Infection and Drug Resistance最新文献

Background: Due to the rapid progression of the pneumonia in patients with Myasthenia gravis (MG), faster pathogen detection techniques are needed. The droplet digital polymerase chain reaction (ddPCR) has the ability to detect pathogens in about 3 h. Thus, this study focused on application of ddPCR in sputum samples in the MG patients with pneumonia and analyzed the association between ddPCR and other laboratory results.

Methods: We prospectively enrolled 22 MG inpatients with pneumonia and collected 24 sputum samples. All samples were analyzed using traditional culture, ddPCR and metagenomic next-generation sequencing (mNGS) in parallel. Clinical outcomes during hospitalization were documented.

Results: Among the 24 sputum samples collected from 22 MG patients, ddPCR achieved a 100% positivity rate with the identification of bacteria in all 24 samples, while mNGS also demonstrated a high detection rate, identifying bacteria in 23 of 24 samples (95.8%), and additionally detecting viral and fungal pathogens across multiple cases. In 4 patients with negative sputum culture results, pathogens were identified by both ddPCR and mNGS.

Conclusion: The ddPCR demonstrated rapid and sensitive identification of predefined bacterial targets and drug-resistance genes, making it suitable for initial diagnostic screening and timely clinical decision-making in MG patients with pneumonia. The speed of ddPCR detection is faster than mNGS and traditional culture, and the results are similar to mNGS and culture, with good consistency.

Pasteurella multocida (P. multocida) bloodstream infections in humans without a history of animal bites are commonly associated with immunocompromise. Empirical therapy typically involves a β-lactam/β-lactamase inhibitor combination (eg, amoxicillin-clavulanate), but a small number of amoxicillin-clavulanate-resistant strains have been reported. Herein, we report a rare case of human P. multocida bacteremia in a patient with no history of animal bites. Antibacterial susceptibility testing showed the strain was sensitive to trimethoprim-sulfamethoxazole; resistant to erythromycin; and non-susceptible to azithromycin, levofloxacin, tetracycline, penicillin, ampicillin, amoxicillin-clavulanate and ceftriaxone. Whole-genome sequencing (WGS) confirmed the presence of CTX-M-14-type extended-spectrum β-lactamases (ESBLs). The potential emergence of multidrug-resistant (MDR) P. multocida may challenge the empirical treatment of the strain. This case highlights the necessity of studying the antibiotic susceptibility patterns of P. multocida in humans and animals, as well as the need for a One Health approach.

Background: This study aimed to analyze the clinical features of Chlamydia psittaci (C. psittaci) pneumonia and identify risk factors for severe patients to facilitate early diagnosis and treatment.

Methods: In this retrospective analysis, we collected and summarized the clinical data of 57 patients with C. psittaci pneumonia confirmed by metagenomic next-generation sequencing (mNGS) or targeted next-generation sequencing (tNGS), who were admitted to the First Affiliated Hospital of Guilin Medical University between July 2020 and August 2025. Patients were further divided into a severe group (n=23) and a non-severe group (n=34) for comparative analysis of their clinical characteristics.

Results: The mean age of the patients was 58.68 ± 12.36 years. Common symptoms included fever, cough/sputum, fatigue, dyspnea, and neurological and gastrointestinal symptoms. The severe group had a significantly higher incidence of fatigue, dyspnea, and neurological and gastrointestinal manifestations. Laboratory findings revealed that most patients had normal or mildly elevated white blood cell counts with lymphopenia, alongside significantly elevated levels of C-reactive protein (CRP), procalcitonin (PCT), and erythrocyte sedimentation rate (ESR). Anemia, hypoalbuminemia, and abnormalities in liver enzymes, myocardial enzymes, and electrolytes were also commonly observed. The predominant chest computed tomography finding was consolidation, with pleural effusion present in 59.6% of all patients and occurring more frequently in the severe group. Multivariate analysis identified CRP as an independent risk factor for severe C. psittaci pneumonia, while albumin and platelet count were protective factors.

Conclusion: Pneumonia patients presenting with non-specific influenza-like symptoms should raise clinical suspicion for C. psittaci pneumonia. Particular vigilance for potential progression to severe disease is warranted in male patients, the elderly, those with underlying comorbidities, and individuals presenting with neurological or gastrointestinal symptoms. Elevated CRP, hypoalbuminemia, and thrombocytopenia serve as significant predictors of severe C. psittaci pneumonia.

