Infection and Drug Resistance最新文献

Purpose: This study aims to investigate the relationship between glycemic control and epidemiological characteristics of patients infected with carbapenem-resistant Klebsiella pneumoniae (CRKP), to identify mortality risk factors associated with CRKP infection, and to evaluate the impact of glucose on the resistance of CRKP to polymyxin and serum killing.

Patients and methods: Clinical cases of 218 patients infected with CRKP were collected from a large tertiary public hospital in Anhui Province. We analyzed whether the glycemic control impacts the clinical and laboratory manifestations of infected patients. Logistic regression identified mortality risk factors. Antibiotic sensitivity, capsular serotypes, and virulence genes were tested of the strains. Three clinically isolated CRKP strains were used to investigate the effect of glucose on bacterial capsule synthesis and the impact on bacterial resistance to polymyxin and serum killing.

Results: Patients with poor glycemic control experienced more severe infections and had a higher likelihood of chronic kidney disease (CKD) and acute renal insufficiency compared to those with good glycemic control. They also exhibited an increased mortality rate. Logistic regression analysis identified age, glycosylated hemoglobin (HbA_1c) ≥7%, CKD, tumor, mechanical ventilation, and sepsis as independent risk factors for death associated with CRKP infection. A 0.5% (0.5 g/100mL) glucose environment can stimulate CRKP capsule synthesis, which is inhibitable by cyclic adenosine monophosphate (cAMP). Moreover, a high-glucose environment can enhance CRKP's resistance to polymyxin and serum killing.

Conclusion: A persistent hyperglycemic environment resulting from poor glycemic control may stimulate the synthesis of CRKP capsules, which could enhance the resistance of CRKP to polymyxin and serum killing, thereby further increasing the risk of patient mortality.

Pantoea is a prevalent environmental Gram-negative bacterium comprising over 20 distinct species. It is a facultative anaerobe capable of forming smooth, translucent colonies on culture plates. Pantoea is typically considered a potential pathogen that may cause infections in plants and animals. With the advancement in mass spectrometry and gene sequencing technologies, human infections caused by Pantoea have increasingly been recognized, raising concerns regarding its pathogenicity and nosocomial transmission that clinicians must address. While there are numerous reports documenting P. agglomerans as a cause of human infections in clinical settings, instances of P. dispersa leading to human pathogenesis are comparatively rare, and the clinical manifestations associated with P. dispersa infections remain largely underexplored. We report a case of a 9-month-old female patient from China whose blood cultures indicated positive Gram-negative bacilli. Through MALDI Biotyper and next-generation sequencing techniques, the pathogen was identified as P. dispersa. Clinically, meropenem was administered for treatment, and the patient's condition improved. We hope this article will help clinicians pay more attention to and better understand infant-related bloodstream infections caused by P. dispersa.

Purpose: In a Vietnamese teaching hospital, this study examined the prevalence and patterns of antimicrobial resistance (AMR) of common bacteria isolated from hospitalized patients with urinary tract infections (UTIs) between 2014 and 2021.

Methods: From 4060 urine samples collected, common pathogens were isolated using quantitative culture on brilliance UTI Clarity agar and blood agar. Bacterial identification, antimicrobial susceptibility testing, and multidrug resistance (MDR) classification followed standardized techniques. Bacteria with a frequency of less than 2% were excluded. Statistical analysis was performed using R software, with the chi-square test applied and significance set at p < 0.05.

Results: Of 4060 urine samples collected, 892 (22.0%) had positive results for common infections. Gram-negative bacteria predominated (591/892; 66.3%), with Escherichia coli being the most prevalent (336/892; 37.7%). Enterococcus spp. (152/892; 17.0%) was the leading Gram-positive pathogen. Some antibiotics had significant resistance rates, especially in Gram-negative bacteria, with ampicillin having the greatest resistance rate (92.8%). Carbapenems and nitrofurantoin remained generally effective. Among Gram-positive bacteria, high resistance was seen for macrolides ranging from 85.5% (azithromycin) to 89.8% (erythromycin), and for tetracyclines, ranging from 0% (teicoplanin) to 85.2% (tetracycline). There was no resistance to tigecycline and teicoplanin, indicating their potential efficacy against multidrug resistance (MDR) bacteria causing UTIs. MDR rates were higher in Gram-negative bacteria (64.8% versus 43.5%), with Klebsiella pneumoniae having the highest rate (78.7%).

