Infection and Drug Resistance最新文献

Objective: This study aimed to investigate the levels of coagulation parameters in elderly patients with severe pneumonia and analyse their correlation with disease severity and prognosis.

Methods: A retrospective study was conducted on 207 elderly patients (aged ≥60 years) with severe pneumonia admitted to our hospital between January 2022 and December 2023. Demographic data, clinical characteristics and coagulation parameters, including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time and fibrinogen (FIB), were collected. Patients were divided into survivor and non-survivor groups based on 28-day mortality. The differences in coagulation parameters between groups and their correlation with disease severity and prognosis were analysed.

Results: The 28-day mortality rate was 52.2%. Non-survivors had significantly higher PT, APTT and D-dimer levels and lower FIB levels than survivors (p < 0.05). Multivariate logistic regression analysis showed that elevated PT (odds ratio [OR] = 1.218, 95% confidence interval [CI]: 1.076-1.379, p = 0.002) and D-dimer (OR = 1.109, 95% CI: 1.032-1.192, p = 0.005) were independent risk factors for 28-day mortality. The combined model using PT and D-dimer showed the highest predictive value for 28-day mortality (area under the curve = 0.801, 95% CI: 0.739-0.863, p < 0.001), with a sensitivity of 0.759 and specificity of 0.758.

Conclusion: Coagulation dysfunction is common in elderly patients with severe pneumonia. Prothrombin time and D-dimer levels are closely associated with disease severity and can be valuable indicators for predicting prognosis in this population.

Objective: To evaluate the diagnostic performance and clinical impact of targeted next-generation sequencing (tNGS) in patients with suspected lower respiratory tract infections.

Methods: Following propensity score matching, we compared the diagnostic performances of tNGS and metagenomic next-generation sequencing (mNGS). Furthermore, the diagnostic performance of tNGS was compared with that of culture, and its clinical impact was assessed.

Results: After propensity score matching, the coincidence rate of tNGS was comparable to that of mNGS (82.9% vs 73.9%, P=0.079). The detection rates for bacterial, viral, fungal, and mixed infections were not significantly different (P>0.05). Bacterial-viral co-infection (16.7%) was the most common mixed infection detected by tNGS. tNGS showed a higher detection rate than culture (75.2% vs 19.0%, P<0.01). The positive detection rate by tNGS was not significantly different between immunocompromised and immunocompetent patients (88.6% vs 80.5%, P=0.202), but was significantly higher than that by culture (P<0.001). Moreover, 65 patients (44.5%) had their medications modified based on the tNGS results, and the majority exhibited notable improvement regardless of treatment adjustment.

Conclusion: tNGS performs comparably to mNGS and surpasses culture in detecting lower respiratory tract infections. Nevertheless, tNGS is faster and more cost-effective than mNGS, making it highly significant for guiding rational treatment.

Introduction: Nanobubble ozone stored in hyaluronic acid-decorated liposomes (patent application PCT/TR2022/050177) was used, and the Minimum Inhibitory Concentration (MIC) was found to be 1562 ppm. Pseudomonas aeruginosa (patient isolate), Acinetobacter baumannii (patient isolate), Methicillin-Resistant Staphylococcus aureus (MRSA) (ATCC12493), and Escherichia coli (ATCC25922) bacteria, which are hospital-acquired and healthcare-associated infections, were used. A time-dependent efficacy study was conducted at 1600 ppm. Our study aimed to determine whether the newly developed solution maintains long-term effectiveness and can be used as an antibacterial agent, especially in intensive care units.

Methods: Antibacterial tests of the nanobubble liposome solution, developed with a different technique than the standard ozonation procedures, were performed with the CLSI M07 A9 (Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard) standard test method, and the solution was tested at Minimal Inhibitory Concentration (MIC) value and time-dependent effects were determined. For the stability test of the nanobubble liposome solution, according to the ASTM F 1980 standard, it was kept at 55 °C for 74 days as two-year stability.

Results: The MIC of the nanobubble ozone solution was 1.562 ppm for MRSA and E. coli (ATCC 25922) standard test method using CLSI M07 A9 (Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard). P. aeruginosa, A. baumannii, Methicillin-Resistant Staphylococcus aureus (MRSA) (ATCC12493), and E. coli (ATCC 25922). No activity was observed at 2 min, but 1600 ppm nanobubble liposomes at 10 min were found to be effective. In terms of effectiveness, the solution would still be effective after 2 years according to the ASTM F 1980 standard, contrary to expectations.

Conclusion: It is thought that nanobubble ozone stored in hyaluronic acid-decorated liposome solutions will play an important role in the fight against infections because of its non-toxic effect, effectiveness against resistant bacteria, and stability for at least two years. In the following process, it would be appropriate to support the product through clinical studies.

The Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI) patients infected with methicillin-resistant Staphylococcus aureus (MRSA) urgently require safe and effective treatment options due to their compromised hepatic and renal functions, as well as thrombocytopenia resulting from hypersplenism. In our case, an HRS-AKI patient who underwent continuous renal replacement therapy for fluid overload developed fever with chills. His blood tests indicated elevated C-reactive protein and neutrophils, low platelet count, and bilateral lung infiltrates. Subsequently, his blood culture and catheter culture confirmed a catheter-related MRSA bloodstream infection. To address this complex clinical challenge, a novel oxazolidinone antibiotic, contezolid (800mg orally every 12 hours), was introduced into the patient's anti-infection regimen. Notably, the patient exhibited remarkable improvements and responded favorably to this treatment. During subsequent follow-up, no recurrence of the infection or drug-related adverse events was observed. The successful utilization of contezolid in this case underscores its potential as a novel therapeutic option for treating MRSA infections in patients with HRS-AKI.

Objective: Patients with acute pancreatitis (AP) complicated by carbapenem-resistant Enterobacteriaceae (CRE) infection often have a higher mortality rate. However, little investigation on the risk factor analysis has been published for the AP complicated by CRE. Therefore, this study conducted a retrospective analysis of the clinical characteristics, risk factors, and molecular epidemiological features associated with CRE infection in patients with AP.

Methods: A total of 240 patients with AP were admitted to our hospital from 2011 to 2021 as the research objects, and were divided into a CRE group of 60 cases and a non-CRE group of 180 cases based on whether they were co-infected with CRE or not. Furthermore, both univariate analysis and multivariate analysis were used to analyze the risk factors of AP co-infection with CRE. In the CRE group, polymerase chain reaction (PCR) and agarose gel electrophoresis (AGE) were used to detect the expression of five common carbapenemase genes including bla _KPC, bla_IMP, bla_VIM, bla_NDM , and bla_OXA-48 .

Results: The pathogenic bacteria in the CRE group are composed of Klebsiella pneumonia at 35.00%, Escherichia coli at 33.33%, Enterobacter cloacae at 25.00%, and Citrobacter freundii at 6.67%. Multivariate analysis showed that APACHE-II scores (OR=1.22), history of abdominal surgery (OR=81.82), and ERCP (OR=3.66) were independent risk factors for AP co-infection with CRE (P<0.05). About half (18/40) of the CRE carried carbapenemase genes. bla _KPC was the major carbapenemase gene.

Conclusion: There are many risk factors for AP co-infection with CRE, which can occur in patients with high APACHE-II scores, experienced ERCP, and a history of abdominal surgery.

Introduction: Coronavirus Disease 19 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Human Immunodeficiency Virus (HIV) are significant 21st-century pandemics with distinct virological and clinical characteristics. COVID-19 primarily presents as an acute respiratory illness, while HIV leads to chronic immune suppression. Understanding their differences can enhance public health strategies and treatment approaches.

Purpose: This narrative review compares the virology, transmission, immune responses, and clinical outcomes of SARS-CoV-2 and HIV to inform treatment strategies and public health interventions.

Methods: A narrative review was conducted, synthesizing data from peer-reviewed literature and expert commentary from 2010 to 2024. Databases such as PubMed, Cochrane Library, and Google Scholar were searched for relevant studies.

Results: SARS-CoV-2 primarily spreads through airborne droplets and contaminated surfaces, while HIV transmits through direct contact with infected bodily fluids. The immune response to SARS-CoV-2 involves both innate and adaptive systems, potentially leading to a cytokine storm in severe cases. In contrast, HIV evades the immune system by integrating into host cells, resulting in chronic infection and progressive immune deterioration. Treatment for SARS-CoV-2 focuses on symptom management and prevention, with antiviral medications and vaccines playing crucial roles. Conversely, HIV treatment relies on antiretroviral therapy (ART) to suppress viral replication and maintain immune function.

Conclusion: The review highlights the acute nature of SARS-CoV-2 versus the chronic progression of HIV. Tailored prevention and treatment strategies are essential for effective disease management.

Recommendations: Public health strategies should address the unique transmission routes and progression of both viruses. Further research into vaccine development and therapeutic interventions is critical for improving disease management.

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that often occurs secondary to human immunodeficiency virus (HIV) infection. However, for non-HIV immunocompromised patients, such as those undergoing novel immunosuppressive treatments to manage malignancies, organ transplants, or connective tissue diseases, PJP is emerging as an increasing threat. The clinical manifestations of PJP in HIV-infected and non-HIV-infected patients differ significantly. In non-HIV-infected patients, PJP progresses rapidly and is challenging to diagnose, resulting in severe respiratory failure and a poor prognosis. We describe lymphocytopenia in two women who were recently treated with methotrexate, tacrolimus, and corticosteroids for immunosuppressive therapy following adjuvant chemotherapy for breast cancer and kidney transplantation. The initial examination included a high-resolution chest CT indicating atypical pneumonia, and treatment was initiated with trimethoprim - sulfamethoxazole and oxygen support. Subsequently, bronchoscopy and bronchoalveolar lavage with mNGS detected Pneumocystis jirovecii. After 3 weeks of treatment with cotrimoxazole, the two patients recovered significantly and their condition was stable.

