Infection and Drug Resistance最新文献

Background: Streptococcus intermedius is a commensal microflora commonly found in various mucosal sites in the respiratory, gastrointestinal, and genitourinary tracts. It causes invasive suppurative infections including liver and brain abscesses along with thoracic empyema. However, it rarely causes meningitis without abscess formation.

Case presentation: A 56-year-old immunocompetent man who presented with fever and headache. Bacterial meningitis was confirmed using cerebrospinal fluid analysis. Magnetic resonance imaging of the brain revealed leptomeningitis and ventriculitis. However, conventional methods, such as microbiological culture failed to identify the causative pathogens. Metagenomic next-generation sequencing of cerebrospinal fluid revealed the presence of S. intermedius. It allowed us the optimal treatment for him. The patient underwent antibiotic treatment with 6-week duration of ceftriaxone administration accompanied by surgical intervention, resulting in a favorable prognosis.

Conclusion: Herein, we report a rare case of meningitis and ventriculitis caused by S. intermedius using metagenomic next-generation sequencing. The patient recovered well after antibiotic treatment and surgery. We present this rare case and summarize previous studies to remind clinicians that timely identification of the pathogen and optimal treatment are crucial for management of S. intermedius-induced infections.

Background: Clostridioides difficile sequence type (ST) 81, mainly associated with ribotype (RT) 369, is a TcdA-negative and TcdB-positive genotype and a common ST found in China. Furthermore, ST81 strains are reported with highest resistance rates to many antimicrobial agents. However, given the potential for C. difficile ST81 transmission, research into the epidemiological characteristics of this type of ST remain limited.

Methods: We conducted a genomic epidemiology study addressing the genetic characteristics of C. difficile ST81 in five tertiary hospitals covering different regions in China between January 2010 and January 2021. Clinical toxigenic C. difficile strains were identified, typed by multi-locus sequence typing (MLST), and phylogenetic analysis, antimicrobial resistant gene (AMR) identification were performed after all these strains were conducted by whole genome sequencing (WGS).

Results: In total, 108 clinical C. difficile strains of ST81 were isolated and successfully analyzed by WGS, which showed that the percentage of isolates with AMRs was common in this type of ST. Furthermore, two types of transposons, Tn916 and Tn6189, were also detected. We found that all C. difficile ST81 genomes were closely related as pairwise core-genomic SNP (cgSNP) distance between the strains was on average 13 cgSNPs (range, 0-425 cgSNPs). Notably, these isolates were split into two sub-lineages (SL I and SL II) by Bayesian analysis, which suggested that both sub-lineages emerged independently. It is noted that some AMRs (such as clbA, dfrF, and cfrB) and Tn916 were only detected in SL I.

Conclusion: C. difficile ST81 is among the common STs in this study. Two independent sub-lineages of C. difficile ST81 strains are found. Furthermore, the presence of a high number of AMR genes and multiple mobile elements indicate a potential risk for transmission of C. difficile ST81. Based on these results, a robust surveillance system is crucial for identifying outbreaks, tracking infection trends, and implementing timely interventions.

Introduction: Mycobacterium gordonae is a nonpathogenic pathogen commonly found in nature and is generally considered a contaminant in clinical practice. Although there have been few reported cases of infection, most of them are secondary to immunosuppression. This paper described a rare case of globular shadow in the chest of an immunocompetent male who was diagnosed with M. gordonae pulmonary disease. He went to the hospital with chest pains that had lasted for more than two weeks. The routine clinical pathogen detection failed to discover the cause of the infection. Although metagenomic next-generation sequencing (mNGS) of the lung tissue was negative, M. gordonae was detected in the background microorganism with only one read. Based on the pathological results, it was considered to be the causative pathogen. Two months of treatment with rifampicin, ethambutol, clarithromycin, and levofloxacin resulted in significant reduction and absorption of lung lesions. No abnormalities were detected in either lung one year later. The lack of positive culture and other conventional microbiological test results make this case is not a strictly confirmed case. This study also explored the clinical features and treatment options of 32 cases of M. gordonae pulmonary disease through a systematic review of the literature. Although there is no standard recommended treatment regimen for M. gordonae infection, but combination therapy with macrolides, rifampicin, and ethambutol has been proven effective.

