International Journal of Infectious Diseases最新文献

Objective: To evaluate the microbiological detection efficacy and turnaround time of a microfluidic quantitative real-time PCR (qPCR) platform for periprosthetic infection (PJI) patients.

Methods: This study included PJI patients with Staphylococcus aureus or Staphylococcus epidermidis and patients with aseptic failure (AF) from our clinical center. We analyzed the microbiological detection efficacy and turn-around-time of three bacterial detection methods: joint fluid culture, qPCR, and the microfluidic chip.

Results: A total of 310 patients were included in the study, comprising 106 PJI patients and 204 AF patients. CRP, ESR, synovial white blood cell and synovial PMN percentages in the PJI group were significantly higher than those in the AF group (P < 0.001). Compared to joint fluid culture (7011.3 ± 3013.0 min) and qPCR (131.7 ± 7.9 min), the microfluidic chip showed a significantly shorter turnaround time (59.4 ± 4.2 min, P<0.001). Additionally, low-load Staphylococcus aureus or Staphylococcus epidermidis which below the positive threshold were detected in some PJI or AF patients.

Conclusion: The microfluidic chip offers microbiological detection efficacy and time advantages for detecting Staphylococcus aureus and Staphylococcus epidermidis compared to joint fluid culture and traditional qPCR.

Objectives: To describe a series of doxycycline-induced fixed drug eruptions (FDE) observed in sexual health clinics, in a context of increasing doxycycline use for sexually transmitted infection (STI) management and prophylaxis in France.

Methods: We conducted a retrospective case series, combined with a doxycycline prescription audit and a sexual health clinician survey.

Results: Thirteen male patients (mean age: 32.5 years) were diagnosed with doxycycline-induced FDE. Most were MSM (men who have sex with men, 84.6%) and received doxycycline for STI treatment (92.3%). Lesions were mainly genital (85%) and often misdiagnosed as ulcerative STIs. Doxycycline prescriptions increased by 345% between 2018 and 2024. When performed, allergy workups confirmed the diagnosis in 60% of cases.

Conclusions: The sharp rise in doxycycline use for STI prophylaxis coincides with the identification of multiple FDE cases. Enhanced dermatological awareness is needed within antimicrobial stewardship programs to ensure safer implementation of doxycycline-based prevention strategies.

Introduction: Virus coinfections are common in young children. We quantified single and coinfections and their association with acute respiratory illness (ARI) in a prospective community-based cohort.

Methods: Healthy children (<4 years) were randomly invited for participation. Between October-May of 2021-2024, weekly nasal samples and daily symptom diaries were collected over 16-weeks, regardless of symptoms. Samples were PCR-tested for 17 respiratory viruses. Associations between ARI and infection status (coinfection, single virus, none) were analysed using mixed-effects logistic regression.

Results: 228 children (median age:19.9 months) contributed 24,432 diaries and 3,332 nasal samples. Of 1,241 virus infection episodes, 247 (19.9%) were coinfections, 613 (49.4%) were associated with ARI. Single virus versus no infection increased the odds of ARI (OR:2.15; 95% CI:1.69-2.73). Three virulence categories emerged: Mild (not associated with ARI; enterovirus, adenovirus, bocavirus); Moderate (ORs:1.36-1.81; rhinovirus, seasonal coronaviruses, SARS-CoV-2) and Severe (ORs:3.44-5.01; influenza, human metapneumovirus, parainfluenza, RSV). Coinfection further increased the odds of ARI by 1.87 (95% CI:1.22-2.89), even when accounting for virulence category.

Discussion: About half of respiratory viral infections in young children are associated with ARI. This likelihood varies by virus, reflecting virulence differences. Coinfection increases the odds of ARI beyond individual virus effects, suggesting virus interactions mediate severity.

Objectives: To achieve global TB control, more sensitive and user-friendly diagnostic tools for tuberculosis infection (TBI) are necessary, as it is a potential transmission reservoir. VIDAS® TB-IGRA (bioMérieux) is a fully automated assay recently developed. We report here the results of a global, multi-center, cross-sectional, prospective study to evaluate the diagnostic accuracy of the assay.

Methods: Patients with TB disease (n=200) or participants at varying levels of TB exposure risk (n=1460; mixed TB-exposure risk population) were tested with both the VIDAS® TB-IGRA and the QuantiFERON®-TB Gold Plus (QFT®-Plus, QIAGEN).

Results: In culture-confirmed TB cases, VIDAS® TB-IGRA had a sensitivity significantly higher than QFT®-Plus (97.5% vs. 80.7%, p<0.0001). Specificity evaluated in blood donors from a low-prevalence country (n = 125) was high for both VIDAS® TB-IGRA and QFT®-Plus (97.6% [93.1-99.5] vs. 95.2% [89.8-98.2]; p=0.083), respectively. In the whole mixed TB-exposure risk population, negative (NPA) and positive percent agreement (PPA) were 90.1% (1097/1217) and 92.1% (223/242), respectively. However, regression analyses revealed that VIDAS® TB-IGRA correlated better with the TB-exposure risk gradient than QFT®‑Plus.

