and IGRA results were included in this analysis. The concordance between TBST and IGRA was 89.4% (95% CI, 89.0–89.8%) with a kappa coefficient of 0.61 (95% CI, 0.60–0.62). In those aged ≥65 years, the concordance was 86.5% (95% CI, 85.6–87.4%) with a kappa coefficient of 0.55 (95% CI, 0.52–0.58). 21.2% (35/165) of the participants with indeterminate IGRA results were TBST positive, and nine of them were aged ≥65 years.

Discussion

The consistent agreement between TBST and IGRA in individuals aged ≥65 years suggests that TBST has the potential to be used in the elderly with age beyond instruction for use in China. The respective diagnostic performance of each test will be analysed when the longitudinal data on incident TB is obtained in the future.

目的方法：根据随机对照试验的基线调查，以探索合适的结核病预防治疗方案为目标，在中国≥65 岁的老年人中同时使用结核分枝杆菌抗原皮试（TBST）和γ干扰素释放试验（IGRA）检测 MTB 感染情况：方法：在随机对照试验基线调查的基础上，以探索合适的结核病预防治疗方案为目标，采用横断面研究设计，对 50-70 岁的农村居民同时使用 TBST 和 IGRA 检测 MTB 感染情况：本次分析共纳入了 21219 名同时获得 TBST 和 IGRA 结果的参与者。TBST 和 IGRA 的一致性为 89.4%（95%CI：89.0 - 89.8%），卡帕系数为 0.61（95%CI：0.60 - 0.62）。在年龄≥ 65 岁的人群中，一致性为 86.5%（95%CI：85.6 - 87.4%），卡帕系数为 0.55（95%CI：0.52 - 0.58）。IGRA结果不确定的参与者中有21.2%（35/165）为TBST阳性，其中9人年龄≥65岁：结论：TBST 和 IGRA 在年龄≥ 65 岁的人群中的一致性表明，TBST 有可能用于年龄超出中国使用说明的老年人。将来获得结核病发病的纵向数据后，将对每种检测方法各自的诊断性能进行分析。

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引用次数: 0

Interventions targeting the nasal microbiome to eradicate methicilin-resistant Staphylococcus aureus 针对鼻腔微生物组的干预措施可根除 MRSA。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.10.022

Mary T. Bessesen

Background

Staphylococcus aureus is an important pathogen in many sites, including the bloodstream, skin and soft tissue, bone and joints. When infection is caused by methicilin-resistant S. aureus (MRSA), therapy is more difficult and outcomes are less favourable. Nasal colonization is associated with increased risk for MRSA infections. The nasal microbiome may play a role in risk for nasal colonization and infection.

Objectives

To review the role of the microbiome in MRSA nasal colonization and infection.

Sources

Peer-reviewed literature identified in a MEDLINE search using MRSA, S. aureus, prebiotic and microbiota as search terms.

Content

Reduction of S. aureus nasal colonization has been shown to reduce risk of S. aureus infections, but decolonization methods are imperfect. The role of the nasal microbiome in host defence against S. aureus colonization and infection is explored. Numerous organisms have been shown to be negatively associated with S. aureus colonization. The antimicrobial molecules produced by these organisms are an active area of research.

Implications

Future research should focus on development of safe and effective molecules that can inhibit S. aureus in the nasal vestibule. Damage to the diverse nasal microbiota by unnecessary antibiotics should be avoided.

背景：金黄色葡萄球菌是许多部位的重要病原体，包括血液、皮肤和软组织、骨骼和关节。当感染由耐甲氧西林金黄色葡萄球菌（MRSA）引起时，治疗会更加困难，疗效也较差。鼻腔定植与 MRSA 感染风险增加有关。鼻腔微生物组可能在鼻腔定植和感染风险中发挥作用：回顾微生物组在 MRSA 鼻腔定植和感染中的作用：来源：以MRSA、金黄色葡萄球菌、益生元和微生物群为检索词，在Medline检索中发现的同行评审文献：减少金黄色葡萄球菌的鼻腔定植已被证明可降低金黄色葡萄球菌感染的风险，但去菌落的方法并不完善。本文探讨了鼻腔微生物组在宿主防御金黄色葡萄球菌定植和感染中的作用。许多生物已被证明与金黄色葡萄球菌的定植呈负相关。这些生物产生的抗菌分子是一个活跃的研究领域：未来的研究应侧重于开发可抑制鼻前庭金黄色葡萄球菌的安全有效的分子。应避免不必要的抗生素对多样化的鼻腔微生物群造成损害。

