Infection and Drug Resistance最新文献

Background and aims: The coexistence of chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) is increasingly common, yet their combined impact on antiviral outcomes remains unclear. This study aimed to compare baseline histopathological features and longitudinal virological responses to entecavir (ETV) therapy in CHB patients with and without NAFLD.

Methods: From October 2014 to January 2022, 299 treatment-naïve CHB patients (130 with NAFLD, 169 without NAFLD) were enrolled in a real-world observational cohort at Tianjin Second People's Hospital. NAFLD diagnosis was confirmed by liver biopsy and (or) ultrasound examination following AASLD guidelines. Baseline characteristics (histopathology, metabolic profiles, HBV markers) and serial virological outcomes (HBV DNA seroconversion, HBsAg/HBeAg loss rate) were analyzed over 96 weeks of ETV therapy. Statistical comparisons utilized Mann-Whitney U and chi-square tests.

Results: At baseline, NAFLD-comorbid patients exhibited milder hepatic inflammation (G≥3: 6.9% vs 17.2%, P =0.022) and fibrosis (S≥3: 10.8% vs 17.2%, P =0.020) despite higher metabolic dysregulation (BMI: 24.8 vs 21.5 kg/m², TG: 1.05 vs 0.89 mmol/L, P <0.001). While early virological responses (4-48 weeks) were comparable, NAFLD patients showed significantly lower HBV DNA seroconversion rates at 96 weeks (82.7% vs 92.1%, P =0.038) and persistently reduced HBsAg levels (3.17±1.07 vs 3.57±0.67, P = 0.017).

Conclusion: Despite milder baseline histology, NAFLD comorbidity predicts suboptimal 96-week HBV DNA seroconversion and slower HBsAg decline during entecavir therapy, underscoring the need for intensified, integrated metabolic-antiviral management in this cohort.

Purpose: To analyze the pathogen distribution, epidemiological characteristics, and antimicrobial resistance patterns of bacterial conjunctivitis in a Shanghai secondary hospital from 2020 to 2024, providing evidence for clinical treatment optimization.

Patients and methods: Conjunctival swab specimens from patients clinically diagnosed with bacterial conjunctivitis were collected between January 2020 and December 2024. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK 2 Compact system and Kirby-Bauer disk diffusion method, respectively. Statistical analyses were conducted using WHONET 5.6 and SPSS 26.0.

Results: Among the 611 specimens, 58 bacterial isolates were identified (9.5% positivity rate). Gram-positive cocci predominated (70.7%, 41/58), primarily Staphylococcus epidermidis (21 strains) and Staphylococcus aureus (10 strains). Gram-negative bacilli accounted for 15.5% (9/58), including Pseudomonas aeruginosa and multidrug-resistant Acinetobacter baumannii. A significant seasonal variation was observed, with higher incidence in summer-autumn (72.4%) than in winter (12.1%, P=0.005). Cases in 2023-2024 nearly doubled those in 2020-2022 (65.5% vs 34.5%). The detection rate of S. aureus increased significantly annually (P=0.043). High resistance rates were observed among Gram-positive cocci to penicillin (89.5%), oxacillin (60.5%), and erythromycin (55.3%). All Gram-positive isolates remained susceptible to vancomycin, linezolid, and tigecycline. Gram-negative isolates exhibited 100% resistance to ampicillin, with A. baumannii demonstrating pandrug-resistance.

Conclusion: Gram-positive cocci, particularly Staphylococcus spp. were the predominant pathogens in bacterial conjunctivitis, with an increasing trend of S. aureus and multidrug-resistant A. baumannii. The significant seasonal pattern and high resistance to first-line antibiotics emphasize the necessity for culture-guided therapy and enhanced antimicrobial stewardship in ocular infections.

We present the two adult cases of influenza diagnosed by multiplex polymerase chain reaction (PCR) in the 2024-2025 season, which was a major season of influenza in Japan. Although rapid antigen tests (RATs) were negative in these two cases, these patients were effectively treated by anti-influenza agents after influenza was definitively diagnosed by multiplex PCR. Relative low sensitivity and specificity might be shown in influenza diagnosis at bedside by RATs, therefore, these data suggest that multiplex PCR could be useful in influenza diagnosis and management during the influenza-endemic season.

