Infection and Drug Resistance最新文献_第10页

Assessment of Non-Adherence to Anti-TB Drugs and Associated Factors Among Patients Attending TB Treatment Centers During COVID-19 Pandemic in Mogadishu, Somalia: A Cross-Sectional Study 评估索马里摩加迪沙 COVID-19 大流行期间结核病治疗中心就诊患者不坚持服用抗结核药物的情况及其相关因素：横断面研究

IF 3.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-06 DOI: 10.2147/idr.s468985

Abdullahi Abdirahman Omar, Jamal Hassan Mohamoud, Mohamed Hussein Adam, Bashiru Garba, Mariam Abdi Hassan, Ibrahim Abdullahi Mohamed, Zakaria Mohamed Adam

Background: The COVID-19 pandemic’s first wave and subsequent lockdowns disrupted global healthcare systems, significantly impacting essential services including tuberculosis (TB) care. Non-adherence to anti-TB drugs is a critical concern, leading to treatment failure, drug resistance, and increased morbidity and mortality. This study assessed the rate and determinants of non-adherence to TB treatment among patients at TB centers during the first wave of the pandemic.
Material and Methods: A cross-sectional study was conducted from June 15 to July 30, 2020, involving 255 TB patients at three centers in Mogadishu. Data were gathered using the Morisky Medication Adherence Scale-8 (MMAS-8) through structured interviews and analyzed using descriptive statistics and binary logistic regression.
Results: The study found a 34.5% non-adherence rate during the pandemic. Key reasons for non-adherence included forgetting to take medication (33%), feeling well (29%), experiencing side effects (18%), and fear of contracting COVID-19 (16%). Significant factors associated with non-adherence were age groups 25– 34 years (OR = 2.96, p = 0.024) and 35– 44 years (OR = 4.55, p = 0.005), unemployment (OR = 2.57, p = 0.037), smoking (OR = 3.49, p = 0.029), tobacco use (OR = 4.15, p = 0.034), proximity to a health facility (OR = 0.44, p = 0.033), perception of healthcare providers as very friendly (OR = 0.24, p = 0.031) or friendly (OR = 0.45, p = 0.023), being in the continuous treatment phase (OR = 3.2, p < 0.001), and experiencing adverse treatment effects (OR = 2.42, p = 0.003).
Conclusion: Non-adherence to anti-tuberculosis treatment was notably high in Mogadishu during the first wave of the pandemic, necessitating targeted interventions to improve adherence.

背景：COVID-19 大流行的第一波和随后的封锁扰乱了全球医疗保健系统，严重影响了包括结核病（TB）护理在内的基本服务。不坚持服用抗结核药物是一个令人严重关切的问题，它会导致治疗失败、耐药性以及发病率和死亡率上升。本研究评估了结核病大流行第一波期间结核病中心患者不坚持结核病治疗的比例和决定因素：这项横断面研究于 2020 年 6 月 15 日至 7 月 30 日进行，涉及摩加迪沙三个中心的 255 名结核病患者。通过结构化访谈使用莫里斯基用药依从性量表-8（MMAS-8）收集数据，并使用描述性统计和二元逻辑回归进行分析：研究发现，大流行期间不坚持用药的比例为 34.5%。不坚持服药的主要原因包括忘记服药（33%）、感觉不适（29%）、出现副作用（18%）和害怕感染 COVID-19（16%）。与不坚持服药相关的重要因素有：年龄组 25- 34 岁（OR = 2.96，p = 0.024）和 35- 44 岁（OR = 4.55，p = 0.005）、失业（OR = 2.57，p = 0.037）、吸烟（OR = 3.49，p = 0.029）、吸烟（OR = 4.15，p = 0.034）、距离医疗机构远近（OR = 0.44，p = 0.033）、认为医疗服务提供者非常友好（OR = 0.24，p = 0.031）或友好（OR = 0.45，p = 0.023）、处于持续治疗阶段（OR = 3.2，p <0.001）和经历不良治疗效果（OR = 2.42，p = 0.003）：结论：在大流行病的第一波期间，摩加迪沙不坚持抗结核治疗的人数明显偏高，因此有必要采取有针对性的干预措施来改善坚持治疗的情况。

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引用次数: 0

A Machine Learning Model Based on CT Imaging Metrics and Clinical Features to Predict the Risk of Hospital-Acquired Pneumonia After Traumatic Brain Injury 基于 CT 成像指标和临床特征的机器学习模型预测创伤性脑损伤后医院获得性肺炎的风险

IF 3.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-05 DOI: 10.2147/idr.s473825

Shaojie Li, Qiangqiang Feng, Jiayin Wang, Baofang Wu, Weizhi Qiu, Yiming Zhuang, Yong Wang, Hongzhi Gao

Objective: To develop a validated machine learning (ML) algorithm for predicting the risk of hospital-acquired pneumonia (HAP) in patients with traumatic brain injury (TBI).
Materials and Methods: We employed the Least Absolute Shrinkage and Selection Operator (LASSO) to identify critical features related to pneumonia. Five ML models—Logistic Regression (LR), Extreme Gradient Boosting (XGB), Random Forest (RF), Naive Bayes Classifier (NB), and Support Vector Machine (SVC)—were developed and assessed using the training and validation datasets. The optimal model was selected based on its performance metrics and used to create a dynamic web-based nomogram.
Results: In a cohort of 858 TBI patients, the HAP incidence was 41.02%. LR was determined to be the optimal model with superior performance metrics including AUC, accuracy, and F1-score. Key predictive factors included Age, Glasgow Coma Score, Rotterdam Score, D-dimer, and the Systemic Immune Response to Inflammation Index (SIRI). The nomogram developed based on these predictors demonstrated high predictive accuracy, with AUCs of 0.818 and 0.819 for the training and validation datasets, respectively. Decision curve analysis (DCA) and calibration curves validated the model’s clinical utility and accuracy.
Conclusion: We successfully developed and validated a high-performance ML algorithm to assess the risk of HAP in TBI patients. The dynamic nomogram provides a practical tool for real-time risk assessment, potentially improving clinical outcomes by aiding in early intervention and personalized patient management.

