Infection and Drug Resistance最新文献

Objective: This study aims to investigate the effectiveness of combining serum lectin galactoside-binding soluble 3 binding protein (LGALS3BP) with growth differentiation factor 15 (GDF-15) for predicting outcomes in sepsis patients in an intensive care unit (ICU) setting.

Methods: The study involved 208 sepsis patients from the ICU of our hospital. These patients were categorized based on their 28-day survival outcomes into two groups: 166 in the survival group and 42 in the mortality group. The serum levels of LGALS3BP and GDF-15 were measured using the ELISA technique. Pearson and Spearman methods were utilized for correlation analysis. Factors affecting mortality in ICU sepsis patients were evaluated through multivariate logistic regression analysis. The efficacy of these biomarkers in prognosis prediction was assessed using receiver operating characteristic (ROC) curve analysis.

Results: The proportion of septic shock, APACHE II score, SOFA score, and serum LGALS3BP and GDF-15 levels in ICU sepsis patients in the death group were obviously higher than those in the survival group (P<0.05). The severity of ICU sepsis patients, APACHE II score, and SOFA score were obviously positively correlated with serum LGALS3BP and GDF-15 levels (P<0.05). LGALS3BP (OR: 95% CI=2.745:1.583~4.761) and GDF-15 (OR: 95% CI=2.639:1.423~4.893) were independent risk factors for death in ICU sepsis patients (P<0.05). The AUC of serum LGALS3BP and GDF-15 levels alone in predicting death in ICU sepsis patients was 0.859 and 0.854, obviously lower than the AUC of the combination, 0.943 (Z=2.704, 2.287, P<0.05). The AUC for predicting mortality in ICU sepsis patients using the APACHE II and SOFA scores were 0.832 and 0.842, respectively. The differences in comparison to the AUCs of LGALS3BP and GDF-15 were not statistically significant (P > 0.05).

Conclusion: Serum levels of LGALS3BP and GDF-15 can both be used as predictive indicators for death in ICU sepsis patients, and their combined predictive efficacy is better.

Purpose: To evaluate the clinical outcomes and safety of tigecycline (TGC) plus cefoperazone/sulbactam (CPS) or TGC monotherapy in patients with hospital-acquired pneumonia (HAP) caused by Carbapenem-Resistant Acinetobacter baumannii (CRAB).

Methods: This was a retrospective analysis of multicenter data from 62 Chinese hospitals with CRAB HAP. Risk factors for receiving TGC with CPS therapy and predictors of mortality were assessed using multivariate logistic and Cox regression analyses, respectively. Propensity score matching (PSM) evaluated the efficacy and safety of antimicrobial regimens.

Results: A total of the 180 patients were included, with 95 receiving TGC monotherapy and 85 receiving combination therapy. Multivariate logistic regression analysis revealed that older age (P = 0.011), and intensive care unit (ICU) admission (P = 0.007) were significant risk factors for combination therapy. Multivariate Cox regression demonstrated that combination therapy was associated with a significantly higher risk of 90-day mortality (P = 0.031). Patients in the standard-dose TGC (SDT) plus CPS subgroup had significantly higher rates of SOFA scores ≥ 7 (P = 0.009) and MV used (P = 0.028), as well as higher 30-/90-day mortality compared to high-dose TGC (HDT) plus CPS group. TGC plus CPS significantly reduced CRP levels (P = 0.009), while the variations in ALT, TBIL, Cr, Hb, and PLT levels did not differ between different antimicrobial regimens after PSM.

Conclusion: HDT and CPS combination therapy was more effective in patients with advanced age and more severe condition. Safety profiles of different antimicrobial regimens were similar with liver, kidneys, and coagulation functions.

Background: To establish and validate a nomogram for predicting the culture results of Mycobacterium tuberculosis in superficial lymph nodes.

Methods: The clinical data of patients with superficial lymph node tuberculosis admitted to Xi'an City Chest Hospital from November 23, 2018, to May 30, 2024, were selected and divided into a training set and a validation set according to a ratio of 7:3. Influencing factors were identified through multivariate logistic regression analyses. Using R version 4.3.2, we developed a predictive model and generated a nomogram based on this model. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curve analysis (CCA), and decision curve analysis (DCA).

