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Safety and efficacy of new generation azole antifungals in the management of recalcitrant superficial fungal infections and onychomycosis. 新一代唑类抗真菌药治疗顽固性浅部真菌感染和甲癣的安全性和有效性。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-06-12 DOI: 10.1080/14787210.2024.2362911
Aditya K Gupta, Mesbah Talukder, Avner Shemer, Eran Galili

Introduction: Terbinafine is considered the gold standard for treating skin fungal infections and onychomycosis. However, recent reports suggest that dermatophytes are developing resistance to terbinafine and the other traditional antifungal agents, itraconazole and fluconazole. When there is resistance to terbinafine, itraconazole or fluconazole, or when these agents cannot used, for example, due to potential drug interactions with the patient's current medications, clinicians may need to consider off-label use of new generation azoles, such as voriconazole, posaconazole, fosravuconazole, or oteseconazole. It is essential to emphasize that we do not advocate the use of newer generation azoles unless traditional agents such as terbinafine, itraconazole, or fluconazole have been thoroughly evaluated as first-line therapies.

Areas covered: This article reviews the clinical evidence, safety, dosage regimens, pharmacokinetics, and management algorithm of new-generation azole antifungals.

Expert opinion: Antifungal stewardship should be the top priority when prescribing new-generation azoles. First-line antifungal therapy is terbinafine and itraconazole. Fluconazole is a consideration but is generally less effective and its use may be off-label in many countries. For difficult-to-treat skin fungal infections and onychomycosis, that have failed terbinafine, itraconazole and fluconazole, we propose consideration of off-label voriconazole or posaconazole.

简介特比萘芬被认为是治疗皮肤真菌感染和甲癣的金标准。然而,最近的报告显示,皮癣菌正在对特比萘芬和其他传统抗真菌药物(伊曲康唑和氟康唑)产生抗药性。如果对特比萘芬、伊曲康唑或氟康唑产生抗药性,或者由于这些药物可能与患者目前服用的药物发生相互作用等原因而无法使用,临床医生可能需要考虑在标签外使用新一代唑类药物,如伏立康唑、泊沙康唑、福斯拉康唑或奥替康唑。必须强调的是,我们不主张使用新一代唑类药物,除非特比萘芬、伊曲康唑或氟康唑等传统药物已被彻底评估为一线疗法:本文回顾了新一代唑类抗真菌药物的临床证据、安全性、剂量方案、药代动力学和管理算法:专家观点:在处方新一代唑类抗真菌药物时,抗真菌管理应是重中之重。特比萘芬和伊曲康唑是一线抗真菌治疗药物。氟康唑也在考虑之列,但其疗效通常较差,而且在许多国家,氟康唑的使用可能不在标签范围内。对于特比萘芬、伊曲康唑和氟康唑治疗无效的难治性皮肤真菌感染和甲真菌病,我们建议考虑标签外使用伏立康唑或泊沙康唑。
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引用次数: 0
Hospital-acquired bacterial pneumonia in critically ill patients: from research to clinical practice. 重症患者在医院获得的细菌性肺炎:从研究到临床实践。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-05-20 DOI: 10.1080/14787210.2024.2354828
Pompeo Costantino Kouroupis, Niall O'Rourke, Sinead Kelly, Myles McKittrick, Elne Noppe, Luis F Reyes, Alejandro Rodriguez, Ignacio Martin-Loeches

Introduction: Hospital-acquired pneumonia (HAP) represents a significant cause of mortality among critically ill patients admitted to Intensive Care Units (ICUs). Timely and precise diagnosis is imperative to enhance therapeutic efficacy and patient outcomes. However, the diagnostic process is challenged by test limitations and a wide-ranging list of differential diagnoses, particularly in patients exhibiting escalating oxygen requirements, leukocytosis, and increased secretions.