Keywords: traumatic brain injury, machine learning, hospital-acquired pneumonia, dynamic nomogram, imaging metrics

目的开发一种经过验证的机器学习（ML）算法，用于预测创伤性脑损伤（TBI）患者的医院获得性肺炎（HAP）风险：我们采用最小绝对收缩和选择操作器（LASSO）来识别与肺炎相关的关键特征。我们开发了五种 ML 模型--逻辑回归（LR）、极梯度提升（XGB）、随机森林（RF）、奈夫贝叶斯分类器（NB）和支持向量机（SVC）--并使用训练和验证数据集进行了评估。根据其性能指标选出了最佳模型，并用于创建基于网络的动态提名图：在一组 858 名创伤性脑损伤患者中，HAP 发生率为 41.02%。LR被确定为最佳模型，其AUC、准确率和F1-分数等性能指标均优于其他模型。主要预测因素包括年龄、格拉斯哥昏迷评分、鹿特丹评分、D-二聚体和系统性炎症免疫反应指数（SIRI）。基于这些预测因子开发的提名图显示出很高的预测准确性，训练数据集和验证数据集的AUC分别为0.818和0.819。决策曲线分析（DCA）和校准曲线验证了该模型的临床实用性和准确性：我们成功开发并验证了一种用于评估创伤性脑损伤患者 HAP 风险的高性能 ML 算法。动态提名图为实时风险评估提供了一个实用工具，可通过帮助早期干预和个性化患者管理来改善临床结果。关键词：创伤性脑损伤；机器学习；医院获得性肺炎；动态提名图；成像指标

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引用次数: 0

Candidaemia: A 9-Year Retrospective Analysis of Epidemiology and Antimicrobial Susceptibility in Tertiary Care Hospitals in Western China 念珠菌病：对中国西部地区三级医院流行病学和抗菌药物敏感性的 9 年回顾性分析

IF 3.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-05 DOI: 10.2147/idr.s477815

Kun Li, Xue Yang, Long Li, Lan Zhi

Purpose: This investigation endeavors to scrutinize the resistance profiles to antifungal agents, alongside the clinical distribution of Candida isolates that yielded positive results in blood cultures at Suining Central Hospital spanning the years 2015 to 2023. The objective is to provide crucial epidemiological insights that may aid in early clinical intervention and judicious deployment of antifungal therapies.
Methods: This retrospective analysis analyses data on 182 different Candida strains with positive clinical blood cultures obtained from the Microbiology Laboratory of Suining Central Hospital over a period of nine consecutive years. The study involved identification of Candida species and assessment of resistance patterns to fungal drugs.
Results: Our analysis revealed that the median age of patients diagnosed with Candidaemia from the 182 strains was 62 years, with a distribution of 63.7% females and 36.3% males. Within the cohort of 182 Candida strains, Candida albicans constituted 32.4%, while non-albicans Candida species comprised 67.6% of the cases. Specifically, Candida tropicalis represented 37.4%, Candida glabrata 12.1%, Candida parapsilosis 11.0%,Candida guilliermondii 3.8%, and both Candida krusei and Candida Dublin accounted for 1.6% each. These Candida species were predominantly identified in intensive care units (ICU), hematology, gastroenterology, neurology centers, and endocrine metabolism units.
Conclusion: The findings of this investigation suggest a shift in the prevalence of non-Candida albicans species, notably C. tropicalis, as the predominant cause of Candidaemia at Suining Central Hospital, surpassing C. albicans. Although instances of antifungal resistance are infrequent, there has been a notable rise in resistance to azoles. This study provides important insights into the local epidemiology, which will be essential for informing the selection of empirical antifungal therapy and contributing to the global surveillance of antifungal resistance.

Keywords: candidemia, Candida species, antifungal agents, bloodstream

目的：本调查旨在研究遂宁市中心医院在2015年至2023年期间血液培养结果呈阳性的念珠菌分离株对抗真菌药物的耐药性以及临床分布情况。目的是提供重要的流行病学见解，以帮助早期临床干预和明智地使用抗真菌疗法：这项回顾性分析对连续九年从遂宁市中心医院微生物实验室获得的临床血液培养阳性的 182 株不同念珠菌进行了数据分析。研究包括鉴定念珠菌菌种和评估对真菌药物的耐药性模式：我们的分析表明，从 182 株菌株中确诊的念珠菌病患者的中位年龄为 62 岁，其中女性占 63.7%，男性占 36.3%。在 182 株念珠菌群中，白色念珠菌占 32.4%，非白色念珠菌占 67.6%。具体来说，热带念珠菌占 37.4%，光滑念珠菌占 12.1%，副丝状念珠菌占 11.0%，guilliermondii 念珠菌占 3.8%，克鲁塞念珠菌和都柏林念珠菌各占 1.6%。这些念珠菌主要出现在重症监护室（ICU）、血液科、消化科、神经病学中心和内分泌代谢科：调查结果表明，遂宁市中心医院白色念珠菌病的主要致病菌已从白色念珠菌转变为非白色念珠菌，特别是热带念珠菌。虽然抗真菌药物耐药性的情况并不常见，但对唑类药物的耐药性却明显增加。这项研究为了解当地的流行病学提供了重要依据，对选择经验性抗真菌治疗方法至关重要，并有助于全球对抗真菌耐药性的监测。