Conclusions: Compared with QFT®-Plus, VIDAS® TB-IGRA was significantly more sensitive without a reduction in specificity, and it correlated better with an exposure gradient, suggesting that it is a valuable tool for TBI diagnosis.

Background: Doxycycline post-exposure prophylaxis (doxy-PEP) is recommended to prevent bacterial sexually transmitted infections (STIs) in high-risk populations in some countries, but its potential to promote antimicrobial resistance (AMR) remains a concern. We aimed to determine the cumulative doxycycline intake threshold at which significant shifts occur in antimicrobial resistance genes (ARGs) and gut microbial community composition.

Methods: We analysed data from the US DoxyPEP trial, a randomized clinical trial that enrolled men who have sex with men (MSM) and transgender women who received either doxy-PEP (200 mg doxycycline after condomless sex) or standard of care (SOC). Change-point analysis was applied to six-month cumulative doxycycline exposure to identify dosing thresholds associated with shifts in the gut resistome and microbiome.

Results: Segmented change-point analysis identified a resistome threshold of 64.68 (95% CI: [64.06, 65.3]) doxycycline doses over six months, above which significant increases in ARG abundance were observed. For the microbiome, segmented breakpoints were estimated for 133 genera: the median breakpoint was 43.22 doses (IQR 38.42 - 49.21). Using prespecified significance criteria, 4/133 (3%) genera exhibited significant abundance shifts, which included Acutalibacter, Anaerotignum, Petrimonas, and Sphingobacterium.

Conclusions: Doxy-PEP is associated with a dose-dependent enrichment of gut ARGs, with a threshold effect at ∼65 doses over six months and taxon-specific abundance shifts in the gut microbiome centered around 43 doses. These dose thresholds provide actionable data to optimize safe doxy-PEP implementation and highlight the need for monitoring strategies that mitigate AMR and microbiome disruption risks.

Background: The European & Developing Countries Clinical Trials Partnership (EDCTP) supports clinical research partnerships between countries in Europe and sub-Saharan Africa. A bibliometric analysis of outputs from the second EDCTP programme, EDCTP2, was undertaken to assess its contribution to international collaboration, advancement of scientific knowledge and policy uptake.

Methods: 1429 papers acknowledging EDCTP2 support published between 2014 and the end of 2023 were compared with all publications within the scope of EDCTP2 and with subsets acknowledging other funders.

Findings: 86.3% of EDCTP2 included at least one author from sub-Saharan Africa (SSA) and 62% included authors from both European and SSA countries. SSA researchers were first or last authors on 71% of EDCTP2 papers and women researchers from SSA were lead authors on 33% of EDCTP2 papers. Collaborations across several European-African and African-African country pairs were over-represented in EDCTP2 outputs. EDCTP2 papers were more likely than those from other funders to focus on the affordability and accessibility of medical interventions and on populations with unmet medical needs typically excluded from clinical studies, such as children, pregnant women and people with co-infections and co-morbidities. We corroborated that EDCTP publications were influencing policy.

Conclusion: Although the findings reflect outputs part-way through the EDCTP2 programme, they provide encouraging signs that the EDCTP2 programme is meeting its objectives on promoting international collaboration, widening access to interventions, and delivering public health benefits to populations in sub-Saharan Africa.

Funding: This work was supported by the UK National Institute for Health and Care Research (NIHR) and the EDCTP2 programme, supported by the European Union.

Background: A preemptive approach using plasma cytomegalovirus (CMV) DNA load monitoring is recommended for CMV-seropositive solid organ transplant recipients (SOTr). However, limited access to CMV quantitative nucleic acid amplification testing (QNAT) poses challenges in resource-constrained settings. We hypothesized that absolute lymphocyte count (ALC)-guided monitoring could provide an effective alternative strategy.

Methods: We conducted an open-label, randomized controlled trial at a single transplant center in Thailand (February-November 2023). Adult CMV R+ kidney transplant (KT) recipients who did not receive anti-thymocyte globulin induction were randomized 1:1 to either the logical (LOG) group, which underwent routine plasma CMV QNAT every 4 weeks for 12 weeks, or the ALC group, which underwent testing only when the ALC was <1,000 cells/mm³. Participants were followed for 6 months post-transplant to compare CMV infection rates and testing costs.