Conclusion: This study underscores the urgent need for ongoing surveillance of AMR patterns in Vietnam and emphasizes the significance of efficient infection prevention methods, prudent use of antibiotics, and targeted interventions to combat antimicrobial resistance.

Purpose: Rapid initiation of antiretroviral therapy (ART) in people living with HIV (PLWH) is crucial for achieving viral suppression and improving clinical outcomes. Serum lactate dehydrogenase (LDH) levels serve as a readily accessible and rapid clinical biomarker, has significant predictive potential in various viral diseases. This study aims to evaluate the predictive value of LDH levels for viral suppression in the context of rapid ART initiation.

Patients and methods: LDH levels were measured in 393 newly diagnosed PLWH who received rapid initiation of ART and were subsequently followed up. The PLWH were stratified based on tertile LDH levels and study endpoints. Kaplan-Meier analysis was conducted to generate survival curves, and Cox regression analysis was utilized to confirm the independent prognostic factors for viral suppression.

Results: The overall viral suppression rate was 94.1%. Compared to the low LDH tertile, the middle and high LDH tertiles exhibited longer times to first viral suppression (38 vs 84 vs 88 days, respectively, P < 0.001). Kaplan-Meier analysis revealed that PLWH in high LDH tertile showed the worst prognosis for viral suppression (Log rank test, P<0.001). Multivariate Cox regression analysis identified LDH tertile as a significant predictor of viral suppression (HR = 0.714, 95% CI = 0.553-0.922, P = 0.010 for middle vs low tertile; HR = 0.575, 95% CI = 0.443-0.747, P < 0.001 for high vs low tertile).

Conclusion: LDH levels function as a prognostic indicator for predicting the timing of viral suppression in PLWH on ART. A comprehensive evaluation of LDH levels is beneficial in establishing risk stratification in the context of rapid ART initiation.

Purpose: The pro-inflammatory response triggered by influenza viruses can contribute to viral pneumonia, even death. The effect and mechanism of BaBaoWuDanYaoMo (BB) against influenza virus remains obscure. To predict its therapeutic targets via network pharmacology and verify the therapeutic effect and the mechanism of BB against influenza virus in vitro and in vivo.

Material and methods: The potential active and underlying mechanism of BB in the treatment of influenza virus was predicted through network pharmacological strategies and Molecular Docking. The protective and anti-inflammatory effects of BB were determined by cytopathic effect (CPE), quantitative real-time PCR, mitochondrial membrane potentials and Western blotting assay in vitro. BALB/c mice were intranasally infected with A/PR/8/34 (H1N1) (PR8) and orally administrated BB (500 mg/kg, 250 mg/kg and 125 mg/kg) or oseltamivir daily. The normal group was orally administrated PBS for 5 days. Lung indexes, histological changes and cytokines were determined on the 6th day.

Results: BB could effectively inhibit A/Puerto Rico/8/1934 (H1N1), A/GZ/GIRD07/09 (H1N1), A/HK/Y280/97 (H9N2) and A/Aichi/68 (H3N2) with IC₅₀ values of 116.5 ± 2.2, 59.86 ± 8.33, 102.87 ± 6.66 and 66.43 ± 6.785 μg/mL, respectively. It could inhibit PR8-induced apoptosis and inhibit the expression of apoptosis markers (cleaved PARP). BB inhibited the mRNA expression of MCP-1/CCL-2, IL-6, CXCL-8/IL-8, TNF-α and CXCL-10/IP-10, and downregulated the protein expression of phosphorylated AKT/p38 and TLR3 in vitro. BB (500 and 250 mg/kg) could improve pulmonary histopathological changes, decrease the lung index and suppress the mRNA expression of CXCL1/KC, TNF-α, CXCL9/MIG and IL-1β in vivo.

Conclusion: BB has a protective effect on PR8-induced acute lung injury (ALI) probably via inhibition of apoptosis process and interfering with TLR3, p38 MAPK and PI3K-AKT signaling pathways. This study provided a potential treatment for influenza from BB, and network pharmacology provided a strategy to explore active components and mechanism of TCMs against influenza virus infection.

Introduction: Lymphadenopathies, which can be caused by infections, malignant diseases, autoimmune disorders, and many other diseases, pose a challenge to clinicians in sub-Saharan Africa, as well as all over the world. The purpose of this research was to identify the clinical and diagnostic characteristics of Somalian patients suffering from swollen lymph nodes.