Background: H. pylori infection is a worldwide health issue, fueling rising demand for medical counseling. LLMs have the potential to serve in medical counseling. However, their performance remains unclear.

Objective: This study aimed to evaluate the effectiveness of LLMs in providing H. pylori related medical counseling in a Chinese context.

Methods: 20 H. pylori-related questions were collected, covering four domains: definition and symptoms, diagnosis, treatment, and prevention. Each question was asked thrice in Chinese to each LLM. We assessed the responses across five dimensions (accuracy, relevance, completeness, clarity, and reliability).

Results: 1. In the first batch of tests, the overall performance distribution was 33.3% good, 66.1% medium, and 0.6% poor, respectively. No significant differences were observed among the three LLMs (p=0.158). Good performance was observed with 47.8% in accuracy, 53.9% in relevance, 68.3% in completeness, 36.7% in clarity, and 36.1% in reliability. No significant differences were observed in accuracy, relevance, completeness, or clarity. Reliability differed significantly (p<0.001), with Ernie Bot achieving the best performance. 2. The second test batch yielded performance rates of 70.6% good, 29.4% medium, and 0% poor, with a significant difference among the three LLMs (p=0.018). Doubao attained the best performance, surpassing other models in relevance and clarity. 3. The newly assessed AI batch showed markedly superior overall performance to the counterpart evaluated more than a year prior.

Conclusion: This study is the first to evaluate the effectiveness of various LLMs in H. pylori-related medical counseling in a real-world setting. The study showed that while LLMs generally performed acceptably in terms of accuracy, relevance, and completeness, their clarity and reliability were less satisfactory. Ernie Bot, developed by Chinese company, outperformed ChatGPT in certain aspects of medical counseling in Chinese. With the guidance of professionals, LLMs can serve as potential aids for medical counseling.

Background: Carbapenem-resistant organisms (CROs) are a growing threat in intensive care units (ICUs) worldwide due to the limited treatment options and high risk of morbidity and mortality. While previous studies have assessed the clinical implications of CROs, few have systematically quantified their economic burden.

Aim: This study aimed to evaluate the economic burden attributable to CROs compared with carbapenem-susceptible organisms (CSOs) among critically ill patients in China.

Methods: We conducted a retrospective cohort study including 7,232 ICU patients from two tertiary hospitals in Western China (2019-2024). Patients were assigned to either the CRO group or the CSO group and matched using a 1:1 propensity score matching (PSM) approach. ICU length of stay (LOS), hospital LOS, and total hospitalization cost were compared between the two groups, followed by generalized linear models (GLMs) to assess the independent impact of CRO status. Institutional-level opportunity costs were estimated based on excess ICU occupancy.

Results: Among the 7,232 patients, 379 (5.24%) developed CRO, with carbapenem-resistant Acinetobacter baumannii (CRAB) being the predominant pathogen. PSM produced 379 pairs of CRO and CSO patients. The CRO group had significantly longer ICU LOS (median 11.0 vs 5.0 days, P<0.001), longer hospital LOS (median 24.0 vs 13.0 days, P<0.001), and higher total hospitalization costs (median CNY 99,549 vs CNY 50,279, P<0.001) than the CSO group. GLMs showed that CRO independently predicted longer ICU LOS (OR: 2.37; 95% CI: 2.03-2.76), longer hospital LOS (OR: 1.97; 95% CI: 1.70-2.27), and higher total hospitalization costs (OR: 1.99; 95% CI: 1.78-2.23). An estimated 321 hospital admissions and 459 ICU admissions were lost over six years due to excess bed occupancy by CRO patients, resulting in a total institutional financial loss of approximately CNY 134,000 per year.

Conclusion: CROs are associated with substantially increased economic burden in ICU patients. These findings support the implementation of early screening, targeted prevention, and stewardship strategies to mitigate the impact of CROs.

