Epidemiology and Infection最新文献

This descriptive and exploratory observational case series examined intestinal colonisation and subsequent bacteraemia due to ESBL-producing Klebsiella pneumoniae (ESBL-Kp) in preterm neonates in Morocco. Prospective bacteriological cultures and antibiotic susceptibility testing were supported by phenotypic methods, including Brilliance ESBL Agar and the NG-Test CARBA-5 assay, for the rapid detection of ESBL and carbapenemase producers. Molecular analysis using PCR was also undertaken to identify specific resistance genes. A total of 567 rectal swabs were collected from 339 preterm neonates, yielding 293 K. pneumoniae isolates. ESBL-producing strains were identified in 53.6% of the neonates (182/339). Detected resistance genes included blaSHV (26.3%), blaCTX-M-1 (42.8%), blaTEM (30.2%), blaOXA-48 (50.0%), blaNDM(15.3%), and blaVIM (4.9%). Principal risk factors for colonisation were low birth weight (OR 1.69), very preterm birth (OR 6.24), enteral tube feeding (OR 2.02), and prolonged use of third-generation cephalosporins (OR 1.26). Among the neonates studied, 32 (9.4%) developed healthcare-associated bacteraemia, with 56.2% of these cases preceded by intestinal colonisation with ESBL-Kp. Clinically, severe respiratory distress and alveolar haemorrhage were strongly associated with increased mortality (aRR = 29.32 and 4.45, respectively). The findings highlight the clinical importance of early screening to guide infection control and antimicrobial stewardship in neonatal intensive care settings.

The objective of this study was to evaluate the impact on SARS-CoV-2 transmission prevention of mask wearing by index cases and their household contacts. A prospective study of SARS-CoV-2 transmission to household contacts aged ≥18 years was conducted between May 2022 and February 2024 in Spain. Contacts underwent a rapid antigen test on day zero and a real-time polymerase chain reaction test 7 days later if results were negative. The dependent variable was SARS-CoV-2 infection in contacts. Index case and contact mask use effects were estimated using the adjusted odds ratio (aOR) and its 95% confidence interval (CI). Studied were 230 household contacts, mean (standard deviation) age 53.3 (16.6) years, and 47.8% (110/230) women. Following index case diagnosis, 36.1% of contacts (83/230) used a mask, and 54.3% (125/230) were exposed to a mask-wearing index case. Infection incidence in contacts was 45.2% (104/230) and was lower in contacts exposed to mask-wearing index cases (36.0% vs. 56.2%; p < 0.002). The logistic regression model indicated a protective effect for contacts of both index case mask use (aOR = 0.31; 95% CI: 0.15-0.65) and vaccination (aOR = 0.24; 95% CI: 0.08-0.77). Index case mask use reduced SARS-CoV-2 transmission to contacts, while mask effectiveness was not observed for contacts.

In large public health jurisdictions, only a small proportion of people infected with Salmonella are interviewed due to resource constraints. As such, sources of illness are rarely found, and preventative action not implemented. We trialled alternative methods to contact notified salmonellosis cases to collect information on exposures and risks, focusing particularly on the feasibility of SMS (short message service)-based surveillance. Over five-years period we sequentially mailed letters, sent online surveys, and then text messages. The SMS approach was designed to assess the efficiency of a two-way personalized messaging model in gathering actionable public health data. The personalized SMS-follow-up model demonstrated the highest success: 56% of cases responded, enabling the identification and intervention of 10 distinct point-source outbreaks of Salmonella. SMS-based surveillance offers a novel, efficient, and acceptable method for collecting critical food exposure data in Salmonella cases. In settings where resources are constrained, SMS can complement traditional case follow-up methods, enhancing both the timeliness and effectiveness of outbreak detection. Integrating this follow-up with routine clinical care could further enhance the acceptance and success of this method. This study highlights the promise of SMS in streamlining surveillance efforts and warrants further exploration for application to other infectious diseases.

