Infection最新文献

Introduction: From a public health perspective, it is essential to understand the burden of kidney involvement in leptospirosis. We aimed to assess the frequency of acute kidney injury (AKI) and chronic kidney disease (CKD) in patients with leptospirosis.

Methodology: This systematic review and meta-analysis included all articles up to 14.08.2024 from three databases (PubMed, Scopus, Web of Science) using search terms related to leptospirosis and kidney involvement. After de-duplication, two independent reviewers independently checked the articles in two phases (title-abstract and full-text), and a third reviewer adjudicated any conflicts. Patient demographics, diagnostic procedures, and details of kidney involvement were extracted from the included studies. Risk of bias analysis was done using the Joanna Briggs Institute critical appraisal tool. A random effects model estimated the pooled rates for AKI, oliguria, and the need for dialysis.

Results: Of the 5913 retrieved articles, 48 met the eligibility criteria. The pooled incidence of AKI, reduced urine output, and dialysis requirement was 49.2% (95%CI: 38.2-60.2%, I² of 99.4%), 31.5% (95%CI: 24.2-38.7%, I²-96.1%) and 14.4% (95%CI: 10.3-18.4%, I²-97%) respectively. The pooled mean serum creatinine and urea levels at admission were 3.6 mg/dl (95% CI: 2.9-4.2, I²-99.1%) and 131.8 mg/dl (95% CI: 98.7-164.9, I²-98.6%), respectively. In four studies, the incidence of new-onset CKD after leptospirosis infection varied from 13 to 62%.

Conclusion: AKI reduced urine output and the requirement for dialysis are frequent complications in patients with leptospirosis. Increased resources for their management in endemic areas are essential to mitigate the burden.

Purpose: To assess the incidence and clinical impact of CMV infection in critically ill COVID-19 patients, examining ICU and hospital mortality, and length of hospital stay.

Methods: In this single-center, prospective observational study (March 2020 - September 2022), 431 patients with COVID-19 pneumonia and moderate to severe ARDS were included. An active CMV surveillance protocol was implemented, analyzing CMV DNA in plasma and bronchoalveolar lavage (BAL). Clinical characteristics and outcomes were compared between CMV-COVID co-infected patients and those without CMV reactivation.

Results: CMV-COVID co-infection was detected in 14.8% (64/431) of the cohort. Patients with CMV-COVID co-infection exhibited significantly higher ICU mortality (43.8% vs. 13.6%; p < 0.001) and hospital mortality (48.4% vs. 13.6%; p < 0.001) compared to patients without CMV. CMV infection was an independent predictor of hospital mortality (OR 4.91; 95% CI 2.76-8.75; p = 0.019). Earlier CMV reactivation was associated with an increased risk of hospital mortality (HR = 0.94; 95% CI: 0.90-0.98; p = 0.003). Additionally, CMV-COVID patients had a higher incidence of ICU-acquired infections and a prolonged hospital stay.

Conclusions: In critically ill patients with SARS-CoV-2 pneumonia, CMV infection was frequently observed, and associated with increased ICU and hospital mortality. CMV co-infection correlated with a higher incidence of ICU-acquired bacterial and fungal infections and prolonged hospital stays. This emphasizes the importance of early CMV monitoring upon ICU admission, as timely detection and intervention could potentially mitigate its impact on patient outcomes.

Purposes: A leading cause of death from infectious diseases worldwide is tuberculosis (TB), and it often arises from latent infection. New diagnostic tests for latent tuberculosis infection (LTBI) are needed. Therefore, this study aimed to identify novel biomarker signatures in whole human blood to distinguish between active tuberculosis (ATB) and LTBI.

Methods: Two LEGENDplex^™ kits were used to evaluate the secretion levels of 20 cytokines triggered by ESAT-6/CFP10 antigen in whole blood of ATB, LTBI, and healthy controls, and to search for cytokine combinations utilized to distinguish between ATB and LTBI.

Results: IL-8, IL-18, IL-33, MCP-1, MIG (baseline levels); IL-8, IL-33, IL-1β, MCP-1, MIG, IL-10, I-TAC (ESAT-6/CFP10-stimulated levels); and IL-18, IL-33, IL-1β, IL-10, TNF-α (ESAT-6/CFP10-stimulated minus baseline levels) had the potential to distinguish ATB from LTBI. Our data shows that the sensitivity and specificity of targeted IL-8 and IL-33 distinguishing between ATB and LTBI were 83.3% and 93.75%, and the diagnostic accuracy was 89.28%, and the sensitivity and specificity of targeted IL-18 and IL-33 distinguishing between ATB and LTBI were 91.67% and 81.25%, with the diagnostic accuracy was 85.71%.

Conclusions: Our data suggest that IL-8/IL-33 and IL-33/IL-18 together can be utilized as immunological markers to differentiate between LTBI and ATB. A novel TB diagnostic protocol was established, offering novel perspectives to create better tests.

Background: The effectiveness of infection prevention and control measures combating multidrug-resistant organisms (MDROs) in healthcare settings remains controversial.

