Infection and Drug Resistance最新文献

Background: tNGS and mNGS are valuable tools for diagnosing pathogens in lower respiratory tract infections (LRTIs), which subsequently influence treatment strategies. However, the impact of tNGS and mNGS on antimicrobial stewardship in patients with LRTIs remains unclear.

Methods: Patients diagnosed with LRTIs who underwent tNGS or mNGS between June 2021 and January 2024 were included. Patients who underwent both tNGS and conventional microbiologic tests (CMTs) were grouped into the tNGS group, the others were divided into the mNGS group. Then, the diagnostic efficacy of tNGS and mNGS was compared, along with their impact on antimicrobial management and clinical outcomes.

Results: 548 patients with an initial diagnosis of LRTIs who underwent tNGS or mNGS were evaluated. Finally, 321 patients were analyzed, with 117 patients in tNGS group and 204 patients in mNGS group. The overall pathogen detection rates for tNGS and mNGS were 89.74% and 89.71% (P=0.991). The distribution of detected pathogens was similar between tNGS and mNGS, with bacteria being the predominant microorganisms. The proportions of patients who underwent antimicrobial agent changes and received targeted therapy were not significantly different between tNGS and mNGS groups (P=0.270; P=0.893). Additionally, no significant differences were noted in the rates of antibiotic de-escalation, escalation, or changes in the opposite direction (all P>0.05). The same results was observed in the proportions of patients with addition or reductions in antiviral, antifungal, and antibacterial agents (all P>0.05). Hospital stays, improvement rate and mortality rate were also similar (all P>0.05).

Conclusion: tNGS and mNGS demonstrate comparable overall pathogen yield rates in patients with LRTIs. Furthermore, tNGS is also comparable to mNGS in terms of adjusting antimicrobial treatments and clinical outcomes, tNGS meets the clinical needs of most patients with LRTIs and can be firstly used for these patients.

Purpose: To evaluate the long-term impacts of the feedback intervention on controlling inappropriate use of antimicrobial prescriptions in primary care institutions in China, as a continuation of the previous feedback intervention trial.

Methods: After the intervention ended, we conducted a 12-month follow-up study. The prescription data were collected from the baseline until the end of the follow-up period. The generalized estimation equation was employed to analyze the differences among four representative time points: at the baseline point, at 3 months, at 6 months, and at 18 months. The time-intervention interaction was utilized to evaluate the changing trends of group A and group B. Our primary outcome variable is the monthly inappropriate antimicrobial prescription rate (IAPR).

Results: After adjusting for covariates, the IAPRs in group A decreased by 1.00% on average from the baseline point to the 3 months, 5.00% from the 3 months to the 6 months, -0.92% from the 6 months to the 18 months, and 0.39% from the baseline point to the 18 months. During the corresponding four periods in group B, the average decline was 2.33%, 3.67%, -0.42%, and 0.72%, respectively. As for antimicrobial prescription rates (APRs), the average decline for group A was 1.33%, 3.67%, and 0.17% during the three periods: from the baseline point to the 3 months, from the 3 months to the 6 months, and from the 6 months to the 18 months, respectively. Accordingly in group B, the average decline was 1.00%, 3.67%, and 0.08%, respectively.

Conclusion: Our feedback intervention generated limited long-term impacts. Although the IAPRs and the APRs consistently remained below the baseline point, both rates experienced a rebound within a certain range following the stop of the intervention in the two groups. It is reasonable to think that the desired effects will be difficult to maintain without sustained implementation of feedback intervention.

Background: Therefore, the objectives of this study were to investigate the prevalence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) in Fujian Medical University Union Hospital, identify their genetic characters, characterize their resistance profiles, and identify risk factors for their infection to improve prevention and treatment strategies for CR-hvKp in the area.

Methods: Between January 2021 and January 2022, clinically identified carbapenem-resistant Klebsiella pneumoniae (CRKp) isolates were collected. A PCR assay was used to detect the K capsule type, virulence genes, carbapenemase genes, and membrane pore protein. ERIC-PCR was carried out for homology analysis. Antimicrobial susceptibility test was used to determine drug resistance. Logistic multivariate regression analysis was conducted to confirm the risk factors for CR-hvKp infection.

Results: In total, 239 CRKp isolates were obtained. The virulence genes with the highest detection rates were mrkD, iucA, and rmpA2. Of these isolates, 54 (22.59%) carried both iucA and rmpA2, thus classifying them as CR-hvKp. All CR-hvKp isolates carried bla _KPC. Furthermore, capsular serotypes K64 (94.44%) and K47 (3.70%) were detected. Resistance was observed against most common antibiotics, with the exception of complete sensitivity to ceftazidime-avibactam. ERIC-PCR indicated a potential clonal spread among CR-hvKp. Multivariate analysis found that changing beds was a risk factor for CR-hvKp infection.

