Infection and Drug Resistance最新文献

Background: Mycoplasma genitalium (MG) poses a growing public health concern due to the escalating antimicrobial resistance. We aimed to assess site-specific MG infection and its correlates and macrolide and fluoroquinolones mutations among men who have sex with men (MSM) in Shenzhen, China.

Methods: Samples were obtained from different anatomic sites of MSM based on their sexual behavior. MG infection was detected using nested polymerase chain reaction (nested PCR). Identifying macrolide and fluoroquinolone resistance involved targeting the V region of the 23S rRNA, topoisomerase IV and DNA gyrase genes. Logistic regression was used to evaluate correlates of MG infection.

Results: We collected 124 pharynx swabs, 132 urethral swabs, and 89 rectal swabs from 162 MSM participants based on their sexual behavior. MG was detected in 13.0% (21/162) of MSM. The prevalence of MG in the pharynx, urethra, and rectum was 9.7% (12/124), 6.1% (8/132), and 7.9% (7/89), respectively. Among the 21 MG-positive participants, 4.8% (1/21) were infected at all three sites, and 19.0% (4/21) were infected at two sites. Of the 27 MG-positive specimens, 22.2% (2/9) exhibited mutations at position A2071G, with A2071T being the predominant mutation in the 23S rRNA gene, accounting for 77.8% (7/9) of cases. Mutations in the parC and gyrA genes were detected in 33.3% (1/3) and 33.3% (2/6) of specimens, respectively.

Conclusion: We observed a high prevalence of MG infections at different anatomic sites among the MSM population in Shenzhen, China. The high prevalence of macrolide and fluoroquinolone-resistant MG underscores the importance of implementing resistance-guided therapy, establishing surveillance networks, and exploring new antibiotics against MG.

Objective: This study investigated the distribution and changes in pancreatic infections among patients with acute pancreatitis (AP) from 2019 to 2023, while exploring the impact of multidrug-resistant bacterial infections on the prognosis of patients with poor outcomes.

Methods: This study included patients diagnosed with SAP between 2019 and 2023 and collected the demographic and clinical characteristics of all participants. Based on routine clinical microbiological culture results, the distribution and drug resistance of pathogens associated with pancreatic infections were analyzed. Multivariable logistic regression was used to evaluate the association between multidrug-resistant organism (MDRO) infection and poor prognosis.

Results: A total of 1586 pancreatic fluid specimens were analyzed and collected from 843 patients diagnosed with AP. The positive rate of the culture results was 81% (1280/1586), with the predominant pathogens identified as Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, and Acinetobacter baumannii complex. Of the 843 patients, 756 met the criteria, and the proportion of MDROs in pancreatic infections was 87.57% (662/756). Multivariate logistic regression analysis revealed that septic shock, acute kidney injury, and tracheostomy were associated with a poor prognosis, whereas ICU length of stay, infected pancreatic necrosis, and tracheostomy were associated with multidrug-resistant bacterial infections in patients with severe or critical AP.

Conclusion: The proportion of MDRO infections in patients with severe or critical AP was notably high, primarily involving multidrug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Septic shock, acute kidney injury, and tracheostomy have been identified as independent risk factors of poor prognosis in patients with severe or critical AP.

Introduction: The widespread use of antibiotics is a serious and alarming situation in terms of the development of antimicrobial resistance. The current study was conducted to demonstrate the types of organism isolated from the urine of patients presenting with UTI symptoms as well as their antimicrobial sensitivity spectrum.

Methodology: A descriptive cross-sectional study was conducted, and 272 positive urine cultures from children under 5 years of age with signs and symptoms of a UTI were included in the study. The types of organisms isolated from the urine cultures and their susceptibility to antibiotics were identified. The data collection form was designed as an Excel spreadsheet that included both dependent and independent variables, such as patient age, gender, WBC, red blood cell (RBC) count, nitrite, organism isolated, and antiprogram results.

