Infection最新文献

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.

Purpose: To report an unusual case of symptomatic human intestinal spirochetosis (HIS) in an immunocompetent individual without known risk factors, and a potential zoonotic source (domestic pig).

Methods: A 65-year-old heterosexual man with no gastrointestinal or immunological history presented with acute diarrhea, abdominal pain, vomiting, and rectal bleeding. Colonoscopy revealed two ulcers in the distal transverse colon; biopsies were taken from ulcerated and normal mucosa. Histopathology included Warthin-Starry staining.

Results: Histology showed dense spirochetal colonization forming a "false brush border," consistent with HIS. The ileum was unremarkable. The patient was treated with oral metronidazole 500 mg q6h for 10 days, resulting in complete resolution of symptoms. Follow-up colonoscopy at 13 months confirmed full mucosal healing, and the patient remained asymptomatic.

Conclusion: This case highlights the possible pathogenic role of HIS in gastrointestinal symptoms and colonic ulceration, even in immunocompetent individuals without traditional risk factors. It underscores the diagnostic value of histology in atypical colonic lesions and suggests zoonotic transmission as a plausible route of infection outside classical risk groups.

Introduction: Carbapenem-resistant Enterobacterales (CRE) intestinal colonization is a key risk factor for subsequent infection. The composition of the intestinal microbiota is likely to play a role in the colonization. The aim of the study was to compare the gut microbiota composition between colonised (Col) patients and decolonised (DeCol) patients.

Methods: Patients were identified from a database of CRE colonised patients. They were categorized as either currently Col or having spontaneously DeCol. Baseline characteristics and survival in the following year after the gut microbiota characterization were also collected. Gut microbiota composition was analysed.

Results: A total of 37 patients were included: 14 in the Col group and 23 in the DeCol group. No significant differences in terms of age, BMI, sex, KATZ index, toxics, diet and comorbidity were observed. Previous hospital admission and infections caused by CRE and/or other microorganisms were more frequent in the Col group. During the 12-month follow-up, mortality was higher in the Col group (Col 43% vs. DeCol 9%, p = 0.035). Differences in beta diversity were observed according to Col status (Bray Curtis distance, PERMANOVA, p = 0.013) but not according to recent antibiotic treatment or hospital admission. Suterella, Roseburia faecis and Eubacterium ventriosumwere enriched in DeCol patients. CRE colonisation was associated with a higher abundance of Ruthenibacterium lactatiformans.

Conclusions: The composition of faecal microbiota was different between patients with ongoing CRE colonisation and those who achieved decolonisation. Further studies are needed to assess if specific bacterial taxa could be a marker of a longer colonisation risk.