Conclusion: Currently, the hospital predominantly carries K64 CR-hvKp that harbors the bla _KPC. Our study found that changing patient beds was an independent risk factor for CR-hvKp infection.

Objective: The artificial liver support system (ALSS) has been recruited as an available method for patients with acute-on-chronic liver failure (ACLF), but its impact on the outcome of ACLF remains controversial. This study aimed to investigate the association between ALSS treatment and short-term prognosis of hepatitis B-related ACLF (HBV-ACLF).

Methods: This was a retrospective observational cohort study, and data were obtained from the Center of Infectious Diseases, West China Hospital of Sichuan University, between Mar 2015 and December 2021. The primary outcome was 28-day transplant-free mortality and the secondary outcomes were 60- and 90-day transplant-free mortality. Patients were divided into standard medical therapy (SMT) and ALSS groups. Kaplan-Meier survival analysis curves show the 28-day, 60-day and 90-day transplant-free mortality. Based on the feature selection result of univariate logistic, univariate Cox and Boruta algorithm, the univariate and multivariate logistic and COX regression models were used to investigate the association of ALSS with 28-day, 60-day and 90-day outcomes in patients with HBV-ACLF. Subgroup analyses were conducted to test the robustness of the results.

Results: A total of 589 hBV-ACLF patients were enrolled in this study (median age, 48.00 years [IQR,44.00-55.00 years]; 70 [11.9%] female). The 28-day, 60-day and 90-day transplant-free mortality rates were 25.6%, 35.8% and 38.9%, respectively. In the univariate and Kaplan-Meier survival analysis, ALSS could significantly reduce 28-day, 60-day and 90-day transplant-free mortality compared to SMT. Furthermore, an in-depth analysis of our study revealed that the therapeutic benefits of the ALSS were observed exclusively within the end-stage (PT-INR ≥ 2.5) subgroup of HBV-ACLF patients.

Conclusion: Compared to SMT, ALSS demonstrated efficacy primarily in enhancing the short- term prognosis of end-stage HBV-ACLF patients, rather than across the entire spectrum of HBV-ACLF patients.

Although infection with Mycoplasma pneumoniae is generally self-limited, it may cause refractory or life-threatening pneumonia with pulmonary or extrapulmonary complications. Necrotizing bronchitis is a rare condition with a high mortality rate. The present report describes a patient with mycoplasma pneumonia and necrotizing bronchitis that caused airway obstruction. A 7-year-old girl presented with fever and cough and was hospitalized. Her symptoms did not improve, and mild hypoxemia was observed. Fiberoptic bronchoscopy revealed diffuse bronchitis with necrotic and hemorrhagic material obstructing the bronchus. The necrotic tissue was removed directly, unblocking the airways. This case underscores the importance of fiberoptic bronchoscopy for early diagnosis and treatment of severe respiratory complications associated with Mycoplasma pneumoniae infection, such as necrotizing bronchitis. Early recognition and timely intervention are critical to improving patient outcomes in such cases.

Candida auris is an emerging yeast species and an opportunistic pathogen. Due to its multi-drug resistance and ability to colonize and transmit, it poses a significant risk for outbreaks in medical institutions. In this study, we report the first case of C. auris detected in a pediatric bone marrow transplant child patient in Guangxi, China. C. auris was isolated from urine and identified using matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry, and the isolate belonged to clade I using sequencing. We have implemented stringent infection control measures including personal protective equipment and treatment in a single room, and conducted regular surveillance screening of patients' body surfaces, as well as those of related medical and logistics personnel, medical equipment, and surrounding environmental surfaces. These measures aim to effectively control the colonization of C. auris in patients, prevent its spread within hospitals, and ensure the quality of diagnosis and treatment for patients.

Hypervirulent Klebsiella pneumoniae (hvKp) has attracted increasing attention in recent years. Diabetes and serotype K1 or K2 are risk factors for invasive liver abscess syndrome including liver abscesses and the metastatic complications such as bacteremia, meningitis, endophthalmitis, and necrotizing fasciitis. Simultaneous infections of the liver, lungs, prostate, brain, and eyes are exceedingly rare. In this paper, a 41-year-old male patient who presented with a 4-day history of fever with polydipsia and polyuria and untreated diabetes deteriorated dramatically with sepsis, prostate abscess, lung abscess, liver abscess and intracranial infection as well as endophthalmitis. He was diagnosed with infection by K1/ST1265 hypervirulent Klebsiella pneumoniae and after treatment with antibiotics and abscess drainage, while the patient still passed away. K1/ST1265 hvKp exhibits exceptionally high virulence and invasiveness, necessitating broad awareness and vigilant monitoring.