Conclusion: This case highlights that when the clinical highly suspected of infection, mNGS can contribute to the early identification of non-tuberculous Mycobacterium (NTM) even with low reads, when clinical suspicion is high. Analyzing background microorganisms in sterile samples may help diagnose rare pathogens.

Background: Current guidelines support routine perioperative antibiotic prophylaxis (PAP) to minimize surgical site infection in kidney transplantation (KT), though data regarding the current practices of PAP is lacking in China.

Objective: To survey the routine PAP strategies in KT, and analyze main clinical considerations associated with adjusted antibiotic dosing regimens in different Chinese hospitals.

Methods: A nationwide survey was conducted on behalf of the National Alliance of Transplant Pharmacists. An online questionnaire was created via Wen Juan Xing (http://www.wjx.cn) and sent to all pharmacists in the Alliance.

Results: Twenty-three pharmacists from different teaching hospitals with Grade IIIA participated in the survey, with a response rate of 46.0%. There were wide differences in routine dosing regimens and clinical considerations. Six strategies were involved in living-donor KT and monotherapy was most often used (80.9%), while combination therapy was most common (69.6%) among the ten strategies in deceased-donor KT. Of fifteen antibiotics submitted in the survey, eight agents were prescribed with different doses and/or frequencies among different hospitals. Only 37.5% and 23.1% of the hospitals would stop PAP within 72 hours in living-donor KT and deceased-donor KT, respectively. Among 28 preset factors, four factors were considered significantly important to decide PAP regimens, and eight factors were considered significantly unimportant (P<0.05).

Conclusion: There was wide variability in routine dosing regimens and clinical considerations in PAP decisions in KT. Further investigations are warranted to obtain high-quality evidence and to make PAP in KT more rational.

Purpose: To evaluate the necessity of the application of glucocorticoid (GC) in moderate COVID-19 patients, and which is the optimal choice between methylprednisolone (MP) and dexamethasone (DEX) in the clinical use of GC in different types of COVID-19 patients.

Patients and methods: The study included patients with COVID-19 in Shanxi, China, from December 18, 2022, to March 1, 2023. The main clinical outcomes were 30-day mortality, disease exacerbations, and hospitalization days. Secondary outcomes included the demand for non-invasive ventilator-assisted ventilation (NIPPV)/invasive mechanical ventilation (IMV), the need for GC regimen escalation in follow-up treatment, duration of GC treatment, and complications including hyperglycemia and fungal infection.

Results: In moderate patients (N = 351), the rate of exacerbation and the need for GC regimen escalation in follow-up treatment was highest in the no-use GC group (P = 0.025, P = 0.01), the rate of fungal infections was highest in the DEX group (P = 0.038), and MP 40 mg/day or DEX 5 mg/day reduced exacerbations with consistent effects. In severe patients (N = 371), the two GC regimens do not affect their 30-day mortality and exacerbation rate, but the number of hospital days was significantly lower in the MP group compared with the DEX group (P < 0.001).

Conclusion: GC use is beneficial in mitigating exacerbations in moderate patients and in patients with moderate COVID-19. In severe patients, MP reduces the number of hospitalization days compared with DEX and may be a superior choice.

Background and aim: Infection caused by Aspergillus species poses a growing global concern, yet their prevalence in Southeast China lacks comprehensive documentation. This retrospective analysis aims to elucidate the epidemiological role and antifungal susceptibilities of Aspergillus species at Huashan Hospital of Fudan University, Shanghai, China.

Methods: Data spanning from 2018 to 2022, encompassing demographic, clinical, and laboratory information on Aspergillus species isolates were analyzed. The isolates were subjected to susceptibility testing using YeastOne^TM broth microdilution system.