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引用次数: 0

Case-fatality rate of invasive pneumococcal disease caused by various serotypes—an analysis of nationwide surveillance data from Israel, 2009–2018 各种血清型引起的侵袭性肺炎球菌疾病的病死率--2009-2018 年以色列全国监测数据分析。

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection

Pub Date : 2025-02-01 DOI: 10.1016/j.cmi.2024.11.018

Anat Wieder-Finesod , Dafna Yahav , Carmit Rubin , Shirley Hashkor , Jo Southern , Gabriel Mircus , Christian Theilacker , Ron Dagan , Gili Regev-Yochay

Objectives

The 20-valent pneumococcal conjugate vaccine (PCV20) has been introduced in Israel. Its public health benefit depends on its effect on mortality caused by PCV20 serotypes not present in 13-valent pneumococcal conjugate vaccine (PCV13) (PCV20non13). We aimed to describe invasive pneumococcal disease (IPD) characteristics and case-fatality rate (CFR) among adults by serotypes.

Methods

We analysed data from the Israeli nationwide surveillance database of IPD in adults, 2009–2018. The primary outcome was in-hospital CFR within 30 days, focusing on specific serotypes. Adjusted ORs (aORs) for association between PCV20non13 serotypes and mortality were calculated using logistic regression.

Results

Overall, 3864 IPD episodes were reported, 3733 (96.6%) with known serotype, 54% (1705/3123) were in men; 54% (1997/3733) were aged ≥65 years. PCV13-IPD cases constituted 40% of all IPD and decreased during the study years. PCV20non13 and nonPCV20 serotypes constituted 26% and 34% of cases, respectively, and increased over time. The most frequent non-PCV13 serotypes detected were PCV20non13 serotypes 8 (8%), 12F (7.2%), 22F (3%), and nonPCV20 serotype 16F (5%). In-hospital CFR was 22% (698/3140). CFR for PCV13 serotype was 21.1% (265/1255); for PCV20non13, it was 16.2% (124/766); and for nonPCV20, it was 28.5% (289/1014). Among PCV20non13 serotypes compared with PCV13 serotypes, 11A was associated with higher CFR (41%, aOR 3.1, 95% CI: 1.64–5.83), whereas serotype 8 was associated with lower CFR (8%, aOR: 0.5, 95% CI: 0.3–0.8).

Discussion

PCV20non13 serotypes constituted 26% of all adult IPD in the post-PCV13 era. CFR from PCV20non13 serotype IPD was comparable with that from PCV13 serotypes. These data support the potential added benefit of PCV20 in reducing mortality from IPD, though mortality remains substantial from nonPCV20 serotypes. Future IPD-related mortality will depend on the evolution of serotype distribution over time.

目的：以色列已引入 20 价肺炎球菌结合疫苗 (PCV20)。它对公共卫生的益处取决于它对 PCV20 血清型（PCV20non13）所导致的死亡率的影响。我们旨在按血清型描述侵入性肺炎球菌疾病（IPD）的特征和成人病死率：我们分析了 2009-2018 年以色列全国成人 IPD 监测数据库中的数据。主要结果是30天内的院内病例死亡率（CFR），重点是特定血清型。采用逻辑回归法计算 PCV20non13 血清型与死亡率之间的调整后几率比（aORs）：共报告了 3864 例 IPD 病例，其中 3733 例（96.6%）有已知血清型，54%（1705/3123）为男性；54%（1997/3733）年龄≥65 岁。PCV13-IPD 病例占所有 IPD 病例的 40%，在研究期间有所下降。PCV20-non13和非PCV20血清型分别占病例总数的26%和34%，并随着时间的推移而增加。最常检测到的非 PCV13 血清型为 PCV20non13 血清型 8（8%）、12F（7.2%）、22F（3%）和非 PCV20 血清型 16F（5%）。院内 CFR 为 22%（698/3140）。PCV13 血清型的 CFR 为 21.1%（265/1255）；PCV20non13 血清型的 CFR 为 16.2%（124/766）；非 PCV20 血清型的 CFR 为 28.5%（289/1014）。与 PCV13 血清型相比，PCV20non13 血清型中 11A 与较高的 CFR 相关（41%，aOR 3.1，95% CI 1.64-5.83），而血清型 8 与较低的 CFR 相关（8%，aOR 0.5，95% CI 0.3-0.8）：结论：后 PCV13 时代，PCV20 非 13 血清型占所有成人 IPD 的 26%。PCV20non13 血清型 IPD 的 CFR 与 PCV13 血清型相当。这些数据支持 PCV20 在降低 IPD 死亡率方面的潜在额外益处，尽管非 PCV20 血清型的 IPD 死亡率仍然很高。未来与 IPD 相关的死亡率将取决于血清型分布随时间的变化。

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