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引用次数: 0

Retrospective Analysis of Risk Factors for Cefoperazone/Sulbactam-Induced Thrombocytopenia in Adult Chinese Patients: A Six-Year Real-World Study 中国成年患者中头孢哌酮/舒巴坦诱发血小板减少症风险因素的回顾性分析：一项为期六年的真实世界研究

IF 3.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-05 DOI: 10.2147/idr.s475590

Bolin Zhu, Pengfei Jin, Jianchun Li, Yuanchao Zhu

Background: Drug-induced thrombocytopenia is a rare adverse reaction of drug therapy and usually underdiagnosed. Cefoperazone/sulbactam is a compound preparation composed of the third generation of cephalosporin and β-lactamase inhibitor, of which thrombocytopenia is an uncommon but serious adverse reaction. However, the existing literature on cefoperazone/sulbactam-induced thrombocytopenia remains limited, and the specific risk factors associated with this adverse effect have not been thoroughly elucidated. Consequently, this study aims to investigate the clinical characteristics and identify the risk factors for thrombocytopenia in adult patients undergoing cefoperazone/sulbactam therapy.
Methods: In this retrospective study, we reviewed patients treated with cefoperazone/sulbactam at Beijing Hospital between January 2017 and June 2023. Patients were categorized into two groups based on the presence or absence of thrombocytopenia: the thrombocytopenia group and the non-thrombocytopenia group. We collected data on demographic features, clinical characteristics, laboratory parameters, treatments, and outcomes. Subsequently, univariate and multivariate logistic regression analyses were performed to identify potential risk factors for cefoperazone/sulbactam-induced thrombocytopenia.
Results: In total, 6489 patients were included in this study, and 2.4% (155/6489) developed thrombocytopenia. The results of multivariate analysis showed that cefoperazone/sulbactam therapy duration (d) > 14, PLT (10⁹/L) < 200, daily dose of cefoperazone/sulbactam (g) ≥ 6, TBil (μmoL/L) > 21, AST (U/L) > 35, and use of non-invasive ventilator were risk factors for cefoperazone/sulbactam-induced thrombocytopenia.
Conclusion: Despite the low incidence (2.4%), cefoperazone/sulbactam could cause serious thrombocytopenia sometimes accompanied with hemorrhage. In clinical therapy, clinicians should be vigilant in monitoring platelet count, especially for patients with risk factors of cefoperazone/sulbactam-induced thrombocytopenia.

背景：药物诱发的血小板减少症是一种罕见的药物治疗不良反应，通常诊断不足。头孢哌酮/舒巴坦是由第三代头孢菌素和β-内酰胺酶抑制剂组成的复方制剂，其中血小板减少是一种不常见但严重的不良反应。然而，关于头孢哌酮/舒巴坦诱发血小板减少症的现有文献仍然有限，与这一不良反应相关的具体风险因素尚未得到彻底阐明。因此，本研究旨在调查接受头孢哌酮/舒巴坦治疗的成人患者血小板减少的临床特征并确定其风险因素：在这项回顾性研究中，我们回顾了 2017 年 1 月至 2023 年 6 月期间在北京医院接受头孢哌酮/舒巴坦治疗的患者。根据是否存在血小板减少症将患者分为两组：血小板减少症组和非血小板减少症组。我们收集了有关人口统计学特征、临床特征、实验室参数、治疗方法和结果的数据。随后，我们进行了单变量和多变量逻辑回归分析，以确定头孢哌酮/舒巴坦诱发血小板减少症的潜在风险因素：本研究共纳入 6489 例患者，2.4%（155/6489）的患者出现血小板减少。多变量分析结果显示，头孢哌酮/舒巴坦治疗持续时间（d）> 14、PLT（109/L）< 200、头孢哌酮/舒巴坦日剂量（g）≥6、TBil（μmoL/L）> 21、AST（U/L）> 35、使用无创呼吸机是头孢哌酮/舒巴坦诱发血小板减少的危险因素：尽管发病率较低（2.4%），但头孢哌酮/舒巴坦可导致严重的血小板减少，有时还伴有出血。在临床治疗中，临床医生应警惕监测血小板计数，尤其是对有头孢哌酮/舒巴坦诱发血小板减少危险因素的患者。