Results: Of the patients included, 64% were female. The majority were under one year of age, followed by children aged one to three. Among these children, 63% had pyuria and hematuria, and 64% had nitrite-positive urine samples. The most commonly isolated organisms included Escherichia coli, Klebsiella species, Candida species, Candida albicans, and Enterococcus species. In this study, 62% of gram-negative organisms were ESBL positive, among which the Proteus species demonstrated the highest ESBL positivity, followed by the Klebsiella species and E. coli. The majority of Enterobacteriaceae isolates in this study showed resistance to Augmentin and Ampicillin. Similarly, E. coli was highly resistant to third-generation cephalosporins, ceftazidime, and ceftriaxone.

Conclusion: Due to the high prevalence of UTIs in pediatric patients and their nonspecific signs and symptoms, particularly in infants or young children, diagnosing and treating them, whilst difficult, is crucial. Urine samples should be analyzed for all pediatric patients with fever and, if pyuria is present, a urine culture is necessary.

Monkeypox (mpox), caused by mpox virus (MPXV) infection, reemerged in 2022 and still raises concerns globally. Abundant clinical data indicate that mpox is a sexually transmitted infection and that the urogenital system is the most frequently involved system in mpox, which deserves more attention. Penile lesions are the most common presentation, followed by urethritis. Acute urine retention and acute kidney injury are relatively rare but also highly crucial. Currently, the majority of the urogenital lesions are considered complications secondary to MPXV infection and the common immunosuppression in mpox patients. However, such viewpoints should be treated carefully due to the lack of understanding of the basic mpox pathology. Here, we briefly and comprehensively review the current evidence concerning urogenital lesions caused by mpox, including epidemiology, clinical features, pathogenesis, and therapeutic approaches to provide a preliminary reference for clinicians in future clinical practice.

Aim: Sepsis is a potentially fatal condition characterized by organ failure resulting from an abnormal host response to infection, often leading to liver and kidney damage. Timely recognition and intervention of these dysfunctions have the potential to significantly reduce sepsis mortality rates. Recent studies have emphasized the critical role of serum exosomes and their miRNA content in mediating sepsis-induced organ dysfunction. The objective of this study is to elucidate the mechanism underlying the impact of miR-122-5p on sepsis-associated liver and kidney injury using inhibitors for miR-122-5p as well as GW4869, an inhibitor targeting exosome release.

Materials and methods: Exosomes were isolated from serum samples of septic rats, sepsis patients, and control groups, while liver and kidney tissues were collected for subsequent analysis. The levels of miR-122-5p, inflammation indices, and organ damage were assessed using PCR, ELISA, and pathological identification techniques. Immunohistochemistry and Western blotting methods were employed to investigate the activation of inflammatory pathways. Furthermore, big data analysis was utilized to screen potential targets of miR-122-5p in vivo.

Key findings: Serum exosomal levels of miR-122-5p were significantly elevated in septic patients as well as in LPS-induced septic rats. Inhibition of miR-122-5p reduced serum pro-inflammatory factors and ameliorated liver and kidney damage in septic rats. Mechanistically, miR-122-5p upregulated TAK1, downregulated SIRT1, and facilitated NF-κB activation.

Conclusion: Serum exosomal miR-122-5p promotes inflammation and induces liver/kidney injury in LPS-induced septic rats by modulating the TAK1/SIRT1/NF-κB pathway, highlighting potential therapeutic targets for sepsis management.

Background: Urogenital schistosomiasis is a persistent public health problem in many rural areas of Yemen. Since 2014, Schistosoma haematobium epidemiology has not been assessed in Amran governorate, north of Yemen, where S. haematobium is known to be highly endemic. Therefore, this study determined the prevalence and risk factors associated with S. haematobium infection among schoolchildren in Kharif district of the governorate.

Methods: A cross-sectional survey was conducted among 529 schoolchildren aged 7 to 15 years in Kharif district. Data on children's demographics, clinical features, behaviors, and infection-related environmental factors were collected using a structured questionnaire. The urine filtration technique was used to detect and count S. haematobium eggs, and chemical reagent strips were used to detect microhematuria. The number of eggs per 10 mL of urine (EP10mL) was used to estimate the intensity of infection, which was classified as light (≤50 EP10mL) or heavy (>50 EP10mL). Multivariable binary logistic regression analysis was used to identify predictors of infection.