We investigated the potential yield of conducting active case finding for tuberculosis (TB) within a defined geographic radius (50 or 100 m) around the households of individuals diagnosed with TB at health facilities. In a well-defined geographic area within Kampala, Uganda, residential locations were determined for 85 people diagnosed with TB at local health facilities over an 18-month period and for 60 individuals diagnosed with TB during a subsequent community-wide door-to-door screening campaign. Ten of the individuals diagnosed through community screening lived within 50 m of an individual previously diagnosed with TB in a local health facility (TB prevalence: 0.98%), and 15 lived at a distance of 50-100 m (prevalence: 0.87%). The prevalence ratio was 1.4 (95% confidence interval (CI): 0.7-2.9) for those <50 m and 1.2 (95% CI 0.6-2.2) for those 50-100 m, compared to >100 m. Using TB notifications to identify areas for geographically targeted case finding is at most moderately more efficient than screening the general population in the context of urban Uganda.

Attaining the target of <0.1% HBsAg positives in children aged <5 years in vaccinated populations by 2030 is a WHO indicator of hepatitis B elimination. We aimed to calculate the prevalence of HBsAg- and anti-HBc-positive children and adolescents in the low-prevalence country of Germany. In total, 3567 children and adolescents aged 3-17 years participated in a national population based cross-sectional study. Data were collected between 2014 and 2017 using questionnaires and health examinations, including blood samples. Applying a weighted analysis to account for survey design and participant characteristics, we calculated the HBsAg and anti-HBc prevalence and described them by anti-HBs positivity. In total, 3007 participants had all three sero-markers measured. None were found HBsAg and anti-HBc positive. Seven (0.3%, 95% CI: 0.1-0.8) were anti-HBc positive and HBsAg negative; six were also anti-HBs positive. All anti-HBc-positive participants were aged ≥7 years and three had no migration background. Four anti-HBc-positive participants had known vaccination status; three had been vaccinated according to national recommendations. This very low hepatitis B virus sero-prevalence among children and adolescents indicates that Germany is reaching some hepatitis B virus elimination targets. We recommend maintaining preventive measures, in particular a high vaccination coverage, in order to reach hepatitis B elimination.

β-Lactam/β-lactamase inhibitor combinations and carbapenems are the first-line treatments for multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa) infections. However, carbapenem resistance is increasing globally at an alarming rate, which is especially concerning given the pivotal role of these agents. This study comprehensively evaluated the global distribution of carbapenem resistance in clinical P. aeruginosa isolates. The keywords including 'Pseudomonas', P. aeruginosa', 'P. aeruginosa', 'resistance', 'susceptibility', 'carbapenem antibiotics', 'carbapenems', 'imipenem', 'meropenem', 'ertapenem', 'doripenem', as well as 'prevalence' and 'incidence' were searched in electronic databases as the appropriate keywords. After screening, 160 studies were excluded, with 87 eligible studies from diverse geographic regions retained for final analysis. A comprehensive meta-analysis was then conducted on the data collected. The mean resistance rates (95% CI) were 33.3% (imipenem), 23.3% (meropenem), 60.9% (ertapenem), and 36.7% (doripenem). The time trend analysis showed that the resistance to meropenem has increased from the year 1997 to 2023. Meta-analysis showed substantial heterogeneity (I² = 92%, p < 0.05) but no significant publication bias by Egger's or Begg's test. Global carbapenem resistance is alarmingly high in clinical P. aeruginosa isolates. The increasing prevalence of carbapenem-resistant P. aeruginosa is a major global health threat requiring urgent action through new antimicrobials and improved antibiotic stewardship to protect these last-line drugs.

