Infection最新文献

Introduction: The global resurgence of scarlet fever and invasive group A Streptococcus (GAS) infections has been noted over the past decade. In East Asia, specifically in Hong Kong and China, emm12 isolates that acquired prophage ΦHKU.vir, which carried SSA, SpeC, and Spd1 exotoxins, were over-presented in scarlet fever cases. The prevalence of ssa-positive emm12 isolates was increased significantly in Taiwan; however, it remains unclear whether this increase is mediated by the horizontal transfer of ΦHKU.vir homologs or the expansion of Hong Kong scarlet fever-associated emm12 isolates.

Materials and methods: This study included 240 non-emm1 isolates in Taiwan during 2009-2023. The genome and prophage sequences of clinical isolates were analyzed by whole genome sequencing.

Results: The prophages carried ssa, speC, and spd1 in Taiwan emm12 isolates shared high nucleotide sequence identity with ΦHKU.vir. All analyzed emm12 isolates in Taiwan were phylogenetically closely related to Hong Kong emm12 isolates, suggesting that Taiwan ssa-positive emm12 isolates shared a common origin with those from Hong Kong. This study further identified ΦHKU.vir homologs in emm90 and acapsular emm89 isolates. Although the acquisition of ΦHKU.vir is related to the expansion of emm12 isolates in Hong Kong, this study suggests that the prophage exotoxin SSA did not have significant roles in enhancing bacterial cytotoxicity and intracelluar survival of the acapsular emm89 strains.

Conclusions: The acquisition of prophages is important for the evolution of GAS. Monitoring the expansion of ΦHKU.vir in non-emm1/emm12 isolates is essential, as studying its impact on GAS pathogenicity will help in preventing and controlling GAS infections.

Objectives: For the past five years, COVID-19 has not only been a priority for health planning but also a hotspot for clinical research. Yet, the weight of the worldwide COVID-19 pandemic arises from the critical phase consequences due to the onset of acute disease, associated containment measures, and documented ongoing disabling symptoms. Investigating the global longitudinal effects on children and adolescents will inform future health directives tailored to this population's needs. This review aimed to report the spectrum of persistent neurological sequelae in children and adolescents following SARS-CoV-2 infection.

Methods: Hence, we conducted a scoping review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included the peer-reviewed articles from PubMed, Google Scholar, Web of Science, Cochrane Library, and WHO COVID database to identify relevant literature on long-COVID-19 neurological signs/symptoms among children and adolescents. The search covered the period between September 2020 and September 2024.

Results: The results of our analysis of 33 studies found long-COVID-19-related neurological signs/symptoms were predominantly: pain and sensory problems (N = 74,612/91,543; 81.5%), followed by sleep disturbances (N = 14,630/91,543; 15.9%), and cognitive difficulties (N = 2274/91,543; 2.4%). The global prevalence of long COVID-19 neurological signs/symptoms was estimated between 0.4% (20/5032; 95% CI = 2.1-3%) and 34% (27/79) based on data obtained through online questionnaire; while it varied between 1.8% (4/215) and 83.14% (74/89; 95%CI =   -  0.12; 0.30) based on patient assessment. Long-COVID-19-related neurological signs/symptoms were more common in the 11-16 age group. Children with immunocompetent profiles were at higher risk of developing long-COVID-19-related neurological signs/symptoms.

Conclusion: Our results demonstrate a considerable burden of COVID-19-related persistent neurological signs/symptoms in children and adolescents, which should be taken into consideration in healthcare decision-making.

Purpose: The study aimed to compare the clinical outcomes and safety of trimethoprim/sulfamethoxazole (TMP/SMX) versus levofloxacin monotherapy in patients with monomicrobial Stenotrophomonas maltophilia (S. maltophilia) bacteremia.

