Infection最新文献

Objective: This study aimed to evaluate (1) the association between asthma and long COVID among U.S. adults and (2) the association between asthma control and long COVID among U.S. adults with asthma.

Methods: Data from the 2023 National Health Interview Survey were used. Adults aged ≥ 18 years were included. Asthma control was measured by the history of asthma attacks and emergency room (ER) visits for asthma. Multivariable logistic regression models were used to evaluate the associations. A sensitivity analysis was performed by stratifying long COVID severity.

Results: A total of 258,237,552 adults were included in this study. The prevalence of long COVID among U.S. adults in 2023 was 8.2%. When stratified by the presence of asthma, the prevalence was 15.2% for those with asthma and 7.6% for those without asthma (P < 0.01). After adjusting for covariates, adults with asthma had higher odds of long COVID than those without asthma (OR, 1.58; 95% CI, 1.37-1.83). This association was consistent across long COVID severity levels. Poor asthma control was associated with increased odds of long COVID (asthma attacks: OR, 1.47; 95% CI, 1.09-1.97; ER visits for asthma: OR, 1.52; 95% CI, 1.02-2.27).

Conclusion: Asthma was associated with increased odds of long COVID. Patients with poorly controlled asthma were associated with increased odds of long COVID. From a clinical perspective, it is crucial to proactively identify patients with asthma at increased risk of long COVID, especially those with certain comorbidities. Future research on specific symptoms and the duration of long COVID among patients with asthma will benefit clinical practice.

Introduction: Respiratory infections re-emerge unpredictably. Rapid pathogen identification is crucial for effective targeted therapy.

Methods: From November 15, 2023, to December 15, 2023, 574 respiratory tract samples (nasopharyngeal and oropharyngeal swabs) were collected at Beijing Ditan Hospital and Beijing Haidian Hospital. Targeted next-generation sequencing (tNGS) was further used to examine the respiratory samples identified as unfavorable by quantitative real-time PCR (qPCR).

Results: Using qPCR testing, 368 out of 574 samples (64.1%) were positive, while 206 samples (35.9%) showed no pathogen. TNGS further found that 167 out of these 206 cases (81.1%) had pathogens detected, with 58 different pathogens identified. The most frequent viruses, bacteria, and fungi were H3N2 (n = 73), Streptococcus pneumoniae (S. pneumoniae) (n = 18), Staphylococcus aureus (S. aureus) (n = 18), and Candida albicans (C. albicans) (n = 17). There were 102 cases of mixed infections, among which H3N2 appeared most frequently (51/102, 50%), and coinfections often involved Human betaherpesvirus 7 and S. aureus. In 20 cases where antibiotic resistance genes (ARGs) were detected, four were infected with H3N2. Among these, TEM and tetB were associated with Acinetobacter baumannii, APH was associated with Stenotrophomonas maltophilia, and the remaining resistance genes were linked to S. pneumoniae.

Conclusion: TNGS is more sensitive than qPCR for detecting pathogens, which is crucial for identifying prevalent and harmful ones like H3N2, S. pneumoniae, and S. aureus. Its integration into routine clinical testing is recommended, though more research is needed for clear guidelines.

Background: Therapeutic drug monitoring (TDM) is increasingly recommended for managing multidrug-resistant tuberculosis (MDR-TB) due to significant interindividual pharmacokinetic variability. However, data on plasma concentration variability and associated patient factors for second-line anti-TB drugs remain limited.

Methods: We conducted a retrospective observational study including 74 patients with MDR-TB at West China Hospital, Sichuan University, from January 2022 to December 2024. Plasma concentrations of second-line drugs (levofloxacin, cycloserine, clofazimine, bedaquiline, and linezolid) were measured at steady-state. We analyzed therapeutic target attainment rates, evaluated correlations between drug concentrations and patient baseline characteristics, and explored predictors of drug exposure using multivariable linear regression.

Results: Significant interindividual variability in drug exposure was observed across the studied second-line anti-TB drugs. Clofazimine demonstrated the highest therapeutic target attainment (72.7%), while bedaquiline had the lowest (21.1%). For levofloxacin, 29.8% of patients achieved therapeutic concentrations, whereas cycloserine reached target levels in 43.2% of cases. Age was positively correlated with cycloserine concentrations (ρ = 0.328, p = 0.030). Multivariable regression identified age and liver enzymes (ALT and AST) as independent predictors of levofloxacin exposure. Specifically, elevated ALT was associated with lower levofloxacin levels (B = -0.191, 95% CI: -0.337 to -0.045), while elevated AST was linked to higher levels (B = 0.292, 95% CI: 0.080 to 0.503). Linezolid trough concentrations showed a negative correlation with RBC count, and peak concentrations were positively associated with ESR. Additionally, bedaquiline concentrations correlated positively with CRP levels.

