Infection and Drug Resistance最新文献

Objective: Community-acquired pneumonia (CAP) presents a significant public health concern, necessitating timely and precise diagnosis. Metagenomic next-generation sequencing (mNGS) has shown promise as a powerful tool for pathogen identification in infectious diseases. This study aimed to evaluate the diagnostic efficacy and clinical applicability of mNGS for immunocompromised patients with CAP compared to the culture method.

Methods: This study included 168 patients. We used both mNGS and conventional culture methods to identify the pathogen spectrum and evaluate diagnostic performance. Treatment regimens and clinical outcomes were meticulously documented.

Results: The sensitivity of mNGS was greater than that of the culture method across all samples (79.05% vs 16.03%; p < 0.001). mNGS identified pathogens missed by culture in 59.52% of patients and detected polymicrobial infections that were not detected by culture in 47.62% of patients. Streptococcus pneumoniae, Candida albicans, and Human herpesvirus 4 at classification level emerged as the predominant pathogens identified in CAP patients through mNGS. When examining the mNGS results between groups, the proportions of immunocompromised patients with bacterial (p < 0.001), fungal (p < 0.001), viral (p < 0.05), and mixed infections (p < 0.001) were all significantly higher than those in immunocompetent patients. Treatment adjustments guided by mNGS were observed in 73.21% of patients. Specifically, a beneficial clinical effect was observed in 50.60% (85/168) of patients, treatment confirmation in 22.62% (38/168) of patients, and no clinical benefit in 26.80% (45/168) of patients based on mNGS-guided antibiotic treatment adjustments.

Conclusion: These findings highlight the diagnostic performance of mNGS for identifying pathogens, particularly in immunocompromised patients vulnerable to infections, offering valuable insights for clinical decision-making.

Purpose: Klebsiella pneumoniae infections pose a significant threat to public health with high morbidity and mortality rates. The early identification of risk factors for mortality and accurate prognostic evaluation are important. Therefore, we aimed to identify the risk factors for mortality in patients with K. pneumoniae infections and develop a nomogram model for prognosis.

Methods: Patients diagnosed with K. pneumoniae infection were recruited from the intensive care unit of Peking University Third Hospital. The enrolled patients were categorized into survivor and non-survivor groups. Univariate and multivariate regression analyses were performed to identify independent risk factors for 30-day mortality, and a nomogram was constructed and validated.

Results: A total of 408 patients infected with K. pneumoniae at different sites were included in this study. PO₂, lactate, respiratory failure, urinary tract infection, heart rate, 24h-urineoutput, neutrophil count, alkaline phosphatase, and vasoactive drug use were significant risk factors and were integrated into a nomogram to predict the risk of 7-day, 14-day, 21-day, and 28-day mortality. The nomogram demonstrated superior prognostic ability, achieving higher area under the receiver operating characteristic curve (AUC) (>0.8) and concordance index (C-index) (>0.8) values than the Pitt bacteremia, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation (APACHE) II scores (all AUC and C-index < 0.75). Cross-validation of the nomogram confirmed its consistent performance, with both AUC and C-index values exceeding 0.75. The nomogram demonstrated a strong Hosmer-Leme-show goodness-of-fit and good calibration (p > 0.05). Additionally, decision curve analysis revealed that the nomogram provided significant clinical utility for prognostic prediction.

Conclusion: The 30-day mortality risk factors for K. pneumoniae infections were identified, and a predictive nomogram model was developed. The nomogram demonstrated good accuracy and predictive efficiency, providing a practical tool for short-term risk assessment and potentially improving clinical outcomes by providing early intervention and personalized patient management.

Background: Primary ventriculitis is a rare but serious brain infection characterized by inflammation of the ependyma and purulence within the ventricular system. Due to the challenges in early diagnosis and the potential for suboptimal treatment, this condition carries a significant risk of complications such as recurrence, hydrocephalus, and death. Metagenomic next-generation sequencing (mNGS) enables the rapid and broad-spectrum identification of pathogens, facilitating timely and precise diagnosis.

Case report: This study presents the first reported case of primary ventriculitis caused by Streptococcus constellatus. An 81-year-old female patient with hydrocephalus and clinical signs of central nervous system infection was diagnosed with primary ventriculitis based on brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis using mNGS. The patient underwent external ventricular drainage (EVD) and received a five-week course of ceftriaxone and linezolid. Following timely and targeted therapy, she demonstrated significant clinical improvement and was discharged without residual symptoms.

Conclusion: Key insights from this case include: 1) mNGS is an invaluable tool for the early and accurate diagnosis of primary ventriculitis; 2) MRI is indispensable for identifying characteristic radiological features of the condition; 3) prompt initiation and completion of appropriate antibiotic regimens significantly improve clinical outcomes.

Objective: The distribution characteristics of clinical isolates of A. fumigatus were analyzed to provide the basis for the prevention and control of A. fumigatus infection.