Areas covered: This narrative review aims to update diagnostic modalities, facilitating the prompt identification of nosocomial pneumonia while guiding, developing, and assessing therapeutic interventions. A comprehensive literature review was conducted utilizing the MEDLINE/PubMed database from 2013 to April 2024.

Expert opinion: An integrated approach that integrates clinical, microbiological, and imaging tools is paramount. Progress in diagnostic techniques, including novel molecular methods, the expanding utilization and accuracy of bedside ultrasound, and the emergence of Artificial Intelligence, coupled with an improved comprehension of lung microbiota and host-pathogen interactions, continues to enhance our capability to accurately and swiftly identify HAP and its causative agents. This advancement enables the refinement of treatment strategies and facilitates the implementation of precision medicine approaches.

简介:医院获得性肺炎(HAP医院获得性肺炎(HAP)是导致重症监护病房(ICU)重症患者死亡的一个重要原因。为了提高疗效和改善患者预后,及时准确的诊断势在必行。然而,诊断过程面临着检验局限性和广泛的鉴别诊断清单的挑战,尤其是在患者表现出氧需求增加、白细胞增多和分泌物增多的情况下:本叙述性综述旨在更新诊断方法,以便及时识别非典型肺炎,同时指导、制定和评估治疗干预措施。我们利用 MEDLINE/PubMed 数据库对 2013 年至 2024 年 4 月期间的文献进行了全面综述:整合临床、微生物学和影像学工具的综合方法至关重要。诊断技术(包括新型分子方法)的进步、床旁超声波的使用和准确性的提高、人工智能的出现,再加上对肺部微生物群和宿主-病原体相互作用的进一步了解,不断增强了我们准确、迅速地识别 HAP 及其致病因子的能力。这一进步有助于完善治疗策略,促进精准医疗方法的实施。
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引用次数: 0
Statement of Retraction: Ivermectin role in COVID-19 treatment (IRICT): single-center, adaptive, randomized, double-blind, placebo-controlled, clinical trial. 撤回声明:伊维菌素在COVID-19治疗中的作用(IRICT):单中心、适应性、随机、双盲、安慰剂对照临床试验。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-06-04 DOI: 10.1080/14787210.2024.2362097
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引用次数: 0
Indian consensus on the managemeNt of carbapenem-resistant enterobacterales infection in critically ill patients II (ICONIC II). 印度重症患者耐碳青霉烯类肠杆菌感染管理共识 II(ICONIC II)。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-05-27 DOI: 10.1080/14787210.2024.2360116
Rajeev Soman, Balaji Veeraraghavan, Ashit Hegde, Subhash Varma, Subhash Todi, R K Singh, Vasant Nagavekar, Camilla Rodrigues, Subramanian Swaminathan, V Ramsubramanian, Abdul Ansari, Dhruva Chaudhry, Amullya Pednekar, Sagar Bhagat, Saiprasad Patil, Hanmant Barkate

Introduction: The rising challenge of carbapenem-resistant Enterobacterales (CRE) infections in Indian healthcare settings calls for clear clinical guidance on the management of these infections. The Indian consensus on the management of CRE infection in critically ill patients (ICONIC-II) is a follow-up of the ICONIC-I study, which was undertaken in 2019.

Areas covered: A modified Delphi method was used to build expert consensus on CRE management in India, involving online surveys, face-to - face expert meetings, and a literature review. A panel of 12 experts was formed to develop potential clinical consensus statements (CCSs), which were rated through two survey rounds. The CCSs were finalized in a final face-to - face discussion. The finalized CCSs were categorized as consensus, near consensus, and no consensus.

Expert opinion: The outcomes included 46 CCSs (consensus: 40; near consensus: 3; and no consensus: 3). The expert panel discussed and achieved consensus on various strategies for managing CRE infections, emphasizing the significance of existing and emerging resistance mechanisms, prompt and tailored empiric therapy, and use of combination therapies. The consensus statements based on the collective expertise of the panel can potentially assist clinicians in the management of CRE infections that lack high-level evidence.