Results: A total of 253 Aspergillus isolates were identified, with A. fumigatus (57.71%) being the predominant species, followed by A. niger (26.88%), A. flavus (10.67%), and A. terreus (3.95%). Notably, the highest number of isolates originated from the Department of Infectious Disease (28.06%), with sputum (54.94%) being the primary source of isolation, where A. fumigatus was the dominant species. Gastrointestinal disorder (23.90%), hepatic disorder (9.09%), and diabetes (8.30%) were identified as the most prevalent underlying conditions, with A. fumigatus being the most abundant species in each case, accounting for 65.08%, 82.60%, and 73.91%, respectively, followed by A. flavus. Non-wild-type (NWT) Aspergillus isolates exhibited higher resistance against amphotericin B (AMB) compared to triazoles. Specifically, A. fumigatus showed greater resistance to AMB, with only 23.28% of isolates being susceptible, while the majority of isolates were susceptible to triazoles like itraconazole (ITR) and posaconazole (POS). POS demonstrated the highest efficacy against all species. Sequencing revealed mutations in the promoter region of the cyp51A gene and at positions Y121F and E247K in A, fumigatus which confer resistance to ITR, voriconazole (VRC), and POS.

Conclusion: These findings contribute to a better understanding of the epidemiology and antifungal resistance pattern of Aspergillus species in the region, providing valuable insights for the management of Aspergillus-related infections.

Background: Currently, there is a lack of serum biomarkers that can accurately predict the short-term prognosis of enterogenic sepsis.

Methods: 99 patients with enterogenic sepsis were categorized based on their Acute Gastrointestinal Injury (AGI) grade on the third day of ICU admission into four groups: no AGI, AGI grade I, AGI grade II, and AGI (III+IV). Additionally, patients were classified into survival and death groups according to their 28-day clinical outcomes. Peripheral venous blood samples were collected to measure levels of interleukin (IL)-27, intestinal fatty acid-binding protein (IFABP), and diamine oxidase (DAO). Receiver operating characteristic (ROC) curves were generated to assess the ability of IL-27, IFABP, and DAO to predict the short-term prognosis of patients with enterogenic sepsis.

Results: On the third day, both the survival and death groups exhibited elevated serum levels of IL-27 and IFABP compared to the first day, while levels of DAO were lower than those observed on day one. Furthermore, a significant positive correlation was observed between IL-27 and both IFABP and DAO, with stronger correlations evident on day three compared to day one. As the Acute Gastrointestinal Injury (AGI) grading increased, levels of IL-27, IFABP, and DAO rose correspondingly, correlating with a gradual decrease in survival rates, all demonstrating statistical significance (all P < 0.05). The Area Under the Curve (AUC) values for IL-27, IFABP, and DAO on the third day, predicting short-term prognosis for intestinal sepsis patients, were 0.714, 0.772, and 0.724, respectively. Notably, these values surpassed those of the first day, with IFABP on the third day exhibiting the highest predictive capability.

Conclusion: IL-27, IFABP, and DAO levels measured on the third day of hospitalization can accurately predict the short-term prognosis of enterogenic sepsis.

Background: Tuberculosis (TB) among women and infants during the perinatal period is not rare, particularly in countries with a high TB burden. And the risk would increase significantly following in vitro fertilization-embryo transfer (IVFET). Worse still, TB in this stage is apt to develop into severe forms in women and neonates, such as disseminated TB or tuberculous meningitis (TBM). On the other hand, severe adverse effects (SAEs) of anti-tuberculosis (ATB) agents in neonates were common but difficult to diagnose early and manage well.