Methods: From January 2021 to December 2023, the First Affiliated Hospital of Nanjing Medical University collected clinical isolates of A. fumigatus from hospitalized patients for study. Duplicate strains from the same patient in the same area were eliminated, and community-, hospital-, and colonization infections were grouped.

Results: A total of 561 clinical isolates of A. fumigatus were identified, with 402 (82.35%) originating from male patients and 159 (17.65%) from female patients. The percentage of individuals aged 51 to 90 years was 78.97% (443/561). With the exception of surgery, which predominantly involved colonization, other departments mainly exhibited community-acquired infections (CAI) (P=0.002). The length of hospital stay was less than <15-30 days for most cases in the healthcare-associated infection group (HAI) (P<0.001). Lower respiratory tract infection accounted for the main site of infection across all three groups (95.37%), with ventilator-associated pneumonia being most prevalent in the HAI group (P<0.001). The detection rates of A. fumigatus from 2021 to 2023 were 3.89‱, 7.15‱, and 12.50‱, respectively. The detection frequencies of A. fumigatus throughout the three groups exhibited a year-on-year increase (P<0.001). Sputum samples constituted the main source of clinical isolates for all three groups, accounting for 61 strains (89.71%), 277 strains (78.69%), and 122 strains (86.52%) respectively, followed by bronchoalveolar lavage fluid samples.

Conclusion: The detection rate of A. fumigatus has exhibited a consistent upward trend over the past three years, with varying epidemiological characteristics observed across different infection types. It is recommended that medical institutions develop targeted prevention and control measures for A. fumigatus infections based on these unique characteristics.

Epidermolysis bullosa (EB) is a group of rare genetic skin disorders that are hereditary and heterogeneous, characterized by skin and mucosal fragility and blister formation, often induced by minimal trauma. Esophageal complications represent a significant extracutaneous manifestation of EB. The lack of standardized diagnostic and therapeutic guidelines of EB with esophageal complications contributes to inconsistent management and a higher susceptibility to recurrence. For patients with EB experiencing digestive tract symptoms, there are few reports that specifically address the follow-up and continuity of mucosal repair treatment. To date, EB with esophageal complications and co-infection with Helicobacter pylori (H. pylori) has been rarely reported. The impact of H. pylori infection on EB remains unclear. Here, we report a case of a 26-year-old man diagnosed with EB and esophageal complications. The patient presented with post-sternal pain, dysphagia, esophageal obstruction, and vomiting. Gastroscopy revealed scattered flake erosions on the esophageal mucosa. The pathological examination revealed inflammatory granulation tissue with necrosis and focal squamous epithelium showing mild atypical hyperplasia. Significant improvement in symptoms was observed after long-term mucosal repair therapy. After being lost to follow-up, the patient developed symptomatic exacerbation and co-infection with H. pylori. The patient's condition improved after the eradication of H. pylori, combined with ongoing treatment for esophageal complications and regular follow-up. Patients with EB who have esophageal complications require long-term mucosal repair treatment and regular follow-up. Co-infection with H. pylori may be an important factor in disease recurrence.

Background: Gram-negative bacteria are the predominant pathogens responsible for biliary infections; however, the prevalence of Gram-positive bacteria is currently increasing. Investigating the bacterial spectrum and evolving antibiotic resistance patterns of Gram-positive bacteria is crucial for optimizing the management of acute cholangitis, particularly in the context of the global rise in antibiotic resistance.

Methods: This retrospective analysis focused on Gram-positive bacteria isolated from the bile of patients undergoing biliary drainage with acute cholangitis at our hospital from January 1, 2018, to March 31, 2024. In total, 342 strains of Gram-positive bacteria were examined.

Results: The main Gram-positive bacteria detected included Enterococcus (57.23%), Staphylococcus (23.41%), and Streptococcus (13.01%). The most common species detected were Enterococcus faecium (36.42%), Enterococcus faecalis (14.16%), and Staphylococcus epidermidis (7.80%). Trend analysis revealed a decrease in the proportion of Enterococcus and an increase in Streptococcus. Additionally, the detection rate of methicillin-resistant Staphylococcus (MRS) showed a significant rise. Gram-positive bacteria exhibited high resistance to erythromycin and penicillin but remained highly susceptible to linezolid and vancomycin. Further, resistance to quinolones among Gram-positive bacteria was notably elevated.

Conclusion: The bacterial spectrum and antibiotic resistance patterns of Gram-positive bacteria in acute cholangitis have undergone significant changes. Penicillin is not recommended for the treatment of Gram-positive bacterial infections. Antibiotic resistance should be closely monitored when using quinolones. Particular attention is warranted regarding the markedly increasing antibiotic resistance of Enterococcus faecium.

Introduction: Psittacosis pneumonia, as a zoonotic infection, is induced by the pathogen Chlamydia psittaci. In the present study, we sought to characterize the clinical manifestations and prognosticate the severity of psittacosis pneumonia.

