Infection and Drug Resistance最新文献

Purpose: Ceftazidime-avibactam (CZA), a novel beta-lactam/beta-lactamase inhibitor, plays an important role in the threat of emerging carbapenem-resistant Enterobacterales (CRE) infection. The study aims to analyze the clinical effectiveness and factors influencing treatment response to CZA for carbapenem-resistant Klebsiella pneumoniae (CRKP) infections.

Patients and methods: From February 2020 to December 2021, patients with CRKP infection treated with CZA were enrolled in this retrospective, single-center cohort study in northern Taiwan. The primary outcome was 28-day survival rate. The secondary outcomes were clinical success, and microbiological cure. Multivariate regression analysis was used to evaluate factors associated with 28-day survival.

Results: A total of 142 patients treated with CZA alone (n=82) or in combination therapy (n=60) were included. We found 28-day survival rate, microbiological cure, and clinical success rate were 78% (111/142), 86% (87/101), and 48% (63/132), respectively. In multivariate analysis, there were no significant differences in 28-day survival between monotherapy group and combination therapy group (P=0.424). A relative lower microbiological cure rate can be observed in lower respiratory tract infection from univariate analysis (P=0.07). In addition, significantly better survival was observed in patients with creatinine clearance rate (CCr) ≥50 mL/min than CCr <50 mL/min (P=0.005).

Conclusion: CZA is an effective and important treatment option for CRKP infection even when it is treated as monotherapy. In patients with impaired renal function, a potential impact of CZA dose adjustments on poor survival outcomes has been observed, indicating the need for further research to determine optimal renal dose adjustment strategies.

The Quorum sensing (QS) system is a widely existing communication mechanism, which regulates bacterial community behaviors and the expression of specific genes. The most common pathogenic bacteria in clinical infections are gram-negative bacteria, and QS plays an important regulatory role in the production of virulence factors and development of antibiotic resistance. This article reviews the QS systems of gram-negative bacteria and provides an overview of how they regulate their physiological functions.

Objective: To compare the efficacy of anterior and posterior surgery for thoracolumbar tuberculosis disease.

Methods: Clinical data of 30 patients with thoracolumbar tuberculosis disease undergoing anterior and posterior surgery from January 2021 to December 2023 were collected for a retrospective study. According to the two surgical procedures, patients were divided into two groups: 1) anterior group (n=15) and 2) posterior group (n=15). We compared the two groups regarding age, gender, body mass index, affected segments, past history (cardiovascular and cerebrovascular diseases, respiratory diseases, endocrine system diseases, metabolic diseases, and tuberculosis history), smoking history, drinking history, operation time, postoperative bleeding, postoperative drainage, postoperative time, postoperative complications (dural tear, lower limb intermuscular vein thrombosis, lower limb deep vein thrombosis, sinus infection, postoperative recurrence rate), and waist VAS score before and after surgery, waist ODI score, and JOA score.

Results: The intraoperative blood loss was significantly less in the posterior group than in the anterior group, and the difference was significant (P <0.05); the lumbar VAS score was lower in the posterior group than in the anterior group, and the difference between the two groups was significant (P <0.05). The analysis of the remaining data showed no significant difference between the two groups (P> 0.05), indicating that the efficacy of the two procedures was the same.

Conclusion: In the treatment of thoracolumbar tuberculosis disease, there is no significant difference in the clinical efficacy of anterior surgery and posterior surgery. Intraoperative bleeding in posterior surgery was less than in anterior surgery, but the latter showed a significant improvement in postoperative pain relief. Therefore, spinal surgeons should choose the corresponding surgical treatment according to the actual situation of the patient in order to maximize the efficacy.

Purpose: Clinical trials have documented that tigecycline has a higher mortality risk than other treatments; it continues to be widely used for various infections in real-world settings, where its associated risk factors for clinical failure are understudied.

Patients and methods: This retrospective analysis included a prospective 2019-2021 cohort of tigecycline-treated patients, excluding those with multiple infection sites. We assessed the outcomes on day 28, with clinical failure defined by mortality, persistent initial infection symptoms, or the requirement for continued antimicrobial treatment. Multivariable logistic regression was used for the outcome analysis.

Results: Of 253 patients included in the study, 94 experienced clinical failure. The infection foci included pneumonia (46.3%), bloodstream infection (BSI) (25.3%), and skin/soft tissue infections (10.3%). There were no significant differences in high-dose tigecycline administration or monotherapy rates between patients with favorable outcomes and those with clinical failure. A higher Charlson comorbidity index (adjusted odds ratio [aOR] = 1.20, P = 0.001), Pitt bacteremia score (aOR = 1.25, P = 0.007), and BSI (aOR = 3.94, P < 0.001) were significant predictors of clinical failure. Concomitant use of Pseudomonas aeruginosa-active fluoroquinolone (aOR = 1.97, P = 0.03) and carbapenem (aOR = 2.20, P = 0.01) was linked to increased clinical failure.

