Infection and Drug Resistance最新文献

Introduction: The increasing utilization of antiretroviral (ART) medications by people living with HIV(PLWH) poses a potential risk to the efficacy of standardized ART management protocols in resource-limited settings, particularly as it may accelerate the emergence of transmitted drug resistance (TDR). Our research aimed to elucidate the prevalence, risk factors, geographical variations, and transmission patterns of TDR to inform and enhance ART management strategies.

Methods: The study covered newly diagnosed PLWH in Sichuan from July 2022 to June 2023. We conducted sequencing - based resistance profiling and then analyzed TDR via the Stanford HIV Drug Resistance Database and logistic regression to identify associated factors via SPSS. ArcGIS and spatial statistics were used to create LISA maps showing the TDR distribution. HIV-TRACE's Tamura Nei 93 model was used to assess genetic clustering, and QGIS was used to analyze TDR intensity within and between cities.

Results: This study found that the prevalence of TDR in Sichuan had reached a moderate level, with a resistance rate of 10.91%. Resistance varied by drug class: 8.08% for NNRTIs, 1.34% for NRTIs, and 2.22% for PIs. Regions like LS, DY, SN, and LZ had higher TDR rates. Within NNRTIs, efavirenz (EFV) and nevirapine (NVP) resistance rates were 6.26% and 6.50%, respectively. Furthermore, risk factors for TDR included age under 15, HIV-1 subtypes, and residing in areas with high ART failure rates. In addition, spatial analysis showed significant clustering of TDR, especially for PIs and NNRTIs, with hotspots identified in certain regions. Among 1,486 drug-resistant PLWH, 52.76% formed resistance-linked networks, comprising 181 molecular clusters. Key resistance mutations included K103N, E138A, V179D, Y181C, and Q58E. The transmission intensity of TDR varied across regions, highlighting complex spatial dynamics.

Discussion: The prevalence of TDR in Sichuan had reached moderate epidemic levels, with certain cities already experiencing high epidemic rates. It is urgent that we urgently expand targeted genotypic drug resistance detection and implement interventions to improve medication adherence.

The mpox virus (MPXV) is a zoonotic pathogen that has been causing a worldwide pandemic outbreak since 2022, posing a significant threat to global public health security. During this outbreak, monkeypox has been more prevalent among immunocompromised individuals, particularly those infected with HIV (Human Immunodeficiency Virus). We report a case of a 21-year-old male patient with advanced AIDS in China who developed severe complications, including skin tissue infection, proctitis, and conjunctivitis, following monkeypox infection. Despite early aggressive treatment, the patient ultimately succumbed to infectious shock and multiple organ failure. This case strongly underscores that such patients experience severe skin infections and rapid disease progression, necessitating urgent early recognition and treatment.

Background: Antimicrobial resistance (AMR) is the number one cause of death globally, and Sub-Saharan Africa bears the most significant burden. Previous studies conducted in Uganda have revealed high rates of antimicrobial prescribing in hospitals, with evidence of widespread inappropriate use, which necessitates the development of targeted interventions. The inappropriate use of antimicrobials is a driver of AMR. We conducted point-prevalence surveys of antimicrobial prescribing in selected health facilities in central Uganda to identify areas for improvement.

Methods: The study utilised the Global Point Prevalence Survey (GPPS) to collect data on antimicrobial prescribing among eight public health facilities in Central Uganda from February to April 2024. Both inpatient and outpatient data were collected in three hospitals and five lower-level health facilities, respectively. The data collection tools adopted from GPPS were employed. Data were collected on patient demographics, antimicrobial therapy details, and compliance with standard treatment guidelines.

Results: The overall prevalence of antimicrobial use among inpatients at the hospitals was 87.2%, and ceftriaxone was the most frequently prescribed antimicrobial, accounting for 30.6% of the prescriptions. Prescriptions for prophylactic use were the most predominant, with prophylaxis for obstetric and gynaecological surgery accounting for 30.7% of the prescriptions. The prevalence of antimicrobial use among outpatients at lower-level health facilities was 60.7%. Amoxicillin was the most prescribed antimicrobial across the sites, accounting for 39.1% of the prescriptions. Upper respiratory tract infections accounted for most prescriptions (45.1%). Standard treatment guideline compliance was nearly half (50.5%) among hospitals, with variations observed among the different study sites.

Conclusion: A high prevalence of antimicrobial prescribing was observed, highlighting the need to enhance antimicrobial stewardship practices in health facilities. Compliance with standard treatment guidelines was average among hospitals but high among the lower-level health facilities. Some of the potential areas for stewardship interventions include broad-spectrum antibiotic prescriptions, prolonged antibiotic prophylactic courses, and inappropriate prescription of antibiotics for upper respiratory tract infections.