{"title":"Retrospective Analysis of Risk Factors for Cefoperazone/Sulbactam-Induced Thrombocytopenia in Adult Chinese Patients: A Six-Year Real-World Study","authors":"Bolin Zhu, Pengfei Jin, Jianchun Li, Yuanchao Zhu","doi":"10.2147/idr.s475590","DOIUrl":"https://doi.org/10.2147/idr.s475590","url":null,"abstract":"Background: Drug-induced thrombocytopenia is a rare adverse reaction of drug therapy and usually underdiagnosed. Cefoperazone/sulbactam is a compound preparation composed of the third generation of cephalosporin and β-lactamase inhibitor, of which thrombocytopenia is an uncommon but serious adverse reaction. However, the existing literature on cefoperazone/sulbactam-induced thrombocytopenia remains limited, and the specific risk factors associated with this adverse effect have not been thoroughly elucidated. Consequently, this study aims to investigate the clinical characteristics and identify the risk factors for thrombocytopenia in adult patients undergoing cefoperazone/sulbactam therapy. Methods: In this retrospective study, we reviewed patients treated with cefoperazone/sulbactam at Beijing Hospital between January 2017 and June 2023. Patients were categorized into two groups based on the presence or absence of thrombocytopenia: the thrombocytopenia group and the non-thrombocytopenia group. We collected data on demographic features, clinical characteristics, laboratory parameters, treatments, and outcomes. Subsequently, univariate and multivariate logistic regression analyses were performed to identify potential risk factors for cefoperazone/sulbactam-induced thrombocytopenia. Results: In total, 6489 patients were included in this study, and 2.4% (155/6489) developed thrombocytopenia. The results of multivariate analysis showed that cefoperazone/sulbactam therapy duration (d) > 14, PLT (109/L) < 200, daily dose of cefoperazone/sulbactam (g) ≥ 6, TBil (μmoL/L) > 21, AST (U/L) > 35, and use of non-invasive ventilator were risk factors for cefoperazone/sulbactam-induced thrombocytopenia. Conclusion: Despite the low incidence (2.4%), cefoperazone/sulbactam could cause serious thrombocytopenia sometimes accompanied with hemorrhage. In clinical therapy, clinicians should be vigilant in monitoring platelet count, especially for patients with risk factors of cefoperazone/sulbactam-induced thrombocytopenia. ","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cryptococcus Neoformans Osteomyelitis of the Right Ankle Diagnosed by Metagenomic Next-Generation Sequencing in a HIV-Negative Patient with Tuberculous Lymphadenitis and Pulmonary Tuberculosis: A Case Report and Recent Literature Review 通过元基因组下一代测序确诊的右踝关节隐球菌骨髓炎（HIV 阴性患者伴结核性淋巴结炎和肺结核）：病例报告和最新文献综述

IF 3.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-04 DOI: 10.2147/idr.s476270

Yao Qin, Xingwu Zou, Yanghui Jin, Jinmeng Li, Qingshan Cai

Aim: Cryptococcus neoformans osteomyelitis coupled with tuberculosis and tuberculous lymphadenitis, is a rare occurrence in clinical. Diagnostic challenges arise due to the clinical radiological similarity of this condition to other lung infections and the limited and sensitive nature of traditional approaches. Here, we present a case of co-infection diagnosed using Metagenomic Next-Generation Sequencing, highlighting the effectiveness of advanced genomic techniques in such complex scenarios.
Case Presentation: We present a case of a 67-year-old female infected with cryptococcal osteomyelitis and presented with swelling and pain in the right ankle. Following a biopsy of the right ankle joint, Metagenomic Next-Generation Sequencing (mNGS) of the biopsy tissue revealed Cryptococcus neoformans infection. Positive results for Cryptococcus capsular antigen and pathological findings confirmed the presence of Cryptococcus neoformans. The patient underwent surgical debridement, coupled with oral fluconazole treatment (300mg/day), leading to the resolution of symptoms.
Conclusion: Cryptococcus neoformans is an uncommon cause of ankle infection. Metagenomic Next-Generation Sequencing (mNGS) serves as a valuable diagnostic tool, aiding clinicians in differentiating cryptococcal osteomyelitis from other atypical infections.

Keywords: Cryptococcus neoformans, tuberculosis, diagnosis, metagenomic next-generation sequencing, mNGS

目的：新型隐球菌骨髓炎合并结核病和结核性淋巴结炎在临床上十分罕见。由于这种病症与其他肺部感染在临床放射学上的相似性，以及传统方法的局限性和敏感性，给诊断带来了挑战。在此，我们介绍一例使用元基因组下一代测序技术诊断出的合并感染病例，以突出先进基因组技术在此类复杂情况下的有效性：我们介绍了一例感染了隐球菌骨髓炎的 67 岁女性病例，患者表现为右脚踝肿胀和疼痛。对右踝关节进行活检后，活检组织的元基因组下一代测序（mNGS）显示感染了新型隐球菌。隐球菌荚膜抗原阳性结果和病理结果证实了新生隐球菌的存在。患者接受了手术清创，同时口服氟康唑治疗（300 毫克/天），症状得到缓解：结论：新生隐球菌是脚踝感染的一个不常见原因。元基因组下一代测序（mNGS）可作为一种有价值的诊断工具，帮助临床医生区分隐球菌性骨髓炎和其他非典型感染：新型隐球菌结核病诊断元基因组下一代测序 mNGS

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引用次数: 0

Clinical Characteristics, Serotypes and Antimicrobial Resistance of Invasive Salmonella Infections in HIV-Infected Patients in Hangzhou, China, 2012-2023. 2012-2023 年杭州市艾滋病病毒感染者侵袭性沙门氏菌感染的临床特征、血清型和抗菌药物耐药性。

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-04 eCollection Date: 2024-01-01 DOI: 10.2147/IDR.S465979

Jingying Xu, Yuan Chen, Jianhua Yu, Shourong Liu, Ying Meng, Chaodan Li, Qian Huang, Yunlei Xiao

Purpose: Developing countries, invasive Salmonella infections can cause considerable morbidity and mortality. There is a relative lack of data on coinfection with Salmonella in HIV-infected patients in Hangzhou, China.