Methods: We retrospectively verified instances of psittacosis pneumonia in Zhejiang province, China, from January 2021 to April 2024. Relevant data pertaining to epidemiological, clinical, and laboratory aspects were compiled and evaluated.

Results: Among a total of 110 individuals enrolled who were diagnosed with psittacosis pneumonia, the median age being 62.0 years (IQR, 53-69 years). The most common comorbidities were hypertension (36.4%) and diabetes mellitus (17.3%). Patients categorized as having severe disease (n=68) were significantly older than those with mild disease (n=42). Most patients had notable elevations in aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), D-dimer, C-reactive protein (CRP), procalcitonin, total bilirubin (TBil), and interleukin-6, as along with significant reductions in lymphocytes, monocytes, albumin, and interleukin-4. Chest CT scans showed bilateral lung involvement in 70 cases. In the cohort of patients having received empirical antibiotic therapy, 57.3% had their antibacterial medication adjusted in light of the mNGS findings. mNGS results indicated that 31.8% (35/110) had suspected coinfections. The random forest classifiers based upon the clinical and laboratory characteristics attained AUC values of 0.822.

Discussion: The study underscores the efficacy of mNGS as a robust diagnostic tool for detecting Chlamydia psittaci, which can simultaneously detect other pathogens and guide clinical treatment. Severe patients exhibit significant inflammatory imbalances and lymphocyte depletion. A predictive model based on clinical and laboratory data at admission can effectively guide early clinical intervention.

Objective: To analyze independent risk factors and the distribution of pathogenic bacteria associated with pulmonary infection (PI) in patients with non-small cell lung cancer (NSCLC); and to explore the utility of peripheral blood-related inflammatory markers in the diagnosis of PI after comprehensive treatment of NSCLC.

Methodology: We retrospectively analyzed patients who were first diagnosed with NSCLC and received anti-tumor therapy from January 1, 2022 to December 31, 2022. There were 150 males and 50 females enrolled, and with a median age of 63 years. They were divided into PI (n=59) and non-PI (n=141) groups. The patients' characteristics, treatment histories, and peripheral blood inflammatory indicators of the two groups were compared.

Results: Eighty-two strains of pathogens were isolated from 59 patients with NSCLC complicated by PI, of which 35 (42.7%) were Gram-negative and 29 (35.4%) were Gram-positive bacteria, 15 (18.3%) were fungi, and 3 (3.7%) were viruses. Logistic regression analysis revealed that ≥ 4 cycles of chemotherapy, radiotherapy, and higher neutrophil count before antineoplastic treatment were independent risk factors for PI in patients with NSCLC (P<0.05). C-reactive protein (CRP) and CRP-to-albumin ratio (CAR) exhibited high area under the curve values of 0.807 and 0.791, respectively. CRP demonstrated high sensitivity (Cutoff Value:10.095, P<0.001), whereas CAR had high specificity (Cutoff Value:0.747, P<0.001) for the early diagnosis of PI in patients with NSCLC.

Conclusion: Gram-negative bacteria were the main pathogens causing PI in patients with NSCLC. Greater than or equal to 4 cycles of chemotherapy, radiotherapy, and elevated neutrophil count before antineoplastic treatment were independent risk factors for PI in patients with NSCLC. Elevated CRP levels and higher CAR demonstrated a certain diagnostic utility for PI in patients with NSCLC after antitumor treatment.

Objective: This study aims to investigate the clinical characteristics of vaginal trichomoniasis infection among vaginitis patients and assess their resistance to metronidazole.

Methods: We conducted a retrospective study involving 687 vaginitis patients who visited our hospital from April 2022 to June 2024. Clinical data were collected through questionnaires that included information on age, occupation, season of infection, marital status, contraceptive methods, and frequency of vulvar hygiene. Vaginal secretions were examined for trichomoniasis, and the characteristics of the infection were analyzed. Multivariate logistic regression was employed to identify factors influencing vaginal trichomoniasis infection. Infected vaginal trichomonas samples were cultured in vitro, and metronidazole gradient concentration plates were prepared to determine the minimum lethal concentration (MLC) of metronidazole against vaginal trichomonas, allowing for an assessment of resistance.

Results: Out of 687 vaginitis patients, 65 were diagnosed with vaginal trichomoniasis, resulting in an infection rate of 9.46%. Significant differences in infection rates were observed based on age, occupation, season of infection, marital status, contraceptive methods, and frequency of vulvar hygiene (P < 0.05).

Conclusion: The infection rate of vaginal trichomoniasis is notably higher in younger vaginitis patients compared to middle-aged and elderly individuals, with a peak occurrence in spring. Higher rates were also noted among farmers, married individuals, those using oral contraceptives or no contraception, and those with infrequent vulvar cleaning. Additionally, resistance to metronidazole was identified in some cases. Clinical efforts should prioritize prevention and treatment strategies for high-risk populations.