Kerstersia gyiorum (K. gyiorum) had been reported as a rare cause of human infections. In this study, we isolated an uncommon strain of K. gyiorum from swab specimens of a male patient with cerebral infarction. The identification was performed using VITEK MS in the RUO (Research Use Only) mode and 16s rRNA gene sequencing. We hereby report a case of chronic osteomyelitis caused by K. gyiorum in a patient with cerebral infarction and left-sided limb hemiplegia in China.

Purpose: This study investigated the role of copper metabolism MURR1 domain-containing 1 (COMMD1) in Talaromyces marneffei (TM)-induced osteomyelitis (OM) and its regulation of osteoclast differentiation via the NF-κB pathway.

Methods: A murine TM infection model was used to assess bone destruction and osteoclast activity via micro-CT, histological analysis, biomechanical testing, qPCR, and Western blot. RNA sequencing was performed to analyze differentially expressed genes. Functional validation was conducted using COMMD1 conditional knockout (cKO) mice and bone marrow-derived monocytes macrophages (BMMs). The NF-κB inhibitor JSH-23 was used to verify pathway dependency.

Results: TM infection significantly upregulated inflammatory cytokines (IL-10, IL-17, TNF-α) and induced severe bone structural damage, characterized by trabecular thinning and reduced mechanical strength. These changes were accompanied by increased osteoclast numbers and elevated expression of osteoclast differentiation-related genes (TRAP, NFATc1, Ctsk, FOS). RNA sequencing revealed downregulation of COMMD1 and activation of the NF-κB pathway in TM-infected mice. COMMD1 deficiency exacerbated bone destruction and osteoclast differentiation, while COMMD1 overexpression suppressed these effects. Mechanistic studies showed that COMMD1 deletion increased P65 phosphorylation and decreased IκBα expression, effects that were reversed by JSH-23 treatment.

Conclusion: COMMD1 protects against TM-induced OM by inhibiting the NF-κB pathway, suggesting it as a potential therapeutic target for bone infections.

Objective: To analyze and discuss the clinical characteristics of carbapenem-induced platelet abnormalities.

Methods: The databases of CNKI, Wanfang Data, Chinese VIP, Web of science, PubMed, Embase and Elsevier were searched (up to June 30,2025), and the case reports of carbapenem-induced platelet abnormalities were collected and descriptively analyzed.

Results: A total of 42 patients (21 males and 21 females) were included, with a median age of 64 years (range:0-96 years). Thrombocytosis was observed in 20 patients, while thrombocytopenia occurred in 22 patients. Platelet abnormality most often occurred in patients receiving meropenem (64.3%) followed by imipenem (26.2%). All cases occurred during carbapenem therapy. The median time to platelet count abnormality was 3 days (range 0.125-12), with 79.5% of cases occurring within one week. Specifically, the median time to carbapenem-induced thrombocytopenia was 2.5 days (range 0.125-9), while the median time to carbapenem-induced thrombocytosis was 3 days (range 3-12). The nadir of platelet count was reached at 5 days (range 1-10) after medication, with a median platelet count nadir of 21.5×10⁹ /L (range 0-136). The peak of platelet count was reached at 8 days (range 3-18), with a median platelet count peak of 900×10⁹ /L (range 570-1,440). Complications occurred in 10 thrombocytopenia cases, all of which were bleeding events. After discontinuation of the drug and symptomatic treatment, all cases showed significant improvement in platelet counts and resolution of complications, except for one patient who died from multiple organ dysfunction syndrome.

Conclusion: Carbapenem-induced platelet abnormalities appear to be more frequent than previously recognized, predominantly occurring within the first week of therapy. This potentially severe adverse drug reaction should be particularly considered in elderly patients receiving meropenem therapy.

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy and a high mortality rate if untreated. While TTP can be primary or secondary to factors like drugs, reports linking it to anti-tuberculosis (anti-TB) therapy are scarce. This case highlights the diagnostic challenges and need for vigilance in TB patients receiving standard regimens.

Case presentation: A 76-year-old male on anti-TB therapy (isoniazid, rifampicin, pyrazinamide, ethambutol) presented with acute neurological symptoms, thrombocytopenia (platelets 9×10^9/L), microangiopathic hemolysis (schistocytes), and severely reduced ADAMTS13 activity (<5%). Imaging revealed multiple cerebral infarctions. Despite plasma exchange and steroids, the patient deteriorated and died after family-requested care withdrawal.

Conclusion: This case highlights TTP as a rare but serious complication of anti-TB therapy. Clinical vigilance is essential, including platelet monitoring during initial treatment and a low threshold for ADAMTS13 testing in cases of unexplained thrombocytopenia. Future multicenter studies are needed to investigate immune mechanisms and assess therapies such as rituximab, with the aim of optimizing management strategies for rare adverse drug events and improving patient outcomes.