Conclusion: Our findings highlight substantial pharmacokinetic variability among second-line anti-TB drugs, influenced by patient age, liver function, and systemic inflammation. These results underscore the potential importance of individualized dosing and routine TDM in optimizing drug exposure and minimizing toxicity in patients with MDR-TB.

Purpose: Osteoarticular infections caused by intravesical BCG are rare and poorly characterized. This study presents a case of acromioclavicular joint infection caused by Mycobacterium bovis BCG, alongside a systematic review aimed at improving our understanding of the infection's clinical features, diagnosis, treatment and outcomes.

Methods: This systematic review included all published cases of osteoarticular infections due to M. bovis BCG following intravesical BCG instillation, as identified through a PubMed search conducted up to 1 May 2025. The search used combinations of keywords related to 'BCG', 'bladder', and 'osteoarticular infection'. One additional case from our institution was added. Clinical, biological, radiological, treatment and outcome data were extracted and analyzed.

Results: We reviewed 67 cases, classified as vertebral (n = 45), prosthetic joint (n = 18), and native joint (n = 4). The affected patients were predominantly men (98.5%), with a mean age of 74.1 ± 9.2 years. The median delay in months between the first instillation and the diagnosis was 23 [IQR 13.0-48.0]. Fever was uncommon (20.5%), while elevated C-reactive protein levels were frequent (80%). Imaging (CT/MRI) played a key role in diagnosis by showing images consistent with infection in all cases in which it was used. Treatment typically involved rifampicin and isoniazid for 12 months, alongside ethambutol for two months. Outcomes were favorable in 90.6% of cases, with one death attributed to the infection.

Conclusion: Though rare, M. bovis BCG osteoarticular infections should be considered in patients with unexplained joint symptoms following BCG therapy. Early diagnosis and appropriate therapy are essential for optimal management.

Objectives: Intensive care unit (ICU) patients have an increased risk of bacteremia. We aimed to investigate the 5-year outcome of ICU-acquired infections comparing them with ICU patients without new infections. Our second aim was to compare the outcome of Gram-positive, Gram-negative and fungal ICU-acquired bloodstream infections (BSIs).

Methods: This single-center retrospective registry study occurred in an academic teaching hospital during 2000-2017 in a mixed adult ICU consisting of patients who stayed longer than 48 h in the ICU. Data was retrieved from the ICU and hospital electronic data management systems. Three groups were included: no infection and no new antimicrobial treatment, a new ICU-acquired infection with negative blood cultures (BCs), and a new ICU-acquired BSI. A multivariable-adjusted Cox proportional hazards model was used to determine the impact of ICU-acquired infection on 5-year mortality.

Results: 1857 had no infection and 768 developed an ICU-acquired infection with positive BCs in 195 cases (25.4%). The adjusted HR was 2.03 (95% CI from 1.76-2.35, p < 0.001) for the impact of ICU-acquired infection on 5-year mortality. The highest median sequential organ failure assessment (SOFA) was 7.0 (5.0-8.0) for the no-infection group, 9.0 (7.0-10.0) for the BC-negative ICU-acquired infection group, and 12.0 (9.0-15.0) for the ICU-acquired BSI patients (p < 0.001). The crude 30-day mortalities in the no-infection, the BC-negative, and the BSI groups were 98 (5.5%), 58 (10.1%), and 51 (26.0%), respectively (p < 0.001). The highest median SOFA for Gram-positive BSIs was 11.0 (8.0-13.0), for Gram-negative BSIs 13.0 (11.0-16.0), and for fungal BSIs 12.5 (10.0-16.0) (p = 0.01). The need for RRT was 23.2% (19) in Gram-positive, 29.8% (14) in Gram-negative, and 48.1% (25) in fungal BSIs (p = 0.01). The crude ICU-mortalities were 12.2% (10) in Gram-positive BSIs, 31.9% (15) in Gram-negative BSIs, and 11.5% (6) in fungal BSIs (p = 0.008). Patients with fungal BSI had the worst 5-year outcome, whereas the long-term outcome did not differ between Gram-positive and Gram-negative BSIs.