Patients and methods: In this study, we manually collected case data of patients aged >18 years with HIV combined with invasive Salmonella infections admitted to Xixi Hospital in Hangzhou from January 2012 to August 2023 by logging into the Hospital Information System, and identified 26 strains of invasive Salmonella using a fully automated microbiological identification system and mass spectrometer. Serotypes were determined using Salmonella diagnostic sera based on the White-Kauffmann-Le Minor scheme. Drug sensitivity tests were performed using the automated instrumental method of the MIC method.

Results: A total of 26 HIV-infected patients with invasive Salmonella coinfections were identified over 11 years; Twenty-five of the 26 patients (96.2%) were males, with a mean age of 33.5 years (26.75, 46.75). The most common type of infection was bloodstream infection (92.3%). One patient also had concomitant meningitis and osteoarthritis, followed by pneumonia (7.7%). The presence of multiple bacterial infections or even multiple opportunistic pathogens was clearly established in 7 (26.9%) patients. Three (11.6%) patients were automatically discharged from the hospital with deterioration of their condition, and one (3.8%) patient died. Salmonella enteritidis was the most common serotype in 6 patients (23.2%), and Salmonella Dublin was the most common serotype in 6 patients (23.2%). Drug sensitivity results revealed multidrug resistance in a total of 8 (30.8%) patients.

Conclusion: The clinical presentation of invasive Salmonella infection in HIV patients is nonspecific and easily masked by other mixed infections. A CD4⁺ count <100 cells/µL and comorbid intestinal lesions may be important susceptibility factors. Salmonella has a high rate of resistance to common antibiotics, and the risk of multidrug resistance should not be ignored.

目的：在发展中国家，侵袭性沙门氏菌感染可导致相当高的发病率和死亡率。在中国杭州，有关艾滋病病毒感染者合并沙门氏菌感染的数据相对缺乏：在本研究中，我们通过登录医院信息系统手动收集了2012年1月至2023年8月期间杭州市西溪医院收治的年龄大于18岁的HIV合并侵袭性沙门氏菌感染患者的病例数据，并使用全自动微生物鉴定系统和质谱仪鉴定了26株侵袭性沙门氏菌。根据 White-Kauffmann-Le Minor 方案，使用沙门氏菌诊断血清确定血清型。药敏试验采用 MIC 法的自动仪器法进行：在 11 年的时间里，共发现了 26 名合并侵袭性沙门氏菌感染的 HIV 感染者；26 名患者中有 25 名男性（96.2%），平均年龄为 33.5 岁（26.75，46.75）。最常见的感染类型是血流感染（92.3%）。一名患者还同时患有脑膜炎和骨关节炎，其次是肺炎（7.7%）。7名患者（26.9%）明确存在多种细菌感染，甚至多种机会性病原体。3名（11.6%）患者因病情恶化自动出院，1名（3.8%）患者死亡。肠炎沙门氏菌是 6 名患者（23.2%）最常见的血清型，都柏林沙门氏菌是 6 名患者（23.2%）最常见的血清型。药敏结果显示，共有8名患者（30.8%）对多种药物产生耐药性：结论：HIV 患者侵袭性沙门氏菌感染的临床表现无特异性，很容易被其他混合感染所掩盖。CD4+计数的沙门氏菌对普通抗生素的耐药率很高，多重耐药的风险不容忽视。

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引用次数: 0

In vitro Synergistic and Bactericidal Effects of Aztreonam in Combination with Ceftazidime/ Avibactam, Meropenem/Vaborbactam and Imipenem/Relebactam Against Dual-Carbapenemase-Producing Enterobacterales. 氨曲南与头孢他啶/阿维巴坦、美罗培南/巴巴坦和亚胺培南/雷贝拉坦联用对产双碳青霉烯酶肠杆菌的体外协同和杀菌作用

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-04 eCollection Date: 2024-01-01 DOI: 10.2147/IDR.S474150

Ying Fu, Yufeng Zhu, Feng Zhao, Bingyan Yao, Yunsong Yu, Jun Zhang, Qiong Chen

Objective: Our aim was to elucidate the resistance mechanisms and assess the combined synergistic and bactericidal activities of aztreonam in combination with ceftazidime/avibactam (CZA), meropenem/vaborbactam (MEV), and imipenem/relebactam (IMR) against Enterobacterales strains producing dual carbapenemases.

Methods: Species identification, antimicrobial susceptibility testing and determination of carbapenemase type were performed for these strains. Plasmid sizes, plasmid conjugation abilities and the localization of carbapenemase genes were investigated. Whole-genome sequencing was performed for all strains and their molecular characteristics were analyzed. In vitro synergistic and bactericidal activities of the combination of aztreonam with CZA, MEV and IMR against these strains were determined using checkerboard assay and time-kill curve assay.

Results: A total of 12 Enterobacterales strains producing dual-carbapenemases were collected, including nine K. pneumoniae, two P. rettgeri, and one E. hormaechei. The most common dual-carbapenemase gene pattern observed was bla _{(KPC-2+NDM-5)} (n=4), followed by bla _KPC-2+IMP-26 (n=3), bla _{(KPC-2+NDM-1)} (n=2), bla _{(KPC-2+IMP-4)} (n=1), bla _{(NDM-1+IMP-4)} (n=1) and bla _{(KPC-2+KPC-2)} (n=1). In each strain, the carbapenemase genes were found to be located on two distinct plasmids which were capable of conjugating from the original strain to the receipt strain E. coli J53. The results of the checkerboard synergy analysis consistently revealed good synergistic effects of the combination of ATM with CZA, MEV and IMR. Except for one strain, all strains exhibited significant synergistic activity and bactericidal activity between 2 and 8 hours.