Staphylococcus aureus is a common pathogen of hematogenous lung abscesses. The increased resistance of S. aureus to antibiotics makes infections difficult to treat, often resulting in a poor prognosis. Therefore, it is important to identify S. aureus infections as early as possible and evaluate its sensitivity and resistance to antibiotics, to formulate an appropriate treatment plan. Oxazolidinone antibiotics exhibit potent antibacterial activity against multidrug-resistant (MDR) S. aureus; however, the adverse effects of linezolid, particularly thrombocytopenia, limit its application. Contezolid may ameliorate the hematologic toxicity associated with linezolid. Here, we report the case of a patient with congenital cerebral hypoplasia who was hospitalized due to fever and multiple abscesses in both lungs. In the context of negative blood culture results, the final diagnosis of MDR S. aureus as the causative agent of hematogenous lung abscess was confirmed using macrogenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS). The patient was treated with linezolid but developed significant thrombocytopenia, so switching to sequential therapy with contezolid, the patient's platelet counts returned to normal and his condition improved significantly.

Background: Contezolid (CZD) is an analog of Linezolid (LZD) that has demonstrated potent in vitro and in vivo activity against tuberculosis (TB) while presenting a safer side-effect profile. In this study, we evaluated the early bactericidal activity (EBA) of CZD compared to LZD, with LZD serving as a control.

Methods: Naive, smear-positive pulmonary TB patients were enrolled and randomly assigned to receive either a 14-day monotherapy regimen of 600 mg LZD once daily (QD) or 800 mg CZD twice daily (BID). Sputum samples were collected daily starting one day before treatment initiation and continuing throughout the treatment period. Each sample was processed for the enumeration of acid-fast bacilli (AFB) colonies, and time-to-positivity (TTP) during MGIT960 liquid culture was recorded.

Results: A total of 10 eligible patients were enrolled in each treatment group, although one patient in the CZD group was later excluded from the analysis. The early bactericidal activity (EBA0-14) was 0.08 ± 0.12 log CFU/mL/day (95% CI: -0.02 to 0.18 CFU/mL/day) in the CZD group, compared to 0.03 ± 0.10 log CFU/mL/day (95% CI: -0.05 to 0.10 CFU/mL/day) in the LZD group. The increase in time-to-positivity (TTP0-14) was 38.6 ± 43.69 hours (95% CI: -1.85 to 79 hours) in the CZD group and 27.7 ± 78.21 hours (95% CI: -28.15 to 83.75 hours) in the LZD group. LZD showed rapid bacterial reduction in sputum during the first two days of treatment, whereas CZD demonstrated superior efficacy after a few days of treatment.

Conclusion: 800 mg BID contezolid exhibited comparable efficacy to 600 mg QD LZD in treating pulmonary TB in this EBA study. While CZD showed slower initial bactericidal action compared to LZD, its efficacy surpassed that of LZD after a few days of treatment. Given its similar efficacy and superior safety profile, contezolid may serve as an alternative to linezolid for the treatment of tuberculosis.

Objective: This study aimed to investigate the status of carbapenem-resistant strains of Klebsiella pneumoniae isolated from the Department of Microbiology, Zhejiang Tongde Hospital between September 2023 and February 2024, and to examine the in vitro antibacterial effect of Reduning combined with polymyxin on carbapenem-resistant Klebsiella pneumoniae (CRKP), which may provide evidence on the application of Reduning in the clinical anti-infective therapy.

Methods: A total of 50 different isolates of CRKP were collected, and the minimum inhibitory concentrations (MIC) of polymyxin, Reduning and polymyxin plus Reduning were measured with microbroth dilution method. Then, the fractional inhibition concentration index (FICI) was calculated.

Results: A total of 50 strains of CRKP were isolated, sputum and clean urine were the most common source of CRKP, and intensive care unit was the most common source department. More than 90% of CRKP strains were resistant to cefepime, ceftazidime, piperacillin/tazobactam, and cefoperazone/sulbactam. The rate of resistance to levofloxacin was high, but that to tobramycin, tigecycline, and compound sulfamethoxazole was low. In addition, MIC of Reduning plus polymyxin for CRKP was lower than that of Reduning or polymyxin alone. Among 50 strains of CRKP, FICI ≤0.5 was noted in 7 strains, 0.5 < FICI ≤ 1.0 in 43 strains, and none had FICI >1.0. The results showed Reduning combined with polymyxin B exerted additive effect on CRKP and conferred synergistic effect on several strains of CRKP.

Conclusion: Reduning has antibacterial effect on CRKP in vitro, and the addition of Reduning can reduce the dose of polymyxin in the treatment of CRKP.