Talaromyces marneffei (TM), a temperature-dependent dimorphic fungus and opportunistic pathogen, poses a significant threat to immunocompromised individuals, particularly in Southeast Asian regions such as China and India. This case report details an 8-month-old HIV negative Chinese infant with recurrent cough and fever, who was diagnosed with TM infection through blood culture and metagenomic next-generation sequencing (mNGS). Additionally, whole exome sequencing identified a point mutation (c.346+1G>T) in the child's CD40LG gene, primary immunodeficiency calized to chromosome position chrX:135736590, leading to X-linked Hyper IgM Syndrome (XHIGM). The patient was managed with intravenous immunoglobulin (IVIG) and a 12-day course of amphotericin B and itraconazole, which led to significant clinical improvement and discharge on a quarterly IVIG regimen. However, he required readmission for recurrent TM pneumonia at 9 and 40 months post-discharge. This case highlights the diagnostic challenge and management complexity of TM infection in the context of primary immunodeficiency.

Background: To study the association between antimicrobial use density (AUD) and carbapenem-resistant gram-negative bacteria (CRGN) detection rate in a Hospital from 2015 to 2023 and to determine the critical threshold for antimicrobial drug use.

Methods: The consumption of antibiotics and the detection rates of four CRGN from inpatients were obtained on quarterly. Regression discontinuity design was used to determine the effect of antibiotics on the detection rates of CRGN. Nonlinear time-series analysis with generalized additivity models (GAMs) was applied. A P value of <0.05 and the adjusted R² value of >0.3 were considered statistically significant.

Results: The consumption of antibiotics remained stable from 2015 to 2019, then showed a decreasing trend from the first quarter of 2020 to the first quarter of 2021, subsequently showed a gradual increasing trend from the second quarter of 2021 to the fourth quarter of 2023. The detection rate of carbapenem-resistant Acinetobacter baumannii (CRAB) exceeded 50% from the first quarter of 2015 to the second quarter of 2019, even above 90% from the fourth quarter of 2018 to the second quarter of 2019, then the rate gradually decreased. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) and Carbapenem-resistant Pseudomonas aeruginosa (CRPA) both showed increasing trend from the first quarter of 2015 to the second quarter of 2019, while showed gradual decreasing trend from the fourth quarter of 2019 to the third quarter of 2023. We found that the detection rates of CRGN were significantly associated with the consumption of carbapenems, aminoglycosides, fluoroquinolones, and glycopeptides (lag coefficient [1-3], P < 0.05, adjusted R² [0.347-0.808]).

Conclusion: AUD is associated with the detection rates of CRGN. To reduce the detection rates of CRGN, we determined thresholds for carbapenems, aminoglycosides, fluoroquinolones, and glycopeptides at 5.82, 0.06, 7.09, and 0.77 Defined Daily Doses (DDDs)/(100 patient-days), respectively.

Introduction: Tuberculosis (TB), resulting from the bacterial pathogen Mycobacterium tuberculosis (Mtb), continues to be a leading cause of death and illness globally. Mtb employs secretory proteins to avoid host immune responses during the infection process and is able to survive, spread and replicate within the hostile micro-environment. Early secreted antigenic target 6 kDa (ESAT-6), the major virulence factor of Mtb, plays an important role in Mtb-induced macrophage apoptosis, which could benefit the dissemination of Mtb. However, the underlying mechanism of ESAT-6 in macrophage apoptosis still unclear.

Methods: In this research, the human monocytic leukemia cell lines (THP-1) were treated with Phorbol 12-myristate 13-acetate (PMA) to differentiation into M₀ macrophages, and the role of recombinant ESAT-6 in macrophage apoptosis was investigated using Annexin V-FITC/propidium iodide (PI) assay with Flow CytoMetry analysis. The small interfering RNA (siRNA) of Long non-coding RNA nuclear enriched abundant transcript 1 (lncNEAT1) was used to silencing the RNA expression of lncNEAT1. The expression level of lncNEAT1, microRNA-125b-5p (miR-125b-5p) and tumor necrosis factor-alpha (TNF-α) mRNA were investigated using RT-qPCR technique. Additionally, Western blot was used to detect the protein expression of TNF-α. Furthermore, the downstream regulating mechanisms of lncNEAT1 were investigated using bioinformatics analyses and luciferase reporter assays.

Results: The results showed that ESAT-6 induces macrophage apoptosis in a dose-dependent manner via upregulation of the lncNEAT1 and lncNEAT1 can target miR-125b-5p, while miR-125b-5p can also target the 3'UTR (Untranslated Regions) of TNF-α mRNA. Moreover, inhibition of lncNEAT1 alleviated ESAT-6 induced macrophage apoptosis by targeting miR-125b-5p/TNF-α axis.