Conclusion: Multiple comorbidities, BSI, and higher Pitt bacteremia scores are associated with increased risk of clinical failure in tigecycline-treated patients. These results suggest clinicians should consider alternatives to tigecycline for patients with these risk factors. When administering tigecycline, vigilant monitoring is indicated to manage potential clinical failures.

Carbapenems are the last-resort antibiotics used to treat infections caused by bacterial pathogens. Many bacterial pathogens have evolved to produce NDM carbapenemases to hydrolyze carbapenems, posing a great challenge to public health. In this study, we report a multidrug resistant clinical E. coli strain 673. Strain 673 belongs to sequence type (ST) 1431 and carries several plasmids, p673-blaTEM-1B, p673-blaCTX-M-55, p673-blaNDM-5, p673-13272, and p673-6468. p673-blaNDM-5 is an IncHI2/IncHI2A-type plasmid harboring several antibiotic resistance genes, including bla _NDM-5, strA, strB, and dfrA. The bla _NDM-5 gene was surrounded by two IS26 elements in p673-blaNDM-5, indicating that IS26 could mediate the integration of bla _NDM-5 into p673-blaNDM-5. p673-blaCTX-M-55 is an IncFII-type plasmid harboring fosA, aadA1, and bla _CTX-M-55. p673-blaTEM-1B is an IncFIB-type plasmid harboring bla _TEM-1B and dfrA5. p673-13272 is a ColRNAI-type plasmid that does not carry any drug resistance genes. This is the first report that a bla _NDM-5-bearing IncHI2/IncHI2A-type plasmid has emerged in a clinical E. coli strain in China. Our findings suggest that IS26 mediates the integration of bla _NDM-5 into p673-blaNDM-5. The spread of bla _NDM-5-bearing plasmids is a clinical challenge and endangers public health.

Background: Community-acquired pneumonia (CAP) is a significant global health issue, leading to high morbidity and mortality rates. Despite the existence of various severity scoring systems, accurately predicting patient outcomes remains challenging. The CAP-PIRO (Predisposition, Insult, Response, and Organ dysfunction) scoring system offers a comprehensive approach to evaluating CAP severity and prognosis.

Objective: This study aimed to assess the effectiveness of the CAP-PIRO scoring system in predicting the prognosis and severity of CAP patients, focusing on the development of acute respiratory distress syndrome (ARDS) and 28-day mortality.

Methods: A total of 875 CAP patients were prospectively enrolled from the emergency department of Beijing Chao-yang Hospital between November 2017 and December 2023. Clinical data, including patient demographics, medical history, vital signs, and laboratory findings, were collected within 6 hours of admission. CAP-PIRO, CURB-65, and PSI scores were calculated. Patients were stratified based on ARDS development, 28-day mortality, and PaO2/FiO2 categories (≤100 mmHg, 100-200 mmHg, 200-300 mmHg).

Results: Significant differences were observed in PCT, blood lactate (Lac), CURB-65, PSI, and CAP-PIRO scores between patients with and without ARDS, as well as between survivors and non-survivors at 28 days (P<0.05). CAP-PIRO and Lac were identified as independent predictors for ARDS development and 28-day mortality. The area under the ROC curve (AUC) for CAP-PIRO was higher than that for CURB-65 and PSI in predicting 28-day mortality. The combination of CAP-PIRO and Lac demonstrated improved predictive accuracy for ARDS. Notably, significant differences in CAP-PIRO scores were observed across different PaO2/FiO2 groups.

Conclusion: CAP-PIRO demonstrates strong predictive ability for adverse outcomes and, when combined with lactate, shows enhanced predictive power. These findings underscore the value of CAP-PIRO for clinical risk stratification in CAP patients.

Background: Hemorrhagic fever with renal syndrome (HFRS), caused by Orthohantavirus hantanense (HTNV) infection, is characterized by a range of symptom including fever, hemorrhage, and renal impairment. Acute pancreatitis and leukemoid reaction associated with HFRS have been less frequently reported.

Case presentation: A 20-year-old male presented with fever, dizziness, and gastrointestinal symptom, which progressed to acute pancreatitis and leukemoid reaction. Despite initial treatment, his condition worsened, necessitating transfer to a tertiary care facility. Upon admission, the patient exhibited signs of organ dysfunction, and laboratory tests confirmed leukocytosis and thrombocytopenia, with imaging suggestive of pancreatitis. HTNV antibody test results were positive.

Discussion: This case illustrates the complexity of diagnosing HFRS when the disease presents atypically. The symptom that are shared with other conditions can lead to misdiagnosis. Treatment of HFRS patients requires a multidisciplinary approach, with particular attention to the timing and type of therapy to manage complications effectively.