Conclusions: Patients with ICU-acquired infections had three times higher 5-year mortality than non-infected ICU patients. ICU-acquired Gram-negative BSIs had the highest ICU mortality, whereas the long-term outcome did not differ between Gram-negative and Gram-positive ICU-acquired BSIs. Fungal BSI showed the worst long-term outcome.

A 23-month-old boy was admitted to our hospital with onset of fever and paroxysmal cough but progressed to death on Day 9. Streptococcus pyogenes was positive in cerebrospinal fluid and blood by next-generation sequencing, and was cultured from sputum. The isolate was resistant to erythromycin, clindamycin, and tetracycline. By genomic analysis, the isolate was identified to be emm12 of global Clade II and harbor mobile genetic elements of ICE-emm12 and ΦHKU.vir, carrying resistance genes ermB and tetM. We report a fatal case of meningitis case complicated with streptococcal toxic shock syndrome caused by emm12 S. pyogenes in China, which is rare in this country.

Purpose: Antimicrobial overuse and misuse remain critical challenges. This study examined pharmacist-led post-prescription interventions targeting restricted antimicrobials in a university hospital, identifying underlying drug-related problems (DRPs), their clinical relevance, economic impact and characteristic patterns of inappropriate use.

Methods: A retrospective observational analysis (January- December 2022) was conducted at the Salzburg State Hospitals using routine data of pharmacist-led interventions on restricted antimicrobials. DRPs and intervention types were categorized using validated criteria. Clinical relevance was independently assessed through an external survey, and interrater reliability was determined to ensure consistency in classification and evaluation. Potential cost savings and acceptance rates of the pharmaceutical interventions were assessed.

Results: A total of 3897 restricted antimicrobial prescriptions were analyzed, with 11.7% (456) showing at least one DRP in 366 patients. The majority of DRPs (80.2%) exhibited marked clinical relevance, mainly due to non-conformance with guidelines (27.4%), unclear indication (27.2%), and the need for patient or drug monitoring (12.5%). Broad-spectrum agents linezolid (25.0%), meropenem (24.1%), ciprofloxacin (15.8%), and piperacillin-tazobactam (8.8%) accounted for nearly 74% of all DRPs. DRP-related interventions aimed at optimizing PK/PD parameters (30.6%), treatment discontinuation (28.1%), and de-escalation (17.9%). The acceptance rate of interventions was high (82.7%). A cost reduction potential was identified in 89.7% of interventions, saving €180,420 in avoided drug expenses.

Conclusion: Pharmacist-led post-prescription interventions within an established AMS program effectively identified clinically relevant misuse of restricted antimicrobials. Targeted actions on key agents enable high-impact optimization, supported by strong acceptance and cost-saving potential - thereby enhancing stewardship efforts, guiding improvements in diagnostics, and prescribing behavior.

Background: Melioidosis, caused by Burkholderia pseudomallei, is an underdiagnosed cause of community-acquired pneumonia (CAP) in India. Due to overlapping features with other bacterial pneumonias and limited access to culture facilities, early diagnosis and treatment remain challenging. This study aimed to develop a clinical scoring system to distinguish melioidosis from other bacterial causes of CAP in an endemic setting.

Methods: We conducted a retrospective cohort study of 337 patients with radiologically confirmed blood or respiratory culture-positive CAP cases at a tertiary care hospital in South India from 2017 to 2023. This included 55 melioidosis cases and 282 controls with other documented bacterial etiologies. Demographic, clinical, laboratory, and radiological variables were compared. Multivariable logistic regression identified independent predictors of melioidosis. A scoring system was developed using the natural logarithms of adjusted odds ratios (aORs).

Results: Four independent predictors were retained in the final model: monsoon season exposure (aOR = 9.0, 95% CI: 3.6-22.6), diabetes mellitus (aOR = 10.1, 95% CI: 3.6-28.5), shock at presentation (aOR = 17.2, 95% CI: 5.9-49.9), and extrapulmonary focal involvement (aOR = 36.5, 95% CI: 11.0-121.4). The model showed excellent discrimination. A score of ≥ 4 out of 11 yielded a sensitivity of 87.3% and specificity of 83.6%, while a score of ≥ 5 yielded a sensitivity and specificity of 67.3% and 95.4%, respectively.

Conclusion: We propose a simple four-point clinical scoring tool to identify melioidosis in patients with CAP. This score can guide early suspicion and appropriate therapy in endemic resource-limited settings. Prospective validation in other endemic regions is warranted.