Conclusion: Dual-carbapenemase-producing Enterobacterales posed a significant threat to clinical anti-infection treatment. However, the combination of ATM with innovative β-lactam/β-lactamase inhibitor compounds had proven to be an effective treatment option.

目的我们的目的是阐明耐药机制，并评估阿兹曲南与头孢他啶/阿维菌素（CZA）、美罗培南/伐硼内酰胺（MEV）和亚胺培南/雷巴坦（IMR）联合使用对产生双重碳青霉烯酶的肠杆菌菌株的增效和杀菌活性：方法：对这些菌株进行了菌种鉴定、抗菌药敏感性测试和碳青霉烯酶类型测定。研究了质粒大小、质粒连接能力和碳青霉烯酶基因的定位。对所有菌株进行了全基因组测序，并分析了它们的分子特征。采用棋盘格法和时间杀灭曲线法测定了阿兹曲南与 CZA、MEV 和 IMR 复方制剂对这些菌株的体外增效和杀菌活性：结果：共收集到 12 株产生双碳青霉烯酶的肠杆菌属菌株，其中包括 9 株肺炎克氏菌、2 株雷特格列氏菌和 1 株荷马埃希氏菌。最常见的双碳青霉烯酶基因模式是 bla (KPC-2+NDM-5) (n=4)，其次是 bla KPC-2+IMP-26 (n=3)、bla (KPC-2+NDM-1) (n=2)、bla (KPC-2+IMP-4) (n=1)、bla (NDM-1+IMP-4) (n=1) 和 bla (KPC-2+KPC-2) (n=1)。在每个菌株中，碳青霉烯酶基因都位于两个不同的质粒上，它们能够从原始菌株连接到接收菌株大肠杆菌 J53。棋盘式协同作用分析结果一致显示，ATM 与 CZA、MEV 和 IMR 的组合具有良好的协同作用。除一株菌株外，所有菌株在 2 至 8 小时内均表现出显著的协同活性和杀菌活性：结论：产双碳青霉烯酶肠杆菌对临床抗感染治疗构成了重大威胁。然而，事实证明，ATM 与创新型 β-内酰胺/β-内酰胺酶抑制剂化合物的组合是一种有效的治疗方案。

{"title":"In vitro Synergistic and Bactericidal Effects of Aztreonam in Combination with Ceftazidime/ Avibactam, Meropenem/Vaborbactam and Imipenem/Relebactam Against Dual-Carbapenemase-Producing Enterobacterales.","authors":"Ying Fu, Yufeng Zhu, Feng Zhao, Bingyan Yao, Yunsong Yu, Jun Zhang, Qiong Chen","doi":"10.2147/IDR.S474150","DOIUrl":"10.2147/IDR.S474150","url":null,"abstract":"Objective: Our aim was to elucidate the resistance mechanisms and assess the combined synergistic and bactericidal activities of aztreonam in combination with ceftazidime/avibactam (CZA), meropenem/vaborbactam (MEV), and imipenem/relebactam (IMR) against Enterobacterales strains producing dual carbapenemases.Methods: Species identification, antimicrobial susceptibility testing and determination of carbapenemase type were performed for these strains. Plasmid sizes, plasmid conjugation abilities and the localization of carbapenemase genes were investigated. Whole-genome sequencing was performed for all strains and their molecular characteristics were analyzed. In vitro synergistic and bactericidal activities of the combination of aztreonam with CZA, MEV and IMR against these strains were determined using checkerboard assay and time-kill curve assay.Results: A total of 12 Enterobacterales strains producing dual-carbapenemases were collected, including nine K. pneumoniae, two P. rettgeri, and one E. hormaechei. The most common dual-carbapenemase gene pattern observed was bla (KPC-2+NDM-5) (n=4), followed by bla KPC-2+IMP-26 (n=3), bla (KPC-2+NDM-1) (n=2), bla (KPC-2+IMP-4) (n=1), bla (NDM-1+IMP-4) (n=1) and bla (KPC-2+KPC-2) (n=1). In each strain, the carbapenemase genes were found to be located on two distinct plasmids which were capable of conjugating from the original strain to the receipt strain E. coli J53. The results of the checkerboard synergy analysis consistently revealed good synergistic effects of the combination of ATM with CZA, MEV and IMR. Except for one strain, all strains exhibited significant synergistic activity and bactericidal activity between 2 and 8 hours.Conclusion: Dual-carbapenemase-producing Enterobacterales posed a significant threat to clinical anti-infection treatment. However, the combination of ATM with innovative β-lactam/β-lactamase inhibitor compounds had proven to be an effective treatment option.","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Effectiveness and Safety of Colistin Sulphate in Treating Infections Caused by Carbapenem-Resistant Organisms and Analysis of Influencing Factors. 硫酸考利司汀治疗耐碳青霉烯菌感染的临床有效性和安全性及影响因素分析。

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI: 10.2147/IDR.S473200

Ying-Chao Ma, Ya-Qing Sun, Xia Wu, Yong-Jing Wang, Xiu-Ling Yang, Jian-Jun Gu

Objective: To assess the efficacy and safety of colistin sulfate in treating infections caused by carbapenem-resistant organisms (CRO) and to analyze potential factors impacting its effectiveness.

Methods: In this retrospective study, medical records of CRO-infected patients from June 2020 to June 2023 were analyzed, divided into effective and ineffective treatment groups, and compared for clinical outcomes and adverse reactions. Multifactorial logistic regression and ROC curve analysis were used to identify influencing factors.