导言:印度医疗机构中耐碳青霉烯类肠杆菌(CRE)感染的挑战日益严峻,这就要求对此类感染的管理提供明确的临床指导。印度重症患者 CRE 感染管理共识(ICONIC-II)是 2019 年开展的 ICONIC-I 研究的后续研究:采用改良德尔菲法就印度的 CRE 管理达成专家共识,包括在线调查、面对面专家会议和文献综述。由 12 位专家组成的小组制定了潜在的临床共识声明 (CCS),并通过两轮调查对这些声明进行了评级。在最后的面对面讨论中,最终确定了临床共识声明。最终确定的 CCS 被分为共识、接近共识和无共识:结果包括 46 份综合传播战略(共识:40 份;接近共识:3 份;无共识:3 份)。专家小组就处理 CRE 感染的各种策略进行了讨论并达成了共识,强调了现有和新出现的耐药机制、及时和有针对性的经验疗法以及使用联合疗法的重要性。基于专家组集体专业知识的共识声明有可能帮助临床医生处理缺乏高级别证据的 CRE 感染。
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引用次数: 0
Eravacycline: a comprehensive review of in vitro activity, clinical efficacy, and real-world applications. 依拉维辛:体外活性、临床疗效和实际应用的全面回顾。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.1080/14787210.2024.2351552
Po-Yu Huang, Chi-Kuei Hsu, Hung-Jen Tang, Chih-Cheng Lai

Introduction: The escalating threat of multidrug-resistant organisms necessitates constant exploration for novel antimicrobial agents. Eravacycline has emerged as a promising solution due to its unique chemical structure, which enhances potency and expands its spectrum of activity.

Area covered: This review provides a thorough examination of eravacycline, encompassing its in vitro activity against Gram-positive and Gram-negative aerobes, carbapenem-non-susceptible organisms, anaerobes, and other bacterial strains. Additionally, it evaluates evidence from clinical studies to establish its clinical effect and safety.

Expert opinion: Eravacycline, a synthetic fluorocycline, belongs to the tetracyclines class. Similar to other tetracycline, eravacycline exerts its antibacterial action by reversibly binding to the bacterial ribosomal 30S subunit. Eravacycline demonstrates potent in vitro activity against many Gram-positive and Gram-negative aerobes, anaerobes, and multidrug-resistant organisms. Randomized controlled trials and its associated meta-analysis affirm eravacycline's efficacy in treating complicated intra-abdominal infections. Moreover, real-world studies showcase eravacycline's adaptability and effectiveness in diverse clinical conditions, emphasizing its utility beyond labeled indications. Despite common gastrointestinal adverse events, eravacycline maintains an overall favorable safety profile, reinforcing its status as a tolerable antibiotic. However, ongoing research is essential for refining eravacycline's role, exploring combination therapy, and assessing its performance against biofilms, in combating challenging bacterial infections.

导言:耐多药生物的威胁不断升级,因此需要不断探索新型抗菌剂。埃拉伐环素是新一代四环素衍生物,其独特的化学结构增强了药效并扩大了活性范围,因此成为一种很有前景的解决方案:本综述全面考察了伊拉瓦昔林,包括其对革兰氏阳性和革兰氏阴性需氧菌、碳青霉烯类不敏感菌、厌氧菌和其他细菌菌株的体外活性。此外,它还评估了临床研究的证据,以确定其临床效果和安全性:依拉韦辛是一种人工合成的氟环素,属于四环素类,具有基本的化学结构,并在萘甲烯酸核的 D 环上引入了特定的修饰。与其他四环素类似,埃拉伐环素通过与细菌核糖体 30S 亚基的可逆结合发挥抗菌作用,阻止氨基酸残基结合到延长的肽链中,最终破坏细菌蛋白质的合成。依拉维辛在体外对许多革兰氏阳性和革兰氏阴性需氧菌、厌氧菌和耐多药生物具有很强的活性。随机对照试验及其相关的荟萃分析证实了依拉维辛在治疗复杂的腹腔内感染方面的疗效。此外,真实世界的研究显示了依拉维辛在不同临床条件下的适应性和有效性,强调了它在标示适应症之外的作用。尽管存在常见的胃肠道不良反应,但依拉维辛的总体安全性良好,巩固了其作为可耐受抗生素的地位。然而,持续的研究对于完善依拉维辛的作用、探索联合疗法以及评估其抗生物膜的性能至关重要,这将有助于其继续成功应对具有挑战性的细菌感染。
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引用次数: 0
Innovative strategies for the surveillance, prevention, and management of pediatric infections applied to low-income settings. 适用于低收入环境的儿科感染监测、预防和管理创新战略。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-05-17 DOI: 10.1080/14787210.2024.2354839
David Torres-Fernandez, Jessica Dalsuco, Justina Bramugy, Quique Bassat, Rosauro Varo