Results: A total of 98 KT recipients were enrolled (49 per group; mean ± SD age, 46 ± 11 years; 66.3% male). Baseline demographic characteristics were comparable between groups. Overall, 25 participants (25.5%) developed CMV infection within 6 months after KT. CMV infection occurred in 13 participants (26.5%) in the LOG group and 12 participants (24.5%) in the ALC group (p = 0.817). No significant differences were observed between groups in the rates of CMV DNAemia, CMV disease, anti-CMV therapy, or mortality (all p > 0.05). The total cost of plasma CMV DNA load testing was significantly lower in the ALC group than in the LOG group ($2,320 vs. $10,014, p = 0.002).

Conclusion: ALC-guided monitoring could potentially demonstrate comparable effectiveness to routine CMV DNA surveillance for CMV infection prevention in KT recipients. Given its simplicity and availability, ALC may serve as a feasible and cost-efficient adjunct for guiding preemptive therapy in low- to moderate-risk SOT recipients.

Mycobacterium malmoense is an emerging non-tuberculous mycobacterial (NTM) pathogen that usually causes extra-pulmonary disease particularly in significantly immunosuppressed patients. Recent reports from Scotland and the Netherlands, however, document an increasing proportion of pulmonary NTM infections due to Mycobacterium malmoense, indicating a rising incidence in parts of Northern Europe-though still predominantly associated with pulmonary disease. We report a 78-year-old woman from north-eastern Germany with chronic tenosynovitis caused by Mycobacterium malmoense under minimal long-term prednisone therapy. Diagnosis was established by histopathology, culture, and hsp65 gene sequencing. Although up to 40% of reported Mycobacterium malmoense infections are extrapulmonary, nearly all described tenosynovitis cases have occurred in children or in profoundly immunosuppressed adults. This case therefore represents an exceptionally rare clinical constellation, demonstrating that even minimal immunosuppression can permit infection with this slow-growing NTM. It further underscores the diagnostic complexity, along with the absence of clear guideline recommendations regarding optimal therapy duration, highlighting the need for individualized, multidisciplinary management.

Objectives: To compare the environmental disinfection efficacy of nursing assistants versus environmental services staff in intensive care units (ICUs).

Methods: This retrospective study analyzed 22,828 environmental surface samples from ICUs (2021-2024) for multidrug-resistant organisms (MDROs). A binomial generalized linear model was used to assess the association between cleaning staff role (nursing assistants vs. environmental services staff) and MDRO detection rates, controlling for surface type, department, strain type, and sampling time. Sensitivity analyses using a probit model and exclusion of pediatric departments were conducted to evaluate the robustness. Time trend and spatial distribution of contamination were visualized via stacked area charts and heat maps.

Results: The overall MDRO positivity rate was 0.68%. Surfaces cleaned by nursing assistants showed a 56.61% lower MDRO positivity rate than those cleaned by environmental services staff. Carbapenem-resistant Acinetobacter baumannii (CRAB) was the most prevalent pathogen, with odds of contamination 22.40 times higher than methicillin-resistant Staphylococcus aureus (MRSA). Contamination risk increased over the sampling period and was 74.31% lower in public areas compared to bed rails.

Conclusion: Nursing assistants demonstrated superior environmental cleaning outcomes. These findings underscore the need to reevaluate cleaning responsibilities and strengthen training for environmental services staff.

Objectives: People living with HIV (PLHIV) who are co-infected with tuberculosis are at risk for negative health outcomes. This study describes tuberculosis incidence in Israel and identifies high-risk groups.

Methods: This 42-year study includes all tuberculosis cases reported in Israel after HIV-diagnosis. Fine-Gray models were adjusted to three timeframes, according to the availability of anti-retroviral treatment (ART): 1981-1996 (pre-ART), 1997-2016 (ART), 2017-2023 (immediate ART upon detection).

Results: Of all 12,004 PLHIV, 413 (3.4%) developed tuberculosis: 132 (7.4%) between 1981 and 1996; 263 (3.6%) between 1997 and 2016; and 18 (0.6%) between 2017 and 2023, p<0.001. Non-Israeli-born citizens PLHIV were at higher risk for developing tuberculosis compared with Israeli-born citizens (0.5 vs. 0.05 per 100 person-years, respectively, p<0.001). Risk factors for developing tuberculosis among 6933 Israeli PLHIV included being heterosexual, originating in endemic countries (Hazard ratio [HR] 17.8, 95% CI: 9.7-32.6, p<0.01), intra-venous drug users (IVDU) (HR=12.9, 95% CI: 6.8-24.5, p<0.01), and being diagnosed with HIV in 1981-1996 and 1997-2016 (HR=5.6, 95% CI: 2.3-13.9, p<0.01 and HR=2.5, 95% CI: 1.0-6.0, p=0.05, respectively).

Conclusions: Tuberculosis incidence among PLHIV was highest among migrants from endemic countries and IVDU. Tuberculosis incidence declined after the introduction of ART and was further reduced when ART was provided immediately upon detection.