Results: Light-intensity S. haematobium infection was prevalent among 34.8% of schoolchildren in Kharif district, with a 95% confidence interval (CI) ranging from 30.7 to 38.8. Infection was significantly associated with microhematuria (P <0.001) and self-reported dysuria (P = 0.003). Family ownership of agricultural land was significantly associated with S. haematobium infection among schoolchildren [odds ratio (OR) = 1.8, 95% CI: 1.10-3.17; P = 0.030], which was further identified as an independent predictor of infection (adjusted OR = 2.2, 95% CI: 1.21-3.95; P = 0.010).

Conclusion: A considerable proportion of schoolchildren in Kharif district have light-intensity S. haematobium infections, mostly presenting with microhematuria and self-reported dysuria. The district's level of risk should be updated to moderate. Consequently, the chemopreventive strategy needs to be revisited to treat all school-age children biennially, regardless of enrollment status.

Purpose: To investigate the molecular epidemiology and risk factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection.

Patients and methods: Patient's clinical data and CRKP strains were collected from November 2017 to December 2018 at a tertiary hospital in Wuhan, China. The antimicrobial susceptibilities, carbapenem-resistant genes, multi-locus sequence typing (MLST), homologous analysis, and risk factors for CRKP were determined.

Results: A total of 203 CRKP strains were isolated, and 98.5% (200/203) of patients were nosocomially infected. The mortality rate was 17.7% (36/203). All 203 strains were confirmed as carbapenemases -producing strains. The most predominant carbapenemase gene was bla _IMP-4 (81.3%, 165/203), followed by bla _KPC-2 (25.1%, 51/203) and bla _NDM-1 (23.2%, 47/205). Of the 203 strains, 28 (13.8%) had both bla _KPC-2 and bla _IMP-4 genes, 23 (11.3%) had both bla _IMP-4 and bla _NDM-1 genes, 20 (9.9%) had bla _KPC-2, bla _IMP-4 and bla _NDM-1 three genes. MLST analysis showed that there were 48 ST typologies (including 7 new STs), of which ST-11 was the most prevalent (59.6%, 121/203). Phylogenetic analysis showed that 203 CRKP isolates came from 7 clusters and exhibited a strong correlation with the isolation source. eBURST analyses indicated that CRKP isolates have undergone different evolutionary processes. Patients with ST-11 CRKP underwent more mechanical ventilation (50% vs 32.9%, P=0.020) and gastric catheterization (15.7% vs 6.1%, P=0.042) within 3 months before sample collection, and also had higher drug-resistance rate than non-ST-11 CRKP. Comparing with CSKP (carbapenem-sensitive Klebsiella pneumoniae), gastrointestinal disease (odds ratio [OR]=6.168, P=0.003), nosocomial infection (OR=5.573, P=0.012), antibiotic exposure (OR=4.131, P=0.004), urinary catheterization (OR=3.960, P=0.031) and venous/arterial catheterization (OR=2.738, P=0.026) within the preceding 3 months were independent risk factors for CRKP infection.

Conclusion: The IMP-4 was the most predominant carbapenemase and bla _IMP-4 bearing Klebsiella pneumoniae ST-11 was spreading in the hospital. Nosocomial infections, antibiotic exposure, and urinary and venous/arterial catheterization within 3 months were the risk factors for developing CRKP infection.

Objective: Early reports have indicated that the Omicron variant of coronavirus disease 2019 (COVID-19) may be associated with low mortality. However, the mortality rate of critical patients in Taiwan with COVID-19 caused by different variants has not been well described.

Methods: This retrospective cohort study was conducted at the Linkou Branch of Chang Gung Memorial Hospital, Taiwan, from April 2020 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and were on mechanical ventilation (MV) were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes for different SARS-CoV-2 variants were analyzed.