Introduction: Infectious diseases still cause a significant burden of morbidity and mortality among children in low- and middle-income countries (LMICs). There are ample opportunities for innovation in surveillance, prevention, and management, with the ultimate goal of improving survival.

Areas covered: This review discusses the current status in the use and development of innovative strategies for pediatric infectious diseases in LMICs by focusing on surveillance, diagnosis, prevention, and management. Topics covered are: Minimally Invasive Tissue Sampling as a technique to accurately ascertain the cause of death; Genetic Surveillance to trace the pathogen genomic diversity and emergence of resistance; Artificial Intelligence as a multidisciplinary tool; Portable noninvasive imaging methods; and Prognostic Biomarkers to triage and risk stratify pediatric patients.

Expert opinion: To overcome the specific hurdles in child health for LMICs, some innovative strategies appear at the forefront of research. If the development of these next-generation tools remains focused on accessibility, sustainability and capacity building, reshaping epidemiological surveillance, diagnosis, and treatment in LMICs, can become a reality and result in a significant public health impact. Their integration with existing healthcare infrastructures may revolutionize disease detection and surveillance, and improve child health and survival.

导言:传染病仍然是中低收入国家(LMICs)儿童发病和死亡的主要原因。在监测、预防和管理方面存在大量创新机会,最终目标是提高生存率:本综述通过重点关注监测、诊断、预防和管理,讨论了在低收入和中等收入国家使用和开发儿科传染病创新战略的现状。涉及的主题包括微创组织采样作为一种准确确定死因的技术;基因监测用于追踪病原体基因组多样性和抗药性的出现;人工智能作为一种多学科工具;便携式无创成像方法;预后生物标志物用于对儿科病人进行分流和风险分层:为了克服低收入和中等收入国家在儿童健康方面遇到的具体障碍,一些创新战略正处于研究的前沿。如果这些下一代工具的开发始终以可获得性、可持续性和能力建设为重点,那么重塑低收入和中等收入国家的流行病监测、诊断和治疗就能成为现实,并对公共卫生产生重大影响。这些工具与现有医疗保健基础设施的整合可能会彻底改变疾病的检测和监控,并改善儿童的健康和存活率。
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引用次数: 0
An assessment of the index of rational drug prescribing for severe acute respiratory infections among hospitalised children in Northern Nigeria: a retrospective study. 尼日利亚北部住院儿童严重急性呼吸道感染合理用药指数评估:一项回顾性研究。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-02-09 DOI: 10.1080/14787210.2024.2307913
Aliyu Sulaiman, Mohammad Alfa Isah, Abubakar Usman

Background: This study evaluated drug use pattern among hospitalized children with severe acute respiratory infection (SARI) in Nigeria.

Research design and methods: A retrospective assessment of prescribed medicines for children aged 13 years and below who were admitted and treated for SARI from 1 January 2016 to 31 December 2018 was conducted. The WHO prescribing indicators and the Index of Rational Drug Prescribing were used to evaluate prescriptions.