Methods: Under the purview of this study, the diagnoses, patient clinical courses, and treatment outcomes were ascertained retrospectively by analyzing the biochemical, microbiological, radiological, and pathological data of the cases in all age groups who underwent therapy for lymphadenitis at Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital between January 2016 and September 2023.

Results: During the study period, 317 patients were followed up, with 53.3% of the patients as female, 46.7% as male, 28.1% as pediatric, 63.1% as adult, and 8.8% were elderly patients. With 58.7% of diagnoses, tuberculous lymphadenitis was the most common, pursued by malignant causes (21.8%). The most commonly affected lymph node was the cervical region, the symptom detected was lymph node swelling, the radiological method used was ultrasonography, and the biopsy method was fine needle aspiration biopsy. It was determined that benign conditions, including tuberculosis were more common in pediatric group and younger adults (p<0.001), and weight loss was a significant in terms of malignancy and tuberculosis (p<0.001). White blood cell value (p<0.001), erythrocyte sedimentation rate (p<0.001), and C-reactive protein (p:0.001) revealed differences across the diagnostic groups.

Conclusion: Almost two-thirds of patients were diagnosed with tuberculosis lymphadenitis. Our finding revealed tuberculosis as the commonest cause of lymphadenopathy followed by malignant causes. Therefore, before screening for malignant causes, tuberculosis should be the first diagnosis considered in Somalia, particularly in a patient presenting with weight loss and swelling of the lymph nodes.

Purpose: Nosocomial infections (NI) are a leading cause of mortality in preterm infants in the Neonatal Intensive Care Unit (NICU). The key to reducing the risk of NI is early detection and treatment in time. Nurses are close observers and primary caregivers for neonates at the bedside of the NICU, who are best positioned to capture the risk signals of NI. This study aims to develop a nurse-led prediction model for NI of preterm infants in the NICU.

Patients and methods: This study was designed as a retrospective study, preterm infants of the NICU at Renmin Hospital of Wuhan University from January 2020 to December 2023 were selected and divided into the NI group and non-NI group. Clinical data were collected and then analyzed by univariate analysis, least absolute shrinkage and selection operator (LASSO) regression analysis, and multivariate logistic regression analysis. The outcome constructed a nomogram model and its predictive efficacy was evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrap method was used to repeat 1,000 times for internal validation.

Results: A total of 892 preterm infants were finally included and a nurse-led predictive model established, which included six variables: skin color changes, respiratory related changes, feeding deterioration, birth weight, number of arterial and venous blood draws, and days of nasogastric tube placement. The model's AUC was 0.953, indicating good discriminatory power. The calibration plot demonstrated good calibration and the Hosmer-Lemeshow test showed high consistency. DCA indicated that the nomogram had good clinical utility. Internal validation showed the AUC of 0.952.

Conclusion: This nomogram model, which is mainly based on nurses' observations, shows good predictive ability. It offered a more convenient option for neonatologists and nurses in the NICU.

Background: The emergence of multidrug-resistant bacteria limits antibiotic efficacy, making accurate antimicrobial susceptibility testing (AST) essential for clinical decisions. Broth microdilution (BMD) is the gold standard but is impractical for routine application. Current automated AST systems improve efficiency but face accuracy or operational challenges, highlighting the need for reliable and user-friendly solutions.

Objective: This study aims to evaluate the performance of a novel automated AST system (AutoMic-i600) based on the BMD method for AST of common clinical bacteria.

Methods: A total of 229 clinical isolates (150 Gram-negative and 79 Gram-positive) were prospectively collected from microbiology laboratory between June 2023 and August 2023. We reported the comparison of the AutoMic-i600 and Vitek 2 systems for routine antibiotics, and also validated the detection performance of AutoMic-i600 for novel antibiotics, based on the BMD method.

Results: The overall essential agreement (EA) and categorical agreement (CA) between AutoMic-i600 and BMD were 93.2% and 93.5% for Gram-negative bacteria and 98.5% and 97.8% for Gram-positive bacteria, respectively. The overall EA and CA between Vitek 2 and BMD were 92.6% and 93.5% for Gram-negative bacteria and 97.9% and 97.4% for Gram-positive bacteria. Importantly, for drug-resistant bacteria, AutoMic-i600 demonstrated a higher overall agreement than Vitek 2 (EA: 98.1% vs 94.8%, CA: 97.5% vs 92.0%), especially in Gram-negative bacteria (EA: 97.7% vs 93.5%, CA: 97.7% vs 89.3%). The VME rate for Gram-negative bacteria using AutoMic-i600 was significantly lower than that of Vitek 2 (1.0% vs 2.9%). Novel antibiotics detected by AutoMic-i600 exhibited EA and CA rates exceeding 90.0%.