Background: Periprosthetic joint infection (PJI) lacks a universally accepted gold standard for diagnosis, and the immune microenvironment underlying PJI remains incompletely understood. Calprotectin (S100A8/A9) emerged as a key molecule of interest in PJI, yet its expression profile in synovial tissue has not been fully characterized.

Methods: Bulk RNA sequencing was performed on sonication fluid samples from 53 PJI patients and 40 aseptic failure (AF) controls from the GEO database. Differential gene expression, immune cell infiltration, and pathway enrichment analyses were conducted. Single-cell RNA sequencing (scRNA-seq) data from synovial tissue were integrated to characterize the cellular distribution of S100A8 and S100A9 and to investigate immune cell interactions using the CellChat algorithm. Immunohistochemical staining was performed to validate calprotectin expression in synovial tissue.

Results: By integrating bulk and scRNA-seq, we characterized the cellular expression profile of S100A8 and S100A9 within the immune microenvironment of PJI synovial tissue. The results showed that S100A8 and S100A9 were markedly upregulated in PJI synovial tissue and predominantly expressed by myeloid-derived suppressor cells (MDSCs). The enrichment of S100A8/A9-expressing MDSCs in PJI synovial tissue was associated with immune features indicative of an immunosuppressive microenvironment. Cell-cell communication analysis revealed extensive interactions between MDSCs and NK cells as well as macrophages in the PJI microenvironment. Furthermore, immunohistochemical analysis demonstrated significantly elevated calprotectin expression in PJI synovial tissue, and receiver operating characteristic (ROC) curve analysis supported the diagnostic value of synovial tissue calprotectin for PJI.

Conclusion: This study demonstrates that S100A8 and S100A9 are highly expressed in the synovial tissue of patients with PJI and provides additional evidence supporting the diagnostic value of calprotectin in synovial tissue. In addition, we comprehensively characterize the cellular expression profiles of S100A8 and S100A9 in PJI synovial tissues, revealing a close association with MDSC-related immunosuppression.

Background: Fracture-related infection (FRI) is one of the main complications of hip fracture. Negative pressure wound therapy (NPWT) seems to be a potential solution for FRI, because of offering exudate management, drainage enhancement, and tissue repair. Additionally, ultrasound cannot be ignored because of its role in evaluating musculoskeletal tissue infections.

Case presentation: A 55-year-old man mainly suffered from a fracture of the right proximal femur. The fracture was classified as AO/OTA 31-A3. The patient had a history of smoking. After internal fixation of the fracture and other symptomatic treatment, the patient was discharged. However, the surgical incision dehisced one month later. After examination, the patient was diagnosed with FRI with wound disruption and sinus tract formation. The blurred parafemoral shadow in X-ray, positive bacterial culture result, abnormal secretions, and elevated C-reactive protein and erythrocyte sedimentation rate were the bases for diagnosing FRI. In the course of treatment, we made full use of NPWT following limited debridement surgery to effectively treat FRI, and then continuously monitored the changes of lesions in deep infected areas through ultrasound detection. Intravenous infusion of ceftazidime and local rinsing with vancomycin solution were applied during the treatment process. Follow-up results showed that the patient had no recurrence of infection or other adverse events three months after treatment.

Conclusion: This case shows that NPWT combined with ultrasound monitoring can control early fracture-related infection and allow implant retention. This treatment method may be applicable to areas with scarce medical resources. But larger-scale validation is still needed before clinical adoption.

Background: Preventing outbreaks, antibiotic resistance, and healthcare-associated infections (HAIs), infection prevention and control (IPC) is the cornerstone of safe, robust health systems. There is little data on IPC readiness across the country in Somalia due to its weak health system. The study aims to evaluate the preparedness of IPC systems in Somali healthcare facilities by looking at policies, fundamental procedures, and essential resources; to find gaps that guide focused interventions to improve patient safety and the resilience of the health system.

Methods: We carried out a cross-sectional secondary analysis of the 2024 Harmonized Health Facility Assessment (HHFA), which included 1,219 healthcare facilities of various categories spread over six states. Data were collected through structured interviews, observations, and facility record reviews. IPC indicators were presented using descriptive and inferential statistics. STATA Version 16 was used for the analyses, and a significance level of p < 0.05 was used.