Results: A total of 259 patients were included, mostly diagnosed with bronchopneumonia (56%). A summary of WHO-core prescribing indicators showed the average number of drugs per encounter was 3.9, medicines prescribed by generic name was 82.1%, and an encounter with at least an antibiotic was 99.7%. The percentage of drugs prescribed from the Essential Medicine List for children was 79%. The most frequently prescribed pharmacological class of medicines was antibiotics (41.4%). Cephalosporins (40.0%), aminoglycosides (34.1%), and penicillins (21.5%) were the most commonly prescribed antibiotic classes. Gentamicin (34.1%) and cefuroxime (21.5%) were the most commonly prescribed antibiotics.

Conclusions: Drug prescribing for hospitalized children with SARI was suboptimal, especially with regard to polypharmacy, antibiotics, and injection use. Interventions to promote rational use of medicines including antimicrobial stewardship interventions are recommended.

背景:本研究评估了尼日利亚严重急性呼吸道感染(SARI)住院患儿的用药模式:对2016年1月1日至2018年12月31日期间因SARI住院治疗的13岁及以下儿童的处方药进行了回顾性评估。采用世界卫生组织处方指标和合理用药指数对处方进行评估:共纳入259名患者,大部分被诊断为支气管肺炎(56%)。世卫组织核心处方指标汇总显示,每次就诊的平均药物数量为 3.9 种,82.1% 的处方药物为通用名,99.7% 的就诊处方至少包含一种抗生素。从《儿童基本药物目录》中处方的药物比例为 79%。最常处方的药理类别是抗生素(41.4%)。头孢菌素类(40.0%)、氨基糖苷类(34.1%)和青霉素类(21.5%)是最常处方的抗生素类别。庆大霉素(34.1%)和头孢呋辛(21.5%)是最常处方的抗生素:结论:住院儿童 SARI 患者的处方用药并不理想,尤其是在多药合用、抗生素和注射剂使用方面。建议采取包括抗菌药物管理在内的干预措施,促进合理用药。
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引用次数: 0
Real-life effectiveness of antiviral therapy for HCV infection with pangenotypic regimens in HIV coinfected patients. 在艾滋病毒合并感染患者中使用泛基因型方案抗病毒治疗 HCV 感染的实际效果。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-05-16 DOI: 10.1080/14787210.2024.2353691
Anna Piekarska, Aleksandra Berkan-Kawińska, Hanna Berak, Włodzimierz Mazur, Marek Sitko, Anna Parfieniuk-Kowerda, Beata Lorenc, Dorota Dybowska, Ewa Janczewska, Justyna Janocha-Litwin, Beata Dobracka, Łukasz Socha, Magdalena Tudrujek-Zdunek, Robert Flisiak

Background: The aim of this study was to evaluate the real-life efficacy of pangenotypic antivirals in HIV-HCV-positive patients.

Research design and methods: The analysis included 5650 subjects who were treated with pangenotypic anti-HCV drugs: 5142 were HCV-positive and 508 were HIV-HCV-positive.

Results: Patients with HCV-monoinfection were older (p < 0.0001), however patients with HCV-monoinfection had a higher proportion of advanced fibrosis F4 (p < 0.0001). There were no differences between the study groups in the rate of SVR12 in ITT-analysis (87,6% versus 93,9% in coinfection and monoinfection group, respectively; p > 0.05). However, there was a difference between study groups in PP-analysis, HIV/HCV and HCV, respectively 95.9% vs 97.9%, p = 0.0323. Additionally, there were a higher rate of patients who did not apply for follow-up (SVR12) in coinfected patients (7,9% vs 3,6% respectively p = 0.0001). In multivariante analysis, factors associated with worse response to the pangenotypic anti-HCV therapy included male sex, HCV genotype 3, stage of fibrosis and decompensation of liver function and HIV coinfection.