Conclusion: Based on these findings, we recommend that the AutoMic-i600 system could be a new option for routine AST testing in a clinical setting. Particularly for drug-resistant bacteria and novel antibiotics, detection with AutoMic-i600 may be more reliable, which could further contribute to the prevention and treatment of drug-resistant bacteria.

Background: Diagnosing chronic periprosthetic joint infection (PJI) is challenging. Synovial fluid interleukin-10 (SF IL-10), an anti-inflammatory cytokine produced by leukocytes, plays a pivotal role in inflammation and infection regulation. However, limited research has explored the diagnostic potential of SF IL-10 in chronic PJI patients.

Objective: The study aimed to investigate the relationship between SF IL-10 and incidence of chronic PIJ, and to evaluate its diagnostic reliability.

Design and methods: We analyzed data from 137 patients who underwent revision surgery for aseptic loosening or chronic PJI between 2017 and 2019 in our hospital. PJI diagnoses followed the 2013 International Consensus Meeting criteria. We measured serum ESR, serum CRP, SF PMN%, SF WBC and SF IL-10 levels, using logistic regression and receiver operating characteristic (ROC) curves to evaluate associations and diagnostic accuracy.

Results: Demographic data showed no significant differences. However, SF IL-10 levels differed significantly between groups. Logistic regression indicated a strong association between SF IL-10 and chronic PJI (OR = 1.11, 95% CI 1.05~1.17, p < 0.001). At a cut-off of 10.305 pg/mL, SF IL-10 had an area under the ROC curve (AUC) of 0.891, with 92.16% sensitivity and 77.91% specificity. Adding SF IL-10 to traditional models improved risk prediction for chronic PJI (net reclassification improvement [NRI]: 0.167 [0.023 ~ 0.312]; integrated discrimination improvement [IDI]: 0.160 [0.096 ~ 0.224]).

Conclusion: Higher SF IL-10 levels were significantly associated with chronic PJI in revision surgery patients, and incorporating SF IL-10 into the traditional risk model enhanced its predictive value for chronic PJI in these patients.

Objective: This study aims to evaluate the utility of targeted next-generation sequencing (tNGS) in bronchoalveolar lavage fluid (BALF) for hospitalized patients with pulmonary infections.

Methods: A cohort of 358 patients who received diagnosis and treatment for respiratory infections in the department of Respiratory Medicine at Wenzhou People's hospital from January 2023 to April 2024 were selected for this study. The BALF of the patients was analyzed using tNGS, and the diagnostic efficacy of tNGS was subsequently compared with that of conventional testing methods (CTs) for pathogen detection.

Results: Through the analysis of tNGS from the cohort, the pathogen detection rate in BALF using tNGS was significantly higher than that of CTs (90.22% VS 57.26%, P=0.001). Among them, Tropheryma Whipplei (6.15%), Bordetella pertussis (2.51%), Non-tuberculous mycobacteria (1.96%), Mycobacteria tuberculosis (1.40%), Chlamydia pneumoniae (1.96%), Chlamydia psittaci (0.56%), Legionella pneumophila (0.28%) were detected using tNGS alone, and the CTs results of these microorganisms were all negative. Among the various types of mixed infections observed, concurrent presence of bacteria and viruses was the most common, accounting for 37.15%. The detection rates of tNGS and CTs have statistical significance (66.87% VS 35.12%, P=0.001). Furthermore, a total of 61 cases of antimicrobial resistance genes were detected, including 34 cases of 23S rRNA A2063G, 6 cases of KPC, 5 cases of OXA, 2 cases of CTX-M, 3 cases of IMP, 1 case of NDM and 13 cases of mecA. Using the clinical diagnosis as references, the positive coincidence rate of the tNGS was significantly higher compared to that of the CTs (P=0.012).

Conclusion: Compared to CTs, the application of tNGS enables the identification of a greater diversity of organisms and exhibits superior accuracy, effectively identifying pathogens that are undetectable by CTs, especially fastidious and atypical organisms. Consequently, it holds immense potential in pathogen diagnosis and offers valuable clinical guidance for patients with pulmonary infections.