Discussion: The results of this study indicated that ESAT-6 induces macrophage apoptosis by regulating lncNEAT1/miR-125b-5p/TNF-α pathway, which may provide a possible therapeutic target for the treatment of TB.

Background: Syphilis is characterized by diverse manifestations, including rare complications such as otosyphilis and malignant syphilis, particularly in immunocompromised individuals.

Case presentation: This study reported a case of a 40-year-old Human Immunodeficiency Virus (HIV)-positive male with bilateral sensorineural hearing loss (SNHL) and disseminated ulceronodular skin lesions. Serological testing confirmed active Treponema pallidum infection with a venereal disease research laboratory (VDRL) titer of 1:64. Dermatological results were consistent with malignant syphilis, a rare and aggressive variant of secondary syphilis. Audiological assessment showed mild bilateral SNHL, while cerebrospinal fluid analysis was insignificant. Although histopathological confirmation was not performed due to rapid clinical improvement, a presumptive diagnosis of otosyphilis was made.

Treatment and outcome: The patient was treated with intramuscular ceftriaxone 2 grams daily for 14 days as an alternative to penicillin due to accessibility constraints and preference. This led to complete resolution of hearing loss, regression of cutaneous lesions, and a significant clinical serological response, including VDRL seroconversion at 6 months. The treatment did not produce Jarisch-Herxheimer reaction, showing good tolerance and supporting ceftriaxone effectiveness as an alternative therapy in HIV-associated syphilis.

Conclusion: This case study underscores the importance of early recognition and treatment of otosyphilis and malignant syphilis in HIV-infected individuals. Ceftriaxone may serve as an effective alternative regimen to penicillin, achieving both clinical and serological recovery. Moreover, routine screening for otologic symptoms in patient with syphilis is critical to prevent irreversible complications. The limitations include the absence of histopathology and CSF analysis conducted after therapy initiation.

Invasive fungal infections pose significant challenges in the management of immunocompromised patients, particularly those undergoing treatment for hematologic malignancies. Trichosporon asahii is a rare but severe cause of invasive trichosporonosis, associated with mortality rates. Effective management is complicated by its resistance to echinocandins and reduced susceptibility to polyenes, necessitating azole-based therapy. This paper aims to illustrate the diagnostic challenges associated with Trichosporon infections, analyze the complexities of treatment, review and synthesize known risk factors, and highlight the need for improved clinical management. It addresses the clinical and therapeutic difficulties involved in diagnosing and treating Trichosporon asahii infections in pediatric and adult hemato-oncologic patients. We present the first case of a 14-year-old female with T-cell acute lymphoblastic leukemia who developed a disseminated Trichosporon asahii infection during chemotherapy in Central and Eastern Europe. Initial symptoms included joint pain, fever, and neutropenia. The diagnosis was confirmed through synovial fluid and urine cultures. Despite initial treatment with voriconazole (70 days) and liposomal amphotericin B (309 days), the infection progressed, involving the lungs, liver, kidneys, and spleen. The patient transitioned to isavuconazole (232 days intravenous then orally), along with extensive supportive care, which eventually controlled the infection. However, the patient experienced significant complications, including joint contractures and prolonged hospitalization. Maintenance therapy was carefully adjusted to minimize adverse effects while ensuring disease control. The patient was followed monthly through September 2024, resulting in a successful outcome. A literature review highlighted neutropenia, antibiotic use, central venous catheters, and corticosteroid therapy as significant risk factors for invasive trichosporonosis. The diagnostic challenge stems from its resemblance to Candida and other yeasts, necessitating advanced methods like matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for accurate identification. Voriconazole remains the first-line treatment, with combination therapy using liposomal amphotericin B as a salvage approach. This case underscores the critical importance of early recognition and targeted management of Trichosporon infections in immunocompromised patients. Enhanced diagnostic techniques and tailored antifungal strategies are imperative to improve outcomes. This case provides new insight for pediatric hematology practice by demonstrating that early use of advanced diagnostic methods and timely adjustment to azole-focused antifungal therapy are critical for controlling disseminated Trichosporon asahii infections, even in severely immunocompromised children.