Methods: PubMed, Embase, MEDLINE, Cochrane Library, and CINAHL were searched from inception to June 1, 2024. The interventions encompassed standard precautions (SP), contact precautions (CP), hand hygiene (HH), environmental cleaning (ENV), antimicrobial stewardship programs (ASP), decolonization (DCL), and chlorhexidine baths (CHG). The primary outcome were the acquisition, infection, and colonization of MDROs. Secondary outcomes were all-cause mortality and MDROs-associated bacteraemia. Effect indicators were expressed as rate ratios (RRs) with 95% confidence intervals (CIs).

Results: The study included a total of 97 articles, comprising 19 RCTs and 78 non-RCTs. The results showed that the most effective combination interventions for the acquisition, infection, and colonization of MDROs compared to SP varied as follows: CP + CHG (RR, 0.38 [0.18, 0.79]), SP + CP + ENV (RR, 0.04 [0.02, 0.08]), and SP + CHG (RR, 0.28 [0.14, 0.56]). In subgroup analyses, CP + CHG (RR, 0.36 [0.20,0.64]) was the most effective intervention for the acquisition of MDROs in the ICU setting, whereas SP + CP + ASP (RR, 0.35 [0.14,0.92]) was the most effective hospital-wide. Across subgroups, SP + CP + ENV (RR, 0.04 to 0.09 [95% CI, 0.01 to 0.99]) was identified as the most effective intervention for MDROs infections. In the ICU setting, SP + CHG (RR, 0.28 [0.14,0.56]) demonstrated the highest effectiveness in reducing the colonization of MDROs, whereas SP + CP + ENV + CHG (RR, 0.15 [0.06,0.38]) was the most effective on a hospital-wide scale. SP + CP + DCL (RR, 0.28 [0.24, 0.32]) was associated with reduced CRE colonization. The results of this study were robust according to the sensitivity analysis. None of the analyses related to secondary outcomes were statistically significant. In terms of article quality assessment, 94.7% of the RCTs were medium to high risk, while 92.31% of the non-RCTs. The primary limitation of the RCTs were related to the randomization process, whereas the non-RCTs were primarily affected by confounding bias.

Conclusions: Effective interventions differ based on carriage status, intervention setting, and the resistant strain. Additionally, contact precautions is a crucial component of these combinations. Consequently, healthcare organizations can select appropriate interventions based on their unique resistance profiles to optimize precision and resource efficiency.

Background: The diversity of pathogens causing central nervous system (CNS) infections presents a diagnostic challenge. Patient demographics and geographical location affect the likelihood of certain pathogens causing infection. Current diagnostic methods rely on labour-intensive cultivation or targeted detection. Metagenomic next-generation sequencing (mNGS) is a promising tool for detecting pathogens in CNS infections, offering an unbiased approach. To enhance our understanding of patient demographics and the range of pathogens identified through mNGS, we conducted a systematic review of case reports.

Methods: The PubMed database was searched in March 2024. Case reports on CNS infections and mNGS published from January 2014 through February 2024 were included based on predefined criteria.

Results: The search yielded 649 articles, of which 76 were included, encompassing 104 patients. Most patients were male (75%), the median age was 31,5 years [0-75] and 28% were immunocompromised. The most common diagnosis was encephalitis (36%), followed by meningitis (23%) and meningoencephalitis (22%). 53 unique pathogens were identified, comprising 27 different viruses, 19 bacteria, 5 parasites, and 2 fungi. Syndromic encephalitis/meningitis panels would only have detected four of the viruses and five of the bacteria. Additionally, 14 of the bacterial species are considered slow-growing or fastidious and could be challenging to detect by culture.

Conclusion: The application of mNGS in diagnosing CNS infections reveals the diversity of pathogens responsible for these severe infections, thereby improving diagnostics and facilitating targeted treatment. While case reports may be subjected to bias, they provide valuable insights into the use of mNGS in this clinical context.

Purpose: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with 1.3 million deaths in 2022. Extrapulmonary tuberculosis (EPTB) accounts for approximately 20% of all TB cases. We assessed the clinical presentation and challenges during the course of treatment in EPTB patients in a low-incidence setting.

Methods: We conducted a prospective cohort study involving 44 EPTB patients at the University Hospital of Cologne, Germany. Clinical data were collected before and during treatment.

Results: The cohort comprised 44 patients originating from 21 countries. Two or more invasive procedures were required for microbiological confirmation in 59% (26/44) of the cases. Sputum culture was positive in 18% (8/44) of patients, with 63% (5/8) showing no radiological signs of pulmonary involvement. The median therapy duration was ten months and increased with disease severity. Paradoxical reactions (PR) occurred in 31% (13/42) of the patients. A previously published clinical scoring system assessing EPTB treatment responses showed a favorable treatment outcome in only 68% (21/31) of the patients in this cohort.

Conclusion: EPTB exhibits highly variable disease severity and organ involvement. Treatment initiation is often delayed due to diagnostic challenges. Management is complicated by the frequent occurrence of PR, which can lead to treatment durations exceeding standard recommendations. Clinical scores for treatment response assessment may not be reliably applicable, highlighting the need for alternative biomarkers.