Results: The positive rate of superficial lymph node tuberculosis culture was 23.0% (103/446). Multivariate Logistic regression analysis showed that anti-tuberculosis treatment duration (OR=0.98, 95% CI: 0.97 ~ 0.99), initial treatment or retreatment (OR=0.12, 95% CI: 0.05 ~ 0.28), and adenosine deaminase (OR=1.12, 95% CI: 1.03 ~ 1.22) were independent factors affecting the culture results of Mycobacterium tuberculosis in superficial lymph nodes. The areas under the ROC curves were 0.86 (95% CI: 0.82-0.91) for the training set and 0.89 (95% CI: 0.84-0.95) for the validation set. The P values of calibration curves were 1.000 and 0.961, respectively, and the predicted values were in good agreement with the actual values. The threshold probabilities of clinical decision curves were 3%~64% and 1%~68%, respectively.

Conclusion: The positive rate of Mycobacterium tuberculosis culture in superficial lymph nodes is low. The increase in retreatment patients and anti-tuberculosis treatment time are obstacle factors for Mycobacterium tuberculosis culture positivity, while an increase in adenosine deaminase is a promoting factor for Mycobacterium tuberculosis culture positivity. The nomogram model established based on these factors can be used to predict the results of Mycobacterium tuberculosis culture in superficial lymph nodes.

Background: HIV-1 CRF01_AE is becoming the predominant HIV-1 subtype among patients in China. The distribution and characteristics of transmission clusters of HIV-1 CRF01_AE in Zhejiang, Eastern China remains unclear. This study analyzed the epidemiologic characteristics and transmission clusters of HIV-1 CRF01_AE in Zhejiang.

Methods: Plasma samples obtained from 152 patients of HIV-1 CRF01_AE not undergoing ART were used to amplify HIV-1 pol and env gene. CRF01_AE drug resistance mutations (DRM) prevalence was analysed using Stanford University's HIV Drug Resistance Database. A phylogenetic tree was constructed using FastTree (version 2.1.11) based on the GTR nucleotide substitution model and visualized using Figtree (version 1.4.4) and The Interactive Tree of Life; the Chinese HIV Gene Sequence Data Platform was used to construct genetic transmission networks.

Results: Majority samples could be grouped into CRF01_AE transmission Clusters 1 (11.2%), 4 (64.5%), and 5 (7.2%). The CD4+ T-cell counts in Cluster 1, 4a, 4b are lower than 5 were 15, 38, 30, and 248 cells/mm³, respectively (P < 0.05). The high X4 tropism rates were 13.2%, 11.8%, 20.0%, and 0.0% in Clusters 1, 4a, 4b, and 5, respectively. DRM rates in Clusters 4a and 4b were 17.6%, and 25.45% respectively (P < 0.05), whereas they were 17.6% and 18.2% in Clusters 1 and 5, respectively. In total, 24 transmission genetic networks, comprising 72 sequences and 61 links, were discovered; of them, 61.2%, 11.7%, and 18.2% were from Clusters 4, 1, and 5, respectively (P < 0.05).

Conclusion: In Zhejiang, different CRF01_AE clusters displayed unique clinic features. Cluster 4, particularly Cluster 4b, was considered a high-risk transmission cluster. The surveillance of epidemiology of HIV-1 should be enhanced to minimize its transmission.

Background: Magnusiomyces capitatus (M. capitatus) is a dimorphic opportunistic fungus that is a rare yeast and rarely reported in Asia. Owing to the absence of established clinical breakpoints, the treatment of this fungus poses challenges.

Case presentation: We report a rare case of a young, non-immunocompromised man with cerebral palsy, spinal deformity, and pulmonary M. capitatus infection. The patient's condition improved after treatment with voriconazole and became stable.