Conclusions: The real-life results of pangenotypic anti-HCV treatment are veryeffective in the group of HIV-HCV-coinfected patients. However, the finaleffectiveness is slightly lower than that obtained in HCV monoinfectedpatients.

研究背景本研究旨在评估泛基因型抗病毒药物对HIV-HCV阳性患者的实际疗效:分析包括5650名接受泛基因型HCV药物治疗的受试者:5142例为HCV阳性,508例为HIV-HCV阳性:结果:HCV 单感染患者年龄较大(P P > 0.05)。然而,在 PP 分析中,研究组之间存在差异,HIV/HCV 和 HCV 阳性率分别为 95.9% vs 97.9%,P = 0.0323。此外,合并感染患者未申请随访(SVR12)的比例更高(分别为 7.9% vs 3.6%,P = 0.0001)。在多变量分析中,与泛基因型抗 HCV 治疗反应较差相关的因素包括男性、HCV 基因 3 型、肝纤维化和肝功能失代偿期以及合并 HIV 感染:结论:泛基因型抗 HCV 治疗对 HIV-HCV 合并感染患者的实际疗效非常好。结论:泛基因型抗 HCV 治疗在 HIV-HCV 合并感染患者组中的实际疗效非常好,但最终疗效略低于单感染 HCV 患者。
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引用次数: 0
Monotherapy versus combination for the treatment of Stenotrophomonas maltophilia: a multicenter cohort study. 单药与联合用药治疗嗜麦芽霉单胞菌病:一项多中心队列研究。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-05-13 DOI: 10.1080/14787210.2024.2353704
Thamer A Almangour, Hussain A Alali, Zakiyah Alkherb, Shuroug A Alowais, Khalid Bin Saleh, Sara Almuhisen, Abdullah Almohaizeie, Renad Alsahli, Shatha Alruwaite, Fai Alnashmi, Lolwa Fetyani, Noran Ibrahim Abouobaid, Alnajla Alghofaily, Khalifa M Binkhamis, Yazed Saleh Alsowaida

Background: The aim of this study was to compare the safety and effectiveness of monotherapy versus combination therapy for the treatment of infections caused by S. maltophilia.

Methods: This retrospective, multicenter, cohort study included patients treated with either monotherapy or combination therapy for infections caused by S. maltophilia. Primary outcomes included overall in-hospital mortality, 30-day mortality, and clinical cure. Safety outcomes were also evaluated. Multivariable logistic regression was used as a control for confounding variables.

Results: A total of 407 patients were included, 330 patients received monotherapy and 77 patients received combination therapy. A total of 21% presented with concomitant bacteremia. After adjusting the differences between the two groups, there were no statistically significant differences between patients who received monotherapy versus combination therapy in clinical cure (55% vs 65%; OR, 0.72; 95% CI, 0.40-1.31) and overall in-hospital mortality (52% vs 49%; OR, 0.84; 95% CI, 0.45-1.57). However, patients who received monotherapy had a lower rate of 30-day mortality (28% vs 32%; OR, 0.45; 95% CI, 0.22-0.90) and acute kidney injury (9% vs 18%; OR, 0.35; 95% CI, 0.16-0.78).

Conclusion: Clinical outcomes did not significantly differ in patients who received combination therapy versus monotherapy. More data are needed to validate these findings.