Results: This study included 110 critical patients with COVID-19 who required intubation and intensive care unit (ICU) admission. Among these patients, 46 (41.8%) required intensive care during Alpha predominance period and 64 (58.2%) during the Omicron predominance period. The Alpha group had a higher body mass index, had a longer ICU stay, and included more patients with acute respiratory distress syndrome, and the Omicron group included more active smokers, had more comorbidities, had worse initial laboratory data (including higher white blood cell counts, prothrombin time [PT], activated partial prothrombin time, blood urine nitrogen levels, and creatine levels), and had higher in-hospital mortality rates (40.6% vs 15.2%, p = 0.004). The independent risk factors for in-hospital mortality, were Charlson Comorbidity Index (CCI) ≥ 3 and higher PT and creatine levels.

Conclusion: Our study discovered that CCI ≥ 3, elevated serum creatine levels, and prolonged PT were independently associated with a high mortality rate in patients with critical COVID-19. Patients with those risk factors may require intensive monitoring during their treatment course.

Purpose: Klebsiella pneumoniae is an important pathogenic bacterium in causing urinary tract infection. With the overuse of antibiotics, bacteria resistant to quinolones combined with carbapenems are increasing. In this study, we investigated the epidemiology, molecular characteristics, drug resistance of multidrug-resistant Klebsiella pneumoniae (MDR-KPN) isolated from urine samples. It provides theoretical basis for the treatment of urinary tract infection by clinicians.

Patients and methods: Fifty-one strains of Klebsiella pneumonia were obtained from urine samples collected between 2012 and 2017 in total. All the strains are multi-drug resistant bacteria. This paper used multilocus sequence typing (MLST) to determine molecular epidemiological typing. We performed antimicrobial susceptibility testing and investigated quinolones and carbapenems resistance genes.

Results: The strains which we collected were resistant to ciprofloxacin and Levofloxacin. In an epidemiological analysis using MLST, 86.27% (44/51) of isolates were confirmed to be ST11. The main carbapenem resistance gene was KPC-19, 78.43(40/51). Among the quinolone resistance genes, the major resistance genes were aac(6')-Ib-cr, oqxA and oqxB.

Conclusion: The main molecular epidemiological types we detected was ST11. The main resistance gene of carbapenems was KPC-19. The quinolone resistance genes are mainly aac(6')-Ib-cr, oqxA and oqxB. The experimental results can help control the use of quinolones and carbapenems, and we could provide rational drug use basis for clinicians to treat urinary tract infection. For MDR-KPN, a combination of multiple antibiotics is necessary.

Background: Immune checkpoint inhibitors (ICIs) have emerged as the first-line treatment for driver-negative advanced non-small cell lung cancer (NSCLC). However, there is uncertainty regarding the availability and timing of ICI initiation in patients with NSCLC combined with pulmonary tuberculosis (TB). Additionally, the implementation of dual therapy for anti-TB and anti-tumor treatment poses significant challenges in terms of avoiding drug-drug interactions and reducing adverse reactions during clinical diagnosis and treatment.

Case description: A 65-year-old male patient was admitted to our designated TB hospital following an out-of-hospital TB diagnosis. Relevant examinations were completed after admission, and chest computed tomography revealed that the patient had lung squamous cell carcinoma with multiple metastases in lymph nodes and liver. A multidisciplinary team (MDT) consisting of oncologists, pulmonologists, and clinical pharmacists followed evidence-based practices to determine treatment options. They evaluated the benefits and risks of ICIs and performed therapeutic drug monitoring for the dual treatment of anti-TB and anti-tumor drugs. After 18 days of anti-TB treatment, the patient successfully received ICIs combined with chemotherapy for NSCLC while continuing anti-TB therapy. The patient's anti-TB treatment plan was adjusted due to gastrointestinal reactions, bone marrow suppression, and liver function injury. Ultimately, both NSCLC and pulmonary TB were effectively controlled.

Conclusion: For patients with NSCLC complicated by pulmonary TB, after 2-4 weeks of effective anti-TB treatment, anti-tumor therapies, including ICIs, can be simultaneously implemented with the anti-TB treatment. Therapeutic drug monitoring is beneficial for avoiding serious adverse effects and ensuring the timely treatment of both diseases.