In 2022, an Mpox clade II outbreak affected many countries. To optimize control, knowledge on the number of new introductions (human cases infected from outside the study population) versus local transmission is important. We extracted sequences of all 48 Mpox cases in Slovenia in 2022 from the NCBI database, of which 42 passed quality control. We estimated the number of introductions using the phylodynamic model phybreak by integrating genomic and epidemiological data and inferred transmission events. By repeating this analysis with weekly cumulative case data, we assessed if introductions could have been reliably inferred in real time. The number of introductions, estimated after the outbreak ended, was 19 (95% CI: 13-29), and two larger transmission clusters existed. As these introductions occurred throughout the outbreak, we conclude that the Slovenian Mpox outbreak was mainly driven by new introductions. Analysing the data 'in real time' would have only slightly overestimated the number of introductions per week, capturing the trend of introductions as main driver of the outbreak. This makes it useful for guiding control policy during outbreaks, prioritizing the rapid identification of cases among travellers, and with that preventing emergence of new transmission chains.

There are limited data on the illness trajectory for individuals with long COVID. We prospectively followed 1,234 individuals with long COVID at 3 months post-SARS-CoV-2 infection to identify factors associated with persistence or recovery. At 6 months post-infection, 724 (58.7%) had persistent long COVID and 510 (41.3%) had fully recovered. In multivariable analyses, pre-existing health conditions at the time of initial SARS-CoV-2 infection and reporting fatigue, shortness of breath, and cough 3 months post-infection were independent predictors of persistent long COVID. Age, sex, and number of COVID vaccinations were not significantly associated with persistent long COVID. For persons with persistent long COVID, the median number of symptoms remained stable over follow-up, indicating that there had been little symptomatic improvement. A third of those with persistent long COVID reported seeking medical care for their symptoms and a third had ceased or reduced their hours of work/study. Our findings suggest that there may be distinct clinical trajectories for long COVID observed between 3- and 6-month follow-up, that is, persons who experience full recovery and those with minimal clinical improvement, and this may have implications for management of affected individuals.

A predictive column chart was developed to assess the risk of primary liver cancer (PLC) in hepatitis B patients. Data from 107 PLC patients and 107 controls were used as the training set, with 92 patients as the validation set. An additional 446 patients from other hospitals, including 15 with PLC, formed the external validation group. Multivariate logistic regression identified gender, BMI, alcohol consumption, diabetes, family history of liver cancer, cirrhosis, and HBV DNA load as independent risk factors. The model showed strong discrimination with AUCs of 0.882 and 0.859 in the training and validation sets, respectively, and good calibration (Hosmer-Lemeshow χ² = 2.648, P = 0.954; χ² = 4.117, P = 0.846). Decision curve analysis (DCA) confirmed clinical benefit within a risk threshold of 0.07-0.95. In the external validation group, the model maintained discrimination (AUC = 0.863) and calibration (Hosmer-Lemeshow χ² = 7.999, P = 0.434), with DCA showing net benefit across 0.14-0.95. These results indicate the column chart is a reliable tool for PLC risk prediction in hepatitis B patients.

We aimed to determine the prevalence of antimicrobial resistance, carriage of Panton-Valentine leucocidin (PVL), and the clonal structure of MRSA isolates collected from skin and soft tissue infections at a tertiary care hospital in Pakistan. Between August 2021 and May 2022, 154 non-repetitive MRSA isolates were consecutively collected and characterized by antimicrobial susceptibility testing, SCCmec typing, spa typing, and detection of PVL by PCR. MLST clonal complexes (CCs) were inferred from spa type using the Based Upon Repeat Pattern (BURP) algorithm. High levels of resistance were observed to ciprofloxacin (85.7%), erythromycin (76.0%), sulfamethoxazole (68.8%), gentamicin (68.8%), fusidic acid (57.8%), tetracycline (55.8%), and clindamycin (42.2%). Clonal analysis revealed 16 lineages, with the most frequent being CC8-MRSA-IV (27.3%), PVL-positive "Bengal Bay" CC1/ST772-MRSA-V (26.0%), and CC1-MRSA-IV (16.2%). PVL was detected in 45.5% of isolates across multiple lineages. Our findings highlight the coexistence of high antimicrobial resistance and frequent PVL carriage among MRSA in Pakistan. Given the association of PVL with severe infections and the limited treatment options for multidrug-resistant strains, these data underscore a significant public health concern and the need for systematic surveillance and prudent antibiotic use.