Infectious Diseases and Therapy最新文献

Introduction: Extraintestinal pathogenic Escherichia coli can infect normally sterile body sites, causing invasive E. coli disease (IED). The IED burden is often underestimated. Here, we provide more insights into the real-world epidemiology of IED in the United States from 2002 to 2022.

Methods: In this retrospective cohort study, a narrow and a broad algorithm composed of coded diagnoses combined with laboratory data (microbiology culture) were first validated against the gold-standard IED case definition. The algorithms were selected to identify IED cases among adults in the Kaiser Permanente Northwest database. IED incidence rates (IRs) and case fatality rates (CFRs) were calculated and stratified by period, age, and sex. The risk of IED in the population with pre-defined comorbidities, including urinary tract infections (UTIs), was assessed using incidence rate ratios.

Results: A source population of 1,163,319 and 1,169,224 persons was identified by the narrow and broad algorithms, respectively. In these populations, 5832 (narrow algorithm) and 10,490 (broad algorithm) IED cases were identified, corresponding to an IED IR of 80.9 (95% confidence interval [CI]: 78.8-83.0) and 145.8 (143.0-148.6) cases per 100,000 person-years, respectively. The IR was higher among females than males and increased with age and over time. All-cause mortality among cases at 30 days after IED diagnosis was 7.6% (95% CI: 6.9-8.3%) and 7.2% (6.7-7.7%) based on the narrow and broad algorithms, respectively, and CFRs increased with age to 13.1% (both algorithms) among ≥ 80-year-olds. Having a history of UTIs was confirmed as an independent risk factor, multiplying the risk of IED by more than five compared to the population without a history of UTIs.

Conclusions: These observations demonstrate that IED is a substantial and growing global health concern that disproportionally affects older adults.

Introduction: Although Cutibacterium acnes is considered a typical pathogen of postoperative central nervous system (CNS) infections, data on its role as a pathogen, remain limited. This study aimed to address this knowledge gap.

Methods: A case-case-control study of adults with monomicrobial Cutibacterium acnes infections (CaIs) following nonspine neurosurgical procedures (2016-2024) (Cases I). These were individually matched (1:1:1) by age, year, and procedure type to individuals who did not develop infection (controls) and to individuals with aerobic bacterial infections (abIs; cases II). Multivariable conditional logistic regression models were implemented to assess clinical correlates for infection by either bacterial group, clinical presentation, and outcomes differences.

Results: Cutibacterium acnes isolation predominantly reflected contamination (131/213, 62%), and ultimately 32 (15%) CaIs cases were included. Smoking (adjusted odds ratio [aOR] 3.25, 95% confidence interval [CI] 1.06-9.97) was the only independent risk factor identified for CaIs. In contrast, nonelective procedure was identified as an independent risk factor for abIs (aOR 6.0, 95% CI 1.34-26.81, p = 0.019). CaIs commonly involved empyema (84% [27/32] versus 53% [17/32] with abIs, p = 0.014). Individuals with CaIs tended to follow a relatively indolent clinical course, were less likely to present with fever (aOR 0.15, 95% CI 0.04-0.68), and had favorable outcomes. When compared with CaIs, patients with abIs were less likely to achieve clinical cure at 90 days (aOR 0.02, 95% CI 0.001-0.41).

Conclusions: Although no modifiable risk factors were identified, CaIs frequently caused empyema, were less likely to present with fever, and were associated with a favorable prognosis.

Introduction: Respiratory syncytial virus (RSV) can cause severe outcomes in hospitalized older adults and those with underlying comorbidities, but little is known regarding such outcomes stratified by age and comorbidity status. This study aimed to describe the intensive care unit (ICU) stay and receipt of mechanical ventilation (MV) among adults with RSV-related hospitalizations by age and risk group.

Methods: A retrospective cohort study was conducted using Optum Market Clarity Database to identify RSV-related hospitalizations among adults aged ≥ 18 years. ICU admission, length of ICU stays, and MV use were summarized by age and risk group. Patients with at least one predefined underlying condition were defined as high-risk, while low-risk adults lacked any of these conditions.