Results: The study included 226 patients, with 124 in the effective treatment group and 102 in the ineffective group. A total of 293 CRO strains were cultured. The clinical efficacy rate of colistin sulfate was 54.87%, the microbiological efficacy rate 46.46%, and the hospital mortality rate 20.80%, with nephrotoxicity observed in 11.50% of patients. Multifactorial analysis identified APACHE II scores and vasoactive drug use as independent predictors of ineffective treatment, while treatment duration and albumin levels predicted effective treatment. ROC analysis indicated that albumin levels >34 g/L, APACHE II scores <13, and treatment duration >10 days correlated with better clinical efficacy.

Conclusion: Colistin sulfate is both safe and effective in clinical settings. Factors such as treatment duration, albumin levels, APACHE II scores, and vasoactive drug use independently affect its clinical efficacy, providing valuable guidance for its informed clinical application.

目的评估硫酸考利司汀治疗耐碳青霉烯菌（CRO）感染的有效性和安全性，并分析影响其有效性的潜在因素：在这项回顾性研究中，分析了2020年6月至2023年6月期间CRO感染患者的病历，将其分为有效治疗组和无效治疗组，并比较了临床结果和不良反应。采用多因素逻辑回归和ROC曲线分析确定影响因素：研究共纳入 226 例患者，其中有效治疗组 124 例，无效治疗组 102 例。共培养出 293 株 CRO 菌株。硫酸可乐定的临床有效率为 54.87%，微生物有效率为 46.46%，住院死亡率为 20.80%，11.50% 的患者出现肾毒性。多因素分析表明，APACHE II 评分和血管活性药物的使用是治疗无效的独立预测因素，而治疗时间和白蛋白水平则是治疗有效的预测因素。ROC分析表明，白蛋白水平大于34克/升、APACHE II评分10天与更好的临床疗效相关：结论：硫酸考利司汀在临床上既安全又有效。治疗时间、白蛋白水平、APACHE II 评分和血管活性药物的使用等因素会独立影响其临床疗效，这为临床应用提供了有价值的指导。

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引用次数: 0

Prognostic Factors That Affect Mortality Patients with Acinetobacter baumannii Bloodstream Infection. 影响鲍曼不动杆菌血流感染患者死亡率的预后因素。

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI: 10.2147/IDR.S475073

Chunrong Huang, Yulian Gao, Hongxia Lin, Qinmei Fan, Ling Chen, Yun Feng

Background: To evaluate the clinical features of patients with Acinetobacter baumannii bloodstream infection (BSI).

Methods: Totally 200 inpatients with Acinetobacter baumannii BSI were included, clinical features of Acinetobacter baumannii BSI inpatients between 90-day survival and 90-day mortality groups, between 30-day survival and 30-day mortality groups, between patients infected with multidrug-resistant (MDR group) and sensitive Acinetobacter baumannii (sensitive group) were analyzed. The prognostic factors of 90-day mortality were analyzed by univariate logistic regression and multivariate logistic regression. The survival curve in bloodstream infectious patients with multidrug-resistant (MDR group) and sensitive Acinetobacter baumannii (sensitive group) was analyzed by Kaplan-Meier analysis.

Results: The 90-day mortality patients had significantly higher carbapenem-resistant bacterial infection and critical care unit (ICU) admission. The 90-day and 30-day mortality groups showed higher C-reactive protein (CRP) and serum creatinine (Scr) levels and lower red blood cells (RBC) and albumin (ALB) levels than their survival counterparts, respectively. Critical surgery, ICU admission and delayed antibiotic treatment were independently prognostic risk predictors for 90-day mortality in Acinetobacter baumannii BSI patients, while critical surgery and diabetes were independently prognostic risk predictors for 90-day mortality in carbapenem-resistant Acinetobacter baumannii BSI patients. Compared with sensitive group, MDR group showed significantly longer ICU and whole hospital stay, lower levels of lymphocytes, RBC, hemoglobin, lactate dehydrogenase and ALB, higher frequency of infection originating from the skin and skin structure. Moreover, patients in the MDR group had a significantly worse overall survival than the sensitive group.

Conclusion: We identified the prognostic factors of Acinetobacter baumannii BSI and carbapenem-resistant Acinetobacter baumannii BSI patients. Critical surgery, ICU admission, delayed antibiotic treatment or diabetes were significantly associated with the mortality of those patients. Moreover, aggressive measures to control MDR Acinetobacter baumannii could lead to improved outcomes.