Aim: To perform a comparative analysis of the clinical data of patients with and without recurrent pyogenic liver abscess and explore the influencing factors, clinical characteristics, and pathogenic bacteria associated with the recurrence of liver abscesses.

Patients and methods: A retrospective analysis was conducted on 436 recently diagnosed patients with pyogenic liver abscess admitted to the Affiliated Hospital of Chengde Medical College between June 2017 and June 2023. Patients with recurrence comprised the observation group, whereas those without recurrence comprised the control group.This analysis included the examination of clinical characteristics, pathogens, drug resistance patterns, and treatment modalities. Additionally, regression analysis was employed to investigate the factors influencing liver abscess recurrence.

Results: Of 436 patients initially diagnosed with pyogenic liver abscess, 58 experienced recurrence. The proportion of Escherichia coli infection was 23.3% in the observation group and 10.3% in the control group, indicating a statistically significant difference. Multivariate analysis identified diabetes mellitus and cerebral infarction as significant risk factors for recurrent pyogenic liver abscess.

Conclusion: In comparison with patients without recurrence, those who experienced recurrent pyogenic liver abscess following initial diagnosis exhibited a higher prevalence of E. coli as a pathogenic bacterium. In addition, a history of diabetes mellitus and cerebral infarction are high-risk factors for with pyogenic liver abscess recurrence for the first time.

Q fever is a zoonotic disease caused by the Gram-negative bacterium Coxiella burnetii, typically transmitted through exposure to infected animal secretions. As the clinical signs of Q-fever are largely non-specific in humans, a definitive diagnosis can often be overlooked, particularly when physicians fail to consider C. burnetii on the list of differentials. This case report describes Q-fever in a male patient who had previously undergone orthotopic liver transplantation. The patient had a sudden onset of fever and received the anti-infective moxifloxacin which proved ineffective. Despite the comprehensive laboratory tests and CT imaging that were performed, the etiology remained undetermined. The patient's blood was subjected to metagenomic next-generation sequencing (mNGS), which identified C. burnetii, after which the patient was treated with doxycycline and recovered well. Eight literature articles on Q fever infection in solid organ transplant recipients were reviewed. To our knowledge, this is the first case of Q fever identified by mNGS in an organ transplantation patient. The case underscores the potential of mNGS has in aiding the rapid detection of rare pathogens in immunocompromised patients.

Background: Early differentiation between spinal tuberculosis (STB) and acute osteoporotic vertebral compression fracture (OVCF) is crucial for determining the appropriate clinical management and treatment pathway, thereby significantly impacting patient outcomes.

Objective: To evaluate the efficacy of deep learning (DL) models using reconstructed sagittal CT images in the differentiation of early STB from acute OVCF, with the aim of enhancing diagnostic precision, reducing reliance on MRI and biopsies, and minimizing the risks of misdiagnosis.

Methods: Data were collected from 373 patients, with 302 patients recruited from a university-affiliated hospital serving as the training and internal validation sets, and an additional 71 patients from another university-affiliated hospital serving as the external validation set. MVITV2, Efficient-Net-B5, ResNet101, and ResNet50 were used as the backbone networks for DL model development, training, and validation. Model evaluation was based on accuracy, precision, sensitivity, F1 score, and area under the curve (AUC). The performance of the DL models was compared with the diagnostic accuracy of two spine surgeons who performed a blinded review.

Results: The MVITV2 model outperformed other architectures in the internal validation set, achieving accuracy of 98.98%, precision of 100%, sensitivity of 97.97%, F1 score of 98.98%, and AUC of 0.997. The performance of the DL models notably exceeded that of the spine surgeons, who achieved accuracy rates of 77.38% and 93.56%. The external validation confirmed the models' robustness and generalizability.

Conclusion: The DL models significantly improved the differentiation between STB and OVCF, surpassing experienced spine surgeons in diagnostic accuracy. These models offer a promising alternative to traditional imaging and invasive procedures, potentially promoting early and accurate diagnosis, reducing healthcare costs, and improving patient outcomes. The findings underscore the potential of artificial intelligence for revolutionizing spinal disease diagnostics, and have substantial clinical implications.