Case presentation: A 29-year-old mother receiving IVFET and her 3-month-old infant were diagnosed with disseminated tuberculosis and cranial tuberculoma on Dec 29, 2024, based on typical imaging features and bacteriological evidence. Intrauterine transmission of an isoniazid-resistant strain was confirmed through whole-genome sequencing (WGS) analysis and epidemiological investigation. ATB therapy and adjuvant treatment were initiated as soon as the confirmation of TB. Favorable therapeutic effects were achieved for them, and their condition stayed well until the last visit on Nov 19, 2024. However, the infant's ATB therapy had to be adjusted several times because of severe drug-induced liver injury (DILI) and lactic acidosis caused by ATB drugs during the treatment. In the end, he also obtained satisfactory outcomes.

Conclusion: Clinicians should stay alert for TB in pregnant women who underwent IVFET as well as their neonates. Our case report may improve clinicians' awareness and ability to manage severe TB during the perinatal period.

Purpose: Antimicrobial resistance is a global health crisis exacerbated by excessive and inappropriate use of antibiotics, especially among low- and middle-income countries including Pakistan. The paediatric population is a key area in view of their vulnerability and excessive prescribing of antibiotics in Pakistan. Consequently, there is an urgent need to robustly assess antimicrobial use among hospitalized neonates and children in tertiary hospitals in Pakistan as they are generally the training centres for new physicians subsequently treating children.

Patients and methods: A point prevalence survey (PPS) was conducted in the children's wards of 14 tertiary care hospitals in Punjab Province, covering over 50% of the population of Pakistan. This builds on a previous PPS among tertiary care hospitals treating exclusively neonates and children.

Results: A total of 1811 neonates and children were surveyed with 1744 patients prescribed antibiotics, a prevalence of 96.3%. A total of 2747 antibiotics were prescribed to these 1744 neonates and children, averaging 1.57 antibiotics per patient. Overall, 57.7% of the patients were prescribed one antibiotic and 27.2% two antibiotics, with 85.6% of antibiotics administered parenterally. Over a third (34.4%) of the antibiotics were prescribed prophylactically, with 44.7% of them for surgical procedures. Among those prescribed antibiotics for surgical procedures, 75.2% were prescribed for more than one day. Overall, 92.2% of antibiotics were prescribed empirically, with 86.2% prescribed without mentioning the rationale for their choice in the notes, with 77.6% having no stop date. Respiratory tract infections were the most common indication (43.4%). Staphylococcus species (36.0%) were the most common pathogen with limited Culture and Sensitivity Testing performed. Three quarters (75.2%) of antibiotics were from the Watch list, and 24.4% were Access antibiotics.

Conclusion: A very high prevalence of antibiotic use among neonates and children in tertiary hospitals in Pakistan, including Watch antibiotics, mirroring previous studies. Consequently, initiatives including antimicrobial stewardship programmes are urgently needed to address current inappropriate prescribing.

Pulmonary mucormycosis is a rare and aggressive invasive fungal infection that predominantly affects immunocompromised individuals, such as those with diabetes mellitus or those undergoing immunosuppressive therapy. This case describes a severe instance of pulmonary mucormycosis resulting in progressive tracheal wall destruction in a young, previously healthy male. A 20-year-old male with a denied history of diabetes mellitus was admitted to a local hospital with abdominal pain for 9 days and diagnosed with acute pancreatitis and diabetic ketoacidosis (DKA). During his stay at the local hospital the patient developed respiratory distress and was transferred to our hospital. Although initially given non-invasive respiratory support and broad-spectrum antibiotics, the patient's condition deteriorated and invasive mechanical ventilation and VV-ECMO were given. Bronchoalveolar lavage fluid (BALF) next-generation sequencing (mNGS) identified Rhizopus species, confirming pulmonary mucormycosis. Aggressive antifungal therapy with amphotericin B was administered, followed by the addition of isavuconazole, but the patient's lesions continued to expand, ultimately leading to fatal tracheal and bronchial wall disruption and subsequent haemorrhage. This case emphasizes the rapid progression and extensive tissue destruction characteristics of pulmonary mucormycosis. Early diagnosis and treatment, especially simultaneous antifungal therapy and appropriate surgical intervention, are crucial for improving the prognosis of such severe cases.