Methods: We conducted a retrospective cohort study of adult inpatients with monomicrobial S. maltophilia bacteremia at a tertiary medical center in Taiwan from January 2004 to June 2025. Patients were divided into two groups for comparison based on antibiotic treatment: TMP/SMX and levofloxacin monotherapy. Primary outcome was 30-day mortality. Secondary outcomes included in-hospital mortality, clinical response, microbiological eradication, non-susceptible strains emergence, recurrent bacteremia, and adverse drug reactions. Multivariable logistic regression and propensity score analysis were performed using inverse probability of treatment weighting (IPTW).

Results: Among 226 patients, 129 received levofloxacin and 97 received TMP/SMX. The levofloxacin-treated group was associated with lower 30-day mortality (17.8% vs. 36.1%, p = 0.002) in the primary analysis. In the multivariable logistic regression model, levofloxacin use was independently associated with improved outcomes (p = 0.047). Similarly, in the IPTW analysis, levofloxacin use remained a factor of lower 30-day mortality (p = 0.026). Additionally, microbiological eradication, emergence of non-susceptible strains, and recurrent bacteremia were comparable between the treatment groups, while adverse events were significantly less frequent in patients treated with levofloxacin (3.1% vs. 25.8%, p < 0.001).

Conclusions: Levofloxacin appeared to be more effective and safer than TMP/SMX in this retrospective analysis; however, this interpretation should be made with caution given the observational nature of the study. Further randomized clinical trials are warranted to validate these findings.

Purpose: To evaluate the potential of selective serotonin reuptake inhibitors (SSRIs) in reducing the risk of long COVID in patients with depression.

Methods: This retrospective cohort study analyzed U.S. electronic health records from TriNetX platform to compare the risk of long COVID among adults with depression who were prescribed SSRIs versus non-SSRI antidepressants between March 2020 and December 2022. The main outcome was the long COVID diagnosis. As a sensitivity analysis, CDC-defined long COVID symptoms were used as alternative outcomes. Cox proportional hazards models were used to assess outcomes occurring 3-6 and 3-12 months after the index SARS-CoV-2 infection, with hazard ratios (HRs) and 95% confidence intervals (CIs) calculated.

Results: After propensity score matching, the study included 31,264 patients, and the risk of long COVID diagnosis was significantly lower in the SSRI cohort compared to the matched non-SSRI antidepressant cohort, with hazard ratios of 0.57 (95% CI: 0.44-0.73) for the 3-6-month period and 0.59 (95% CI: 0.49-0.72) for the 3-12-month period. Sensitivity analyses in matched cohorts of 17,100 patients showed that SSRI use was associated with a significantly reduced risk of long COVID symptoms, consistent across symptom categories and pandemic periods.

Conclusions: In adult patients with depression, SSRIs compared with non-SSRI antidepressants were associated with a lower risk of long COVID. These results offer preliminary evidence that SSRIs may help prevent long COVID in high‑risk populations and warrant further preclinical and clinical investigation.

Purpose: Bacterial vaginosis (BV) is associated with sexually transmitted infections (STIs), and it is highly prevalent among sub-Saharan African women. This study investigated the bacterial vaginosis (BV) prevalence, its effect on human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoea, Trachomonas vaginalis, Mycoplasma genitalium and herpes simplex virus 1/2 (HSV1/2) prevalence and associated factors among adolescent girls and young women (AGYW) of Eastern Cape province, South Africa.

Methods: A total of 212 participants were retrospectively recruited from an HPV educational intervention study in Eastern Cape province. This study used secondary data on BV, HPV, C. trachomatis, N. gonorrhoea, T. vaginalis, M. genitalium and HSV1/2 and questionnaires. Associations between STIs, BV and other factors were assessed using GraphPad Prism version 8.

Results: A proportion of 83.0% (176/212) AGYW were infected with ≥ 1 STI(s), and 44.3% (94/212) had BV. BV-negatives had a significantly lower prevalence of having 3-4 STIs than BV-positives (Prevalence Ratio (PR): 0.22, 95% CI: 0.08-0.57, p = 0.001). Compared to BV-negative with a significant amount of Lactobacillus species, BV-positive AGYW were more likely to have C. trachomatis (PR: 1.8, 95% CI: 1.0-3.2, p = 0.028); T. vaginalis (PR: 8.3, 95% CI: 1.1-62.3, p = 0.011) and vaginal discharge or itching (PR: 2.4, 95% CI: 1.2-4.8, p = 0.013). Smoking (PR: 1.6, 95% CI: 1.1-2.4, p = 0.008), having two lifetime partners (PR: 1.9, 95% CI: 1.2-3.1, p = 0.006), three lifetime partners (PR: 2.6, 95% CI: 1.3-5.2, p = 0.007) and new sexual partners past three-month (PR: 1.8, 1.2-2.7, p = 0.005) were the associated factors of BV.

