International Journal of Infectious Diseases最新