背景：评估鲍曼不动杆菌血流感染（BSI）患者的临床特征：评估鲍曼不动杆菌血流感染（BSI）患者的临床特征：方法：纳入200例鲍曼不动杆菌血流感染住院患者，分析90天存活组和90天死亡组之间、30天存活组和30天死亡组之间、耐多药组（MDR组）和敏感组（敏感组）之间鲍曼不动杆菌血流感染住院患者的临床特征。通过单变量逻辑回归和多变量逻辑回归分析了 90 天死亡率的预后因素。采用 Kaplan-Meier 分析法分析了耐多药（MDR 组）和敏感鲍曼不动杆菌（敏感组）血流感染患者的生存曲线：结果：90天死亡患者的碳青霉烯耐药细菌感染率和入住重症监护室（ICU）率明显较高。与生存组相比，90 天和 30 天死亡组的 C 反应蛋白（CRP）和血清肌酐（Scr）水平较高，红细胞（RBC）和白蛋白（ALB）水平较低。危重手术、入住重症监护室和延迟抗生素治疗是预测鲍曼不动杆菌BSI患者90天死亡率的独立预后风险因素，而危重手术和糖尿病是预测耐碳青霉烯类鲍曼不动杆菌BSI患者90天死亡率的独立预后风险因素。与敏感组相比，MDR 组的重症监护室和整个住院时间明显更长，淋巴细胞、红细胞、血红蛋白、乳酸脱氢酶和 ALB 水平更低，源于皮肤和皮肤结构的感染频率更高。此外，MDR 组患者的总生存率明显低于敏感组：我们确定了鲍曼不动杆菌 BSI 和耐碳青霉烯类鲍曼不动杆菌 BSI 患者的预后因素。危重手术、入住重症监护室、延迟抗生素治疗或糖尿病与这些患者的死亡率有显著相关性。此外，采取积极措施控制MDR鲍曼不动杆菌可改善预后。

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引用次数: 0

ESKAPE Pathogens: Antimicrobial Resistance Patterns, Risk Factors, and Outcomes a Retrospective Cross-Sectional Study of Hospitalized Patients in Palestine. ESKAPE 病原体：巴勒斯坦住院患者抗菌药耐药性模式、风险因素和结果的回顾性横断面研究。

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance

Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI: 10.2147/IDR.S471645

Abdallah Damin Abukhalil, Sally Amer Barakat, Aseel Mansour, Ni'meh Al-Shami, Hani Naseef

Background: Antimicrobial resistance to ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp). remains a major challenge in hospital settings.

Objective: This study aimed to determine the ESKAPE antimicrobial resistance patterns and associated factors with multi-drug resistance strains among hospitalized patients in a single tertiary care medical hospital in Palestine.

Methods: A single-center retrospective cross-sectional study was conducted by reviewing patients' electronic medical records and laboratory results from November 1, 2021, to November 30, 2022, at the Palestine Medical Complex in Palestine. The study included patients aged > 18 years who had been infected with ESKAPE pathogens 48 hours after hospital admission.

Results: This study included 231 patients, of whom 90.5% had MDR infections. In total, 331 clinical samples of ESKAPE pathogens were identified. A. baumannii was the most prevalent MDR pathogen (95.6%) with Carbapenem-resistant exceeding 95%, followed by K. pneumoniae (83.8%) with extended-spectrum cephalosporin resistance exceeding 90%, S. aureus (68.2) with 85% oxacillin-resistance, E. faecium (40%) with 20% vancomycin resistance, P. aeruginosa (22.6%) with 30% carbapenem resistance. Furthermore, emergent colistin resistance has been observed in A. baumannii, K. pneumoniae, and P. aerogenesis. Risk factors for MDR infection included age (p< 0.035), department (p< 0.001), and invasive procedures such as IUC (p< 0.001), CVC (p< 0.000), and MV (p< 0.008). Patients diagnosed with MDR bacteria had increased 30-day mortality (p< 0.001).

Conclusion: The findings of this study show alarming MDR among hospitalized patients infected with ESKAPE pathogens, with resistance to first-line antimicrobial agents and emerging resistance to colistin, minimizing treatment options. Healthcare providers and the Ministry of Health must take steps, adopt policies to prevent antimicrobial resistance, adhere to infection control guidelines, implement antimicrobial stewardship programs to prevent and limit the growing health crisis, and support research to discover new treatment options.

背景：ESKAPE病原体（粪肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌属）的抗菌药耐药性仍然是医院环境中的一大挑战：本研究旨在确定巴勒斯坦一家三级医疗医院住院患者的 ESKAPE 抗菌药耐药性模式以及与多重耐药菌株相关的因素：通过回顾 2021 年 11 月 1 日至 2022 年 11 月 30 日期间巴勒斯坦医疗中心患者的电子病历和实验室结果，开展了一项单中心回顾性横断面研究。研究对象包括入院 48 小时后感染 ESKAPE 病原体的 18 岁以上患者：本研究共纳入 231 名患者，其中 90.5%为 MDR 感染。共鉴定出 331 份 ESKAPE 病原体临床样本。鲍曼不动杆菌是最常见的 MDR 病原体（95.6%），对碳青霉烯耐药率超过 95%；其次是肺炎双球菌（83.8%），对广谱头孢菌素耐药率超过 90%；金黄色葡萄球菌（68.2%），对奥沙西林耐药率为 85%；粪大肠杆菌（40%），对万古霉素耐药率为 20%；铜绿假单胞菌（22.6%），对碳青霉烯耐药率为 30%。此外，在鲍曼不动杆菌、肺炎双球菌和产气荚膜杆菌中也发现了对可乐定的耐药性。MDR感染的风险因素包括年龄（p< 0.035）、科室（p< 0.001）和侵入性手术，如IUC（p< 0.001）、CVC（p< 0.000）和MV（p< 0.008）。确诊为 MDR 细菌感染的患者 30 天死亡率增加（p< 0.001）：本研究结果表明，感染 ESKAPE 病原体的住院病人中存在令人担忧的 MDR，对一线抗菌药物产生耐药性，并对可乐定产生新的耐药性，从而最大限度地减少了治疗选择。医疗服务提供者和卫生部必须采取措施，制定预防抗菌药耐药性的政策，遵守感染控制指南，实施抗菌药管理计划，以预防和限制日益严重的健康危机，并支持研究以发现新的治疗方案。

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引用次数: 0