Results: All Somali facilities have inadequate IPC readiness. Just 24% and 18%, respectively, have rules for standard precautions and healthcare waste management; 21% reported waste management training for workers. Hand hygiene supplies (39%), sterilizing equipment (26%), gloves (87%), masks (61%), and protective gowns (61%) were among the critical resources that differed in availability. There were significant regional differences (p < 0.001), with Benadir frequently having better resources than Southwest, Jubaland, Puntland, Galmudug, and Hirshabelle.

Conclusion: This study identifies significant gaps in the infection prevention and control (IPC) systems of Somali healthcare facilities, such as a lack of resources, procedures, and regulations that are critical to patient safety. Geographical disparities were apparent. These results underline the necessity of targeted, system-wide interventions to raise IPC readiness, increase resource accessibility, and guarantee uniform policy integration and training, all of which will contribute to the development of a more secure and robust healthcare system in Somalia.

Purpose: To investigate the relationship between diabetes mellitus (DM) and the risk of central nervous system tuberculosis (CNS-TB), to analyze the age-dependent characteristics of this association, and to assess the combined effects of DM and neutrophil-to-lymphocyte ratio (NLR).

Patients and methods: We retrospectively analyzed clinical data of 862 extrapulmonary tuberculosis patients admitted to Fuzhou Pulmonary Hospital from April 2018 to April 2024, including 685 non-CNS extrapulmonary tuberculosis (non-CNS EPTB) patients and 177 CNS-TB patients. Baseline demographic and laboratory characteristics were compared between groups. Age-stratified analysis (≤40 years, 41-60 years, >60 years) was performed to evaluate the age-dependent nature of the association between diabetes and CNS-TB risk. Multivariate logistic regression analysis was used to identify independent risk factors for CNS-TB, and to assess the combined effects and interaction between diabetes and NLR.

Results: The prevalence of DM was significantly higher in the CNS-TB group than in the non-CNS EPTB group (24.29% vs 12.26%, P<0.001), with significantly elevated NLR (P<0.001). Age-stratified analysis revealed that the association between diabetes and CNS-TB risk exhibited significant age dependence, with no significant correlation in the ≤40 years group (OR=1.52, 95% CI: 0.47-4.94, P=0.506), but significant associations in the 41-60 years group (OR=2.80, 95% CI: 1.40-5.63, P=0.003) and >60 years group (OR=2.22, 95% CI: 1.20-4.13, P=0.010). Multivariate analysis confirmed DM (adjusted OR=2.116, 95% CI: 1.382-3.241, P<0.001) and NLR (adjusted OR=1.051, 95% CI: 1.022-1.080, P<0.001) as independent risk factors for CNS-TB. Combined effects analysis demonstrated that patients with both diabetes and high NLR (>4.194) had the highest risk of CNS-TB (adjusted OR=4.833, 95% CI: 2.737-8.535, P<0.001), with a proportion of 38.4%. However, formal interaction analysis indicated no evidence of a statistically significant additive interaction (RERI=0.198, 95% CI: -2.772-3.169, P=0.896).

Conclusion: DM is an independent risk factor for CNS-TB, significantly increasing risk in individuals aged >40 years. DM and NLR independently contribute to CNS-TB risk, supporting clinical risk assessment and prevention strategies incorporating metabolic and inflammatory biomarkers.

Background: The mechanisms underlying ceftazidime-avibactam resistance in carbapenem-resistant Klebsiella pneumoniae (CRKP^CZA-R) remain to be elucidated.

Methods: CRKP^CZA-R isolates were screened from non-repetitive CRKP isolates at our hospital from January 1, 2018 to October 30, 2021. The antimicrobial susceptibility and molecular characteristics of CRKP^CZA-R were analyzed by broth microdilution method and next-generation sequencing, respectively.