Conclusion: The bacterial vaginosis increased the risk of STIs and coinfection among AGYW. The presence and high amount of Lactobacillus species were associated with decreased risk of STIs. These findings indicate the urgent need to enhance BV and STI prevention, detection and management among AGYW.

Purpose: Recent advances in the treatment of acute myeloid leukemia (AML) and optimized supportive care have improved survival outcomes. However, infections during remission induction chemotherapy remain a leading cause of morbidity and mortality. While antifungal prophylaxis is standard, the role of routine antibacterial prophylaxis is increasingly debated due to adverse effects and resistance. This study aimed to characterize infectious complications in a real-world AML cohort receiving induction chemotherapy without routine antibacterial prophylaxis.

Methods: We retrospectively analyzed 103 adults with newly diagnosed AML who underwent intensive induction therapy at LMU University Hospital between January 2019 and December 2022. All patients received antifungal prophylaxis whereas antibacterial fluoroquinolone (FQ) prophylaxis was not administered. We assessed febrile episodes, clinically and microbiologically documented infections, ICU/IMC admissions, and 30-/90-day mortality.

Results: Febrile episodes occurred in almost all patients. Clinically documented infections accounted for 29.8% and microbiologically confirmed infections for 22.9% of febrile events. Bacteraemia was evenly distributed between Gram-positive and Gram-negative pathogens; multidrug resistance was rare. Proven or probable invasive fungal infections occurred in 6.8% of patients. In 47.2% of cases, the cause of fever remained unknown. Infection-related 30-day mortality was 4.9%. Factors associated with increased 30-day mortality included age ≥ 65 years, ECOG ≥ 2, secondary AML, and ICU/IMC admission for infection.

Conclusion: Infections remain a major challenge during AML induction therapy. Our findings suggest that FQ prophylaxis should be reevaluated in this setting, focussing on a more individualized approach. In addition, novel diagnostic tools are urgently needed to enable earlier and more targeted infection management in this high-risk population.

Purpose: This study aimed to use geospatial analysis to retrospectively determine whether earlier detection of the 2019 brucellosis laboratory leak in China could have been achieved using open-source intelligence data.

Methods: We used open-source intelligence data of brucellosis outbreaks from EPIWATCH^@, from late 2016 to mid-2024. The spatial distribution of brucellosis was mapped using heatmap analysis in China to identify the provinces with the densest outbreak signals. Multiple-ring buffer analysis of outbreak signals within a five and 10-kilometer radius of BSL-3 laboratories in Gansu province was implemented to examine the geospatial analysis techniques' capability to detect the 2019 brucellosis laboratory leak early.

Results: The central Gansu province, where the 2019 laboratory leak occurred, has China's densest signal of brucellosis outbreaks. In the multiple ring buffer analysis, outbreak signals were identified within a five-km radius of the Zhongmu Lanzhou Biopharmaceutical Plant Laboratory (ZLBPL) with an event date in July 2019. This compares to the official identification date of 6 December 2019. We identified 10,528 cases among 68,571 tests associated with the 2019 ZLBPL leak. This matches the 10,528 cases recorded in official reports among 79,357 tests, with 1,604 seeking medical treatment. This corresponds to a 13.3% test-positive rate among suspected cases and a 15.2% rate of medical treatment among confirmed cases.

Conclusion: A prolonged brucellosis laboratory leak occurred in China, with a delay of nearly six months before formal acknowledgment was received from local authorities. Geospatial analysis of open-source intelligence data identified the outbreak early, the likely source and a nearby laboratory affected by the outbreak.