Results: A total of 13,734 RSV-related hospitalizations were identified, including 11,838 unique patients. Of these, 10.2% were low-risk and 89.8% were high-risk. ICU admissions occurred in 31.2% of RSV-related hospitalizations (high-risk, 32.1%; low-risk, 22.6%). High-risk younger adults had higher percentage of ICU admissions (18-49 years, 31.1%; 50-59 years, 34.8%) than older adults at low-risk (60-74 years, 27.8%; ≥ 75 years, 21.6%). Mean length of ICU stay was 4.5 days (high-risk, 4.6 days; low-risk, 2.8 days). Younger adults at high-risk had longer ICU stays (18-49 years, 5.9 days; 50-59 years, 5.4 days) compared to older adults at low-risk (60-74 years, 4.2 days; ≥ 75 years, 1.8 days). MV was used in 6.2% of RSV-related hospitalizations (high-risk, 6.6%; low-risk, 2.6%). ICU stays for those receiving MV were more than twice as long as ICU stays overall (mean 10.6 days).

Conclusions: During RSV-related hospitalizations, adults at high-risk experienced more critical care outcomes compared to low-risk adults. Within risk status, results were similar with increasing age. However, younger adults at high-risk had more severe outcomes compared to older adults without such comorbidities, highlighting the importance of disease prevention in this group.

Introduction: Patients with human papillomavirus-related gynaecological diseases (HPV-RGD) are at risk of synchronous HPV infections in other regions, including the anal canal. The primary objective of this work was to examine the prevalence of anal HPV in patients treated for HPV-RGD. Secondary objectives were to test HPV type distribution and the risk of anal infection depending on the HPV-RGD localization.

Methods: A prospective study was conducted with two groups: the research group, histologically confirmed HPV-RGD, and the control group, gynaecological diseases not related to HPV (all human immunodeficiency virus (HIV) negative). The swabs for HPV genotyping and liquid cytology (Anyplex II HPV HR Detection test) were collected from the anal canal (both groups) and the area of gynaecological disease (research group).

Results: The prevalence of anal HPV infection in the research group (n = 130) was significantly higher than in the control group (n = 100) (64.62% vs. 11%, p < 0.05). All patients with vulva cancer (n = 7) and vaginal precancer (n = 6) exhibited anal HPV infection (p < 0.05). The risk of anal infection in patients with cervical cancer and precancer was 64% and 61.9%, respectively (both p < 0.05). The most common HPV types detected in the anus were 16 (53.6% of all anal HPV-positives), followed by 31 (17.9%) and 51 (14.3%). In 84.5% of cases, the same HPV type was present in the anus and gynaecological organ.

Conclusions: Patients with HPV-RGD, HIV-negative, are at risk for synchronous anal HPV infection, with type 16 being the most common. Further research is warranted to define the clinical significance of this finding and the introduction of anal cancer screening among patients with HPV-RGD.

Trial registration: ClinicalTrials.gov identifier, NCT06574087.

Hospital emergency departments (EDs) represent an acceptable and economically viable source of data on screening for blood-borne viruses (BBVs). In EDs in France, BBV screening is not based on a universal 'opt-out' policy (i.e. where all patients are informed that they will be screened unless they decline). Screening for BBVs is often not systematically offered when clinically appropriate and may have several challenges when it is offered. Nonetheless, opt-out BBV screening is useful in varied urban populations where BBV prevalence is high, although further evaluations of patient, caregiver and provider acceptability, rates of repeat versus new diagnoses, linkage to care (LTC) and cost benefits are warranted. Timely LTC and the retention of patients within care are important for enhancing clinical outcomes and preventing BBV transmission. However, timely LTC may be adversely affected by social deprivation, stigma associated with a BBV diagnosis and poor healthcare organisation. Consistent political commitment and relevant resource allocation are required to target any inequalities in healthcare access. Overall, in France and Europe, universal ED opt-out BBV screening strategies are appropriate for reducing missed opportunities for the early diagnosis of BBV infections. These strategies should be more widely implemented in EDs with high BBV prevalence, together with targeted community-based BBV screening in high-risk and vulnerable populations, so that overall BBV screening remains cost-effective. Reducing BBV-related stigma and discrimination and other barriers to healthcare access is imperative, as is the ongoing need to reinforce and evaluate timely LTC after positive opt-out BBV screening in EDs.