背景:本研究旨在比较单一疗法和联合疗法治疗嗜麦芽糖浆菌感染的安全性和有效性:本研究的目的是比较单一疗法与联合疗法治疗嗜麦芽糖酵母菌感染的安全性和有效性:这项回顾性、多中心、队列研究纳入了接受单一疗法或联合疗法治疗的嗜麦芽糖病菌感染患者。主要结果包括住院总死亡率、30 天死亡率和临床治愈率。同时还评估了安全性结果。多变量逻辑回归用于控制混杂变量:共纳入 407 名患者,其中 330 名患者接受了单一疗法,77 名患者接受了联合疗法。共有21%的患者同时出现菌血症。调整两组之间的差异后,接受单一疗法和联合疗法的患者在临床治愈率(55% vs 65%;OR,0.72;95% CI,0.40-1.31)和院内总死亡率(52% vs 49%;OR,0.84;95% CI,0.45-1.57)方面没有显著统计学差异。然而,接受单一疗法的患者的30天死亡率(28% vs 32%;OR,0.45;95% CI,0.22-0.90)和急性肾损伤率(9% vs 18%;OR,0.35;95% CI,0.16-0.78)较低:结论:接受联合疗法和单一疗法的患者的临床结果没有明显差异。结论:接受联合疗法和单一疗法的患者的临床结果没有明显差异,需要更多数据来验证这些发现。
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引用次数: 0
Clinical effectiveness of nirmatrelvir plus ritonavir for patients with COVID-19 and preexisting psychiatric disorders. 尼马瑞韦加利托那韦对 COVID-19 和原有精神障碍患者的临床疗效。
IF 5.7 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-05-11 DOI: 10.1080/14787210.2024.2351555
Ting-Hui Liu, Jheng-Yan Wu, Po-Yu Huang, Wan-Hsuan Hsu, Min-Hsiang Chuang, Ya-Wen Tsai, Chih-Cheng Lai, Charles Lung-Cheng Huang

Objectives: This study assessed the clinical effectiveness of the combination of nirmatrelvir and ritonavir (NMV-r) in treating nonhospitalized patients with COVID-19 who have preexisting psychiatric disorders.

Methods: Patients diagnosed with COVID-19 and psychiatric disorders between 1 March 2020, and 1 December 2022, were included using the TriNetX network. The primary outcome was the composite outcome of all-cause emergency department (ED) visits, hospitalization, or death within 30 days.

Results: Propensity score matching yielded two cohorts of 20,633 patients each. The composite outcome of all-cause ED visits, hospitalization, or death within 30 days was 3.57% (737 patients) in the NMV-r cohort and 5.69% (1176) in the control cohort, resulting in a reduced risk in the NMV-r cohort (HR: 0.657; 95% confidence interval (CI): 0.599-0.720). The NMV-r cohort exhibited a lower risk of all-cause hospitalization (HR: 0.385; 95% CI: 0.328-0.451) and all-cause death (HR: 0.110; 95% CI: 0.053-0.228) compared with the control group.

Conclusion: NMV-r could mitigate the risk of adverse outcomes in nonhospitalized patients with COVID-19 and preexisting psychiatric disorders. However, only a limited number of patients in this population received adequate treatment, thus emphasizing the importance of promoting its appropriate use.

研究目的本研究评估了尼马瑞韦与利托那韦联合用药(NMV-r)治疗患有精神疾病的非住院 COVID-19 患者的临床疗效:利用 TriNetX 网络纳入 2020 年 3 月 1 日至 2022 年 12 月 1 日期间确诊为 COVID-19 和精神障碍的患者。主要结果是30天内全因急诊就诊、住院或死亡的综合结果:倾向得分匹配产生了两个队列,每个队列有 20,633 名患者。30天内全因急诊就诊、住院或死亡的综合结果在NMV-r队列中为3.57%(737名患者),在对照队列中为5.69%(1176名患者),结果NMV-r队列的风险降低(HR:0.657;95%置信区间(CI):0.599-0.720)。与对照组相比,NMV-r 组的全因住院风险(HR:0.385;95% CI:0.328-0.451)和全因死亡风险(HR:0.110;95% CI:0.053-0.228)更低:结论:NMV-r 可降低 COVID-19 和原有精神障碍的非住院患者出现不良后果的风险。结论:NMV-r 可降低 COVID-19 和原有精神障碍的非住院患者的不良预后风险,但该人群中只有少数患者接受了适当的治疗,因此强调了推广适当使用 NMV-r 的重要性。
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Expert Review of Anti-infective Therapy
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