Results: In total, 67 of 623 CRKP isolates (10.8%) were identified as CRKP^CZA-R. The susceptibility rates of CRKP^CZA-R to polymyxin B, tigecycline, aztreonam-avibactam, and cefiderocol were 97.0% (65/67), 83.6% (56/67), 100.0% (67/67), and 94.0% (63/67), respectively. The most prevalent resistance gene was bla _NDM-1 (44.8%, 30/67), followed by bla _IMP-4 (9.0%, 6/67), bla _NDM-5 (7.5%, 5/67), and bla _NDM-4 (1.5%, 1/67). Furthermore, 37.3% (25/67) of the CRKP^CZA-R isolates co-harbored more than two carbapenemase-encoding genes, mainly bla _NDM-1 and bla _KPC-2 (31.3%, 21/67). The enzyme inhibitor enhancement method detected carbapenemase activity with high sensitivity, except for isolates carrying two or more carbapenemases. Notably, 21 KL64-ST11 CRKP^CZA-R isolates presented bla _NDM-1, bla _KPC-2, and ompk36 deletion, and 17 co-harbored two or more high virulence gene markers. Patients infected with these 21 isolates were older and experienced more serious illness compared to those infected with other drug-resistant isolates.

Conclusion: The detection rate of CRKP^CZA-R was relatively high due to the metallo-β-lactamase-producing isolates. Although enzyme inhibitor enhancement method can detect carbapenemases with high sensitivity and specificity, and provide an important reference for drug selection, it is not as effective for isolates carrying two or more carbapenemases. Patients infected with CRKP^CZA-R co-harboring both bla _KPC-2 and bla _NDM-1 should be closely monitored.

Over the past decade, reports of difficult-to-treat, antifungal-resistant superficial fungal infections have increased markedly, raising global concern among clinicians and public health authorities. Trichophyton mentagrophytes ITS genotype VIII, more recently classified as T. indotineae, has emerged as a principal driver of this shift, with infections often presenting as inflammatory, extensive dermatophytoses that are prone to persistence and relapse despite antifungal therapy. This scoping review synthesizes literature published between 2019 and 2025 to provide a comprehensive overview of emerging trends in epidemiology, clinical features, antifungal susceptibility, molecular resistance mechanisms, and management strategies. Resistance in T. indotineae contributes not only to prolonged disease courses and recurrent infections but also to intrafamilial and community outbreaks, highlighting the species' capacity for rapid and widespread transmission. These challenges are compounded by diagnostic limitations, variable correlation between squalene epoxidase gene mutations and terbinafine susceptibility, and the continued reliance on terbinafine as a first-line systemic therapy in many regions. Together, these factors underscore the urgent need for integrated diagnostic and management approaches, combining phenotypic susceptibility testing, genotypic analysis, and careful clinical assessment. Moreover, updated treatment guidelines and coordinated public health interventions are critical to mitigate transmission, optimize therapeutic outcomes, and address the growing clinical and epidemiological burden posed by resistant T. indotineae infections worldwide.

Background: Previously, MRSA transmission and infections were mostly recognized as healthcare-associated. Community-associated MRSA (CA-MRSA) cases have become increasingly common, also in low-endemicity countries. Hence, also doctors in outpatient care encounter these patients. Despite increased general awareness on risk factors of MRSA carriage, it does not always influence clinical practice. As the total number of MRSA cases had increased in our region, it provoked us to analyze how this may have reflected the recognition of these infections and their empiric treatment adequacy in Hospital District of Southwest Finland (HDSWF).

Methods: All new MRSA cases detected between 2007 and 2016 in Hospital District of Southwest Finland were retrospectively analyzed. This single-center study describes MRSA carriers, whose carriage was first detected from a clinical specimen. The cases were recognized from the hospital's MRSA registry, and their background data, including the antibiotic treatments given, were collected manually from electronic patient records.

Results: A total of 280 MRSA cases having an active clinical infection were detected. Skin and soft tissue infections (SSTIs) were the most common infection type (76%; 213/280 cases). Information on antibiotic treatments were obtained in 46.8% (131/280) of the cases. In 81.7% (107/131) of the cases, the empiric treatment did not cover MRSA. After adjusting the treatment according to susceptibility results, MRSA was ultimately covered in 49.3% (68/138) of the cases.

Conclusion: In low-endemicity settings, skin infections typically caused by S. aureus may be missed to being caused by a resistant pathogen, resulting in suboptimal or ineffective treatment. More awareness is needed to recognize the risk, to evaluate and possibly adjust the treatment.