Purpose: Linezolid serum concentrations in critically ill patients show high variability. In this retrospective study, we analysed the linezolid plasma through levels (C_min) in patients on intensive care units (ICUs) under extracorporeal membrane oxygenation (ECMO) support. The aim was to evaluate if patients' clinical or demographic characteristics influence drug concentrations and if these are within the therapeutic range.

Methods: In total, 156 linezolid trough plasma concentrations from 52 ICU ECMO patients were analysed. Linezolid trough levels were correlated with the following clinical and demographic characteristics: Age, sex, body mass index (BMI), dosage per day, creatinine clearance (CrCl), and requirement for renal replacement therapy (RRT). Drug concentrations were quantified by liquid chromatography with tandem mass spectrometry. The European Committee on Antimicrobial Susceptibility Testing susceptibility breakpoints of 4 mg/L of linezolid for staphylococci and enterococci and of 2 mg/L for streptococci and other Gram-positive rods were used as minimum target concentration.

Results: Patients were treated with standard linezolid dosage (2 × 600 mg iv per day; n = 88 C_min, 56.4%) or by adjusted dosing regimens (n = 68 C_min, 43.6%). The total amount of the drug ranged from 600 to 2400 mg per day (median 1200, IQR 1200-1800 mg). The mean of all trough levels measured among the cohort was 2.32 mg/L (median 1.55 mg/L, IQR 0.61-3.07). In total, 84.0% of all measurements were below the 4 mg/L breakpoint (62.2% below the 2 mg/L breakpoint), with 90.4% (78.8%) of patients showing inadequate levels in at least one measurement and 63.5% (36.5%) of patients below the threshold in every measurement. This result was irrespective of a standard or an adjusted dosing regimen. Female sex (p = 0.022), RRT (p = 0.047), increased CrCl (p = 0.012), and BMI (p = 0.023) were significantly correlated with lower C_min levels. Patients' individual linezolid trough levels and outcomes did not display conclusive patterns, irrespective of dosing or duration of treatment.

Conclusions: Both standard and increased dosing regimens of linezolid showed potentially inadequate linezolid plasma levels in the large majority of critically ill ECMO patients of our study. Future TDM studies with optimized dosing and application regimens in ECMO patients are warranted.

Purpose: Bloodstream infections (BSI) are associated with high mortality. Previous studies have reported worse outcome for polymicrobial than for monomicrobial BSIs. We analyzed patient characteristics and temporal trends of the incidence and outcome of polymicrobial BSIs in Finland during 2004-2018.

Methods: We used data from national registries to identify polymicrobial BSIs during 2004-2018 and to determine origin of infection, patients' comorbidities and death within 30 days. Charlson comorbidity index (CCI) was calculated according to ICD-10 diagnose codes.

Results: In total, 173,715 BSIs were identified; 11,347 (6.5%) were polymicrobial. Compared with monomicrobial BSIs, the proportion of males, healthcare-associated BSIs, and patients with high CCI were greater in polymicrobial BSIs (58.5% vs. 51.5%, 34.7% vs. 28.7%, and 24.9% vs. 21.1%, respectively). Escherichia coli, enterococci, coagulase-negative staphylococci, and Klebsiella sp. were the most common pathogens of polymicrobial BSIs. Anaerobic bacteria were noted in 16.3% of polymicrobial BSIs, compared with 4.3% of monomicrobial BSIs. The annual polymicrobial BSI incidence rose from 9.7 to 21.8/100,000 population during 2004-2018, most sharply among patients aged ≥ 90 years. The 30-day case fatality of polymicrobial BSIs was 20.6%, significantly higher than in monomicrobial BSIs (12.4%), and a decline from 25.2 to 20.8% was observed over time.

Conclusion: Polymicrobial BSI incidence increased twofold during 2004-2018. The case fatality was considerably higher in polymicrobial than in monomicrobial episodes, likely related to patients' older age and more severe comorbidity. Our findings emphasize the need for prompt recognition of patients at risk to guide the choice of empiric treatment.