Background and aim: Antimicrobial resistance (AMR) is a major global health threat, primarily driven by inappropriate antibiotic use. This cross-sectional study assessed the knowledge, attitudes, and practices of healthcare professionals in Saudi Arabia regarding antimicrobial use, resistance, and stewardship to identify gaps contributing to misuse.

Methodology: An observational cross-sectional study was conducted using a validated self-administered questionnaire among physicians, nurses, and pharmacists. Data were analyzed using univariate and multivariate methods.

Results: Among 236 respondents (45.3% physicians, 31.8% nurses, 22.9% pharmacists), most were aged 26-35 (33.9%), with nearly equal gender distribution (53.0% women). While 85.2% were aware of AMR, 64.1% reported limited access to infection control policies. Most (94.9%) acknowledged that unnecessary antibiotic use contributes to resistance, and 96.2% understood its transmissibility. Daily antibiotic prescribed, dispensed, or administered was reported by 57.6%. Key barriers to appropriate prescribing included time constraints (84.7%) and diagnostic uncertainty (75.8%). Only 20.3% used clinical guidelines, whereas 35.2% relied on pharmaceutical industry materials. In the multivariate regression, knowledge scores increased with age (+0.31 per decade, p = 0.024), profession was the strongest predictor (β = 6.4, p < 0.001), and antimicrobial stewardship (ASP) training improved scores by 1.6 points.

Conclusion: Significant gaps exist in access to guidelines and adherence to evidence-based practices. Targeted ASP interventions focusing on professional education, improved resource availability, and institutional support are essential to enhance stewardship and combat AMR in Saudi Arabia.

Objective: To analyze the risk factors for 30-day prognosis in patients with hemorrhagic fever with renal syndrome (HFRS) in the Dali region of China, and to provide a theoretical basis for the diagnosis and treatment of HFRS.

Methods: A retrospective analysis was conducted on the data of patients diagnosed with HFRS at the First Affiliated Hospital of Dali University and People's Hospital of Dali Bai Autonomous Prefecture from January 1, 2015, to January 31, 2025. Based on the 30-day prognosis, patients were categorized into the survival group (n = 341) and the deceased group (n = 32). Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to screen for influential factors affecting the 30-day prognosis of HFRS, followed by binary logistic regression analysis to identify risk factors for short-term prognosis of HFRS. Finally, a nomogram model was constructed based on the identified prognostic risk factors.

Results: A total of 373 patients with HFRS from the Dali region of China were included, with a 30-day mortality rate of 8.579%. LASSO-logistic regression analysis revealed that low levels of prothrombin time (PT), white blood cell (WBC), lactate dehydrogenase-to-albumin ratio (LAR), and free triiodothyronine (FT3) were risk factors for the 30-day prognosis of HFRS patients (P < 0.05). Based on these risk factors, a 30-day prognostic risk nomogram model for HFRS patients was constructed. The results indicated that the observed values in the nomogram model were largely consistent with the predicted values (χ² = 2.834, P = 0.944), and the C-index was 0.946 (95% CI: 0.914-0.978), demonstrating clinical validity. Monitoring these indicators is conducive to the early identification of HFRS patients with poor prognosis, providing a scientific basis for the implementation of individualized treatment and management in clinical practice.

Conclusion: PT, FT3, WBC levels, and LAR values are risk factors for 30-day mortality in patients with HFRS. Moreover, we have, for the first time, identified a close association between FT3 and LAR and the prognosis of HFRS. The developed nomogram demonstrates favorable predictive performance and can serve as an intuitive quantitative tool for the early identification of high-risk patients, thereby guiding clinical intervention strategies.

Purpose: This study leveraged CSF metagenomic next-generation sequencing (mNGS) to bridge this knowledge gap and elucidate the microbiota spectrum of CNS infections.

Patients and methods: We retrospectively analyzed CSF mNGS reports and clinical data from 264 patients with suspected CNS infections, who were enrolled from September 2019 to November 2023.

Results: According to diagnostic criteria, 145 patients were diagnosed with CNS infections, including bacterial (27 cases, 18.6%), Mycobacterium tuberculosis (30, 20.7%), fungal (23, 15.9%), and viral (65, 44.8%) infections. The mNGS positive detection rate was 46.2% (67/145), with significant differences among groups (p < 0.001). A total of 22 pathogens were identified, most commonly Cryptococcus neoformans (16, 23.9%), Mycobacterium tuberculosis (10, 14.9%), and Epstein-Barr virus (9, 13.4%). The most frequent background microorganisms detected by mNGS were Cutibacterium acnes (58.6%), Moraxella osloensis (29.0%), and Malassezia restricta (26.2%).

Conclusion: High-throughput sequencing using mNGS revealed the microbial compositions in CSF samples from patients with CNS infections. This approach may enhance our understanding of pathogens and assist clinicians in making effective therapeutic decisions.