Conclusion: This report emphasizes the importance of recognizing atypical presentations of HFRS and the benefits of a prompt and comprehensive treatment strategy. Early diagnosis and a tailored therapeutic approach are crucial for improving patient outcomes in such rare and complex cases. The case underscores the necessity for clinicians to be vigilant for secondary symptom of HFRS, particularly in high-incidence regions, and the role of early diagnosis and treatment in improving outcomes.

Objective: Treating and managing rifampicin resistant tuberculosis (RR-TB) patients in Yunnan, China, are major challenges. This study aims to evaluate the risk of poor treatment outcomes in RR-TB patients, allowing clinical doctors to proactively target patients who would benefit from enhanced patient management.

Methods: Four RR-TB care facilities in different regions of Yunnan province as the data collection points were selected. A total of 524 RR-TB patients were included in this study and randomly assigned into a training set (n=366) and a validation set (n=158). In the training set, four significant factors were screened by using a random forest model and a Lasso regression model, and then included in a logistic regression model to construct a nomogram for internal validation.

Results: The successful treatment rate of RR-TB patients in training set was 42.6% (156/366), and the main poor treatment outcomes were loss to follow-up (66.7%) and death (18.1%). Low hemoglobin (HGB) (OR=0.977, 95% CI: 0.964-0.989), long-regime (OR=2.784, 95% CI: 1.634-4.842), poor culture results at the end of the 6th month (CR6TM) (OR=11.193, 95% CI: 6.507-20.028), pre-extensively drug-resistant tuberculosis (pre-XDR) (OR=3.736, 95% CI: 1.294-12.034) were risk factors for poor treatment outcomes in RR-TB patients. The Area Under Curve (AUC) of this model was 0.829 (95% CI: 0.787-0.870), and there was good consistency between the predicted probability and the actual probability. The DCA curve showed that when the threshold probability was 20-98%, the use of nomogram to predict the net benefit of poor treatment outcomes risk in RR-TB patients was higher.

Conclusion: We combined multiple models to develop a nomogram for predicting poor treatment outcomes in RR-TB patients. This would help clinical doctors identify high-risk populations and enable them to proactively target RR-TB patients who will benefit from strengthened patient management.

Objective: Physicians play a key role in vaccination advocacy. To explore potential educational gaps, we surveyed the knowledge and opinions on vaccination, as well as their own vaccination status, among Chinese medical students and residents in a single medical institute.

Methods: We recruited sixth- and seventh-year medical students and internal medicine residents to carry out this investigation. All participants were given a questionnaire to fill out.

Results: In total, 118 responses from medical students (n=75) and residents (n=43) were analyzed. Thus, 58.5% of participants (69/118) declared that they had enough knowledge, and 68.6% (81/118) wanted to learn more. The average knowledge score was 15.3±2.4 (the full mark was 21 points), while the average accuracy rate was 72.9%. Most respondents agreed that vaccines are useful and that the national vaccination program is effective. Although nearly all participants supported the importance of revaccination, only 48.3% had actually received boosters. There were no significant differences in knowledge and general attitude between medical students and residents. Vaccine uptake in childhood was good. With regard to the 12 vaccines other than the national standard immunization program, the most frequently declared vaccine was against coronavirus disease 2019 (89.8%), while 55.1% had received the human papillomavirus vaccine. There were no significant differences in vaccination coverage between medical students and residents, except for varicella vaccine (40% in medical students vs 18.6% in residents, p=0.017).

Conclusion: A large proportion of medical students and residents in this tertiary referral center exhibited attitudes that favored vaccine acceptance. However, there are certain gaps in their knowledge of and attitudes toward vaccination, which could be addressed by implementing a formal standardized vaccine curriculum.

Objective: This study aimed to investigate the infection rate, types of human papillomavirus (HPV), and the relationship between HPV types and host factors in Zhejiang and lay a foundation for developing a prophylactic HPV vaccine.

Methods: A retrospective analysis of the genotyping results of 27 hPV types using exfoliated cells from the cervix, vulva, perianal region, or oral mucosa of 28206 females, and exfoliated cells from the penis, perianal region or oral mucosa of 2923 male patients undergoing treatment between January 2016 and December 2021 at Zhejiang Provincial People's Hospital was performed.

Results: In females, the overall positive rate was 30.26%. The top five HPV types were HPV52, 58, 16, 6, and 53. In males, the overall positive rate was 31.85%. The top five HPV types were HPV6, 11, 16, 52, and 43. About 90.48% of patients with CINII+ were HR-HPV+. HPV33, 16 were the top two HPV types that increased CINII+ risks.

Conclusion: Currently, the bivalent (HPV16, 18), quadrivalent (HPV6, 11, 16, 18), and 9-valent (HPV6, 11, 16, 18, 31, 33, 45, 52, 58) HPV vaccines are marketed. Of these, the 9-valent HPV vaccines are more suitable for people in the Zhejiang province; however, it is still insufficient. Therefore, the 11-, 14-, and 15-valent vaccines being developed and marketed include more genotypes, and their outcomes are worth anticipating.