Conclusion: M. capitatus infection is commonly associated with hematologic tumors and compromised immunity. Reports of M. capitatus infection in patients with non-immunocompromised host are uncommon. Insufficient understanding of these fungi may lead to underdiagnosis of fungal infection and clinical misdiagnosis, potentially resulting in delayed treatment and increased mortality.

Purpose: We analyzed the pathogenic bacteria and antibiotic resistance distributions in patients with biliary tract infections (BTI) using samples from the Antimicrobial Resistant Investigation Network of Sichuan Province (ARINSP) to promote the rational use of antibiotics to reduce multidrug resistance.

Patients and methods: Participating hospitals identified isolates between 2017 and 2023 and conducted antimicrobial susceptibility tests. Isolated bacteria were identified and tested for drug sensitivity using MOLDI-TOF mass spectrometry system, VITEK automated drug sensitivity system and paper diffusion method, and the results were interpreted with reference to CLSI M100 30th edition standards. WHONET 5.6 was used to analyze the results.

Results: In total, 25,573 bacterial isolates were collected; 18,134 were Gram-negative (70.9%). The top five most frequently isolated bacteria were Escherichia coli (8,181/25,573; 32.0%), Klebsiella pneumoniae (3,247/25,573; 12.7%), Enterococcus faecium (2,331/25,573; 9.1%), Enterococcus faecalis (1,714/25,573; 6.7%), and Enterobacter cloacae (1,429/25,573; 5.6%). E. coli and E. faecalis slowly declined over time, while K. pneumoniae slowly increased; E. faecium frequency was stable; E. coli resistance to ampicillin was the highest among all antibiotics tested; resistance rates decreased with the addition of sulbactam. K. pneumoniae resistance to aztreonam, imipenem, meropenem, ertapenem, and chloramphenicol remained low. E. cloacae was highly resistant to cephalosporins, especially cefoxitin and cefazolin. E. faecalis' resistance to teicoplanin remained low, decreasing from 6.9% in 2017 to 0.0% in 2019 before stabilizing.

Conclusion: The most frequently isolated bacteria from patients with BTIs were Enterobacteriaceae, including E. coli and K. pneumoniae, followed by E. faecium and E. faecalis. Isolates exhibited high resistance to routinely used antibiotics (cephalosporins) and were highly sensitive to tigecycline, carbapenem, amikacin, and vancomycin. The results guide the rational use and continual revision of antibiotic regimens for BTIs to reduce antibiotic resistance.

Inflammation of the frontal sinus is a relatively common clinical condition among paranasal sinusitis and is curable through anti-infection treatments, with a rare progression to frontal sinus abscess. An even rarer complication is the development of intracranial epidural empyema secondary to frontal sinus abscess. In this report, we describe a case of a 14-year-old male with a frontal sinus abscess that led to intracranial infection and was complicated by an epidural abscess misdiagnosed as an epidural hematoma. The primary symptoms were headache, dizziness, and fever. Following combined antibiotic therapy and surgical intervention, including maxillary and frontal sinus window drainage, the patient was cured. A follow-up period of three months showed no recurrence, indicating a favorable outcome.

Herein we report a case of Lyme borreliosis in a pediatric patient, highlighting the diagnostic challenges associated with this condition. An 11-year-old girl was admitted with high fever, headaches, abdominal pain, and a progressing rash. Initial symptoms included small rashes that vanished with antihistamine treatment, but maculopapular rashes later emerged on the trunk and limbs, prompting further investigation. Differential diagnosis included toxic erythema, Stevens-Johnson syndrome, and Lyme borreliosis. Despite no reported tick bite and initial doubt due to the season, Lyme borreliosis was confirmed by serologic testing, diagnosing the patient with early disseminated Lyme disease. The diagnostic complexity was increased by the rash's atypical presentation - large, homogeneous papular rashes. This case emphasizes the necessity for physicians to adeptly gather detailed histories and employ thorough, up-to-date diagnostic methods. Effective correlation of clinical findings with laboratory results and ongoing patient observation proved critical for an accurate diagnosis. This report underscores the importance of recognizing atypical presentations of Lyme borreliosis in children and the need for careful differential diagnosis.