Introduction: This study evaluated the impact of "risk stacking" on COVID-19-related hospitalizations, emergency department/urgent care (ED/UC) visits, and outpatient visits among non-immunocompromised individuals aged 18-49 and 50-64 years compared with immunocompromised individuals and those ≥ 65 years.

Methods: Using Optum Clinformatics^® data, adults were assigned to ≥ 1 category based on underlying CDC-categorized high-risk (HR) conditions: HR-Conclusive (from which immunocompromising conditions were separated), HR-Suggestive, Mixed Evidence, No HR Conditions. The impact of multimorbidity quantities and HR categories on COVID-19 healthcare resource utilization (HCRU) was evaluated.

Results: Overall (n = 10,631,427), the most prevalent conditions were hypertension (HTN; 47.4%), obesity/overweight (31.9%), chronic heart disease (CHD; 28.1%), and diabetes (DBT; 20.3%). COVID-19 HCRU was higher for CHD with DBT, CHD with obesity, and HTN with obesity than for immunocompromised individuals and highest among those aged ≥ 65 years. Multimorbidity across multiple HR categories resulted in greater adjusted risk for COVID-19 HCRU for all ages.

Conclusion: Younger adults with multiple non-immunocompromising comorbidities had greater risk of COVID-19-related HCRU than those with immunocompromising conditions or ≥ 65 years without multimorbidity. Stacking HR comorbidities increased the risk of HCRU. Ensuring broad vaccination and treatment recommendations and access is critical to mitigating severe COVID-19 in HR groups of any age.

Tuberculosis (TB) continues to represent a significant global public health concern, with China being a country that bears the burden of a high incidence of TB cases on a global scale. Although linezolid (LZD) has been recommended for treating drug-resistant tuberculosis (DR-TB), its intolerability and adverse events, such as myelosuppression, neurotoxicity, etc., have limited its long-term usage in anti-TB treatment. Contezolid (CZD), a new generation of oxazolidinone drug, shows comparable or superior antibacterial activity to LZD, with lower risks of myelosuppressive toxicity, neurotoxicity, and lactic acidosis. Its unique metabolic pathway and favorable pharmacokinetic profile render it a promising alternative to LZD for TB treatment. Recent years have seen mounting evidence of the potential of CZD in treating TB. In this paper, the development history, the mode of action, resistance mechanisms, and research progress on CZD for TB treatment are reviewed, aiming to enhance understanding of its role in anti-TB therapy and to provide valuable references for clinical use and future research.

Introduction: Serious bacterial infections among newborns are associated with significant morbidity, mortality, and economic costs. While most newborns fully recover following the acute phase of illness, some develop long-term complications that require medical care. The objective of this real-world study was to estimate acute and long-term healthcare utilization and expenditures among US newborns with bacterial meningitis or sepsis during their birth hospitalization.

Methods: A retrospective matched-cohort design and a US healthcare claims database were employed. Study population comprised newborns who, during their birth hospitalization, had evidence of meningitis or sepsis due to a bacterial pathogen and matched comparison newborns. Study measures included all-cause healthcare utilization and expenditures during the birth hospitalization as well as the 1-year period following discharge.

Results: Among newborns with bacterial meningitis (N = 678), 61% were born prematurely, 27% had low birthweight, and 56% had ≥ 1 high-risk condition; among those with bacterial sepsis (N = 33,478), corresponding values were 48%, 20%, and 33%. During the birth hospitalization, utilization and expenditures were higher (versus comparators) among newborns with meningitis (hospital days, 37 versus 23; intensive care unit [ICU], 97% versus 64%; expenditures, US $423,390 versus $168,861) and sepsis (hospital days, 18 versus 14; ICU, 93% versus 52%; expenditures, $139,973 versus $78,549). Mean levels during the 1-year follow-up period were also markedly higher (versus comparators) among newborns with meningitis (expenditures: by $218,464) or sepsis (expenditures: by $39,259).

Conclusions: Serious bacterial infections among newborns place a substantial burden on the US healthcare system for the treatment of acute illness as well as long-term complications. Interventions targeting the prevention of newborn bacterial infections have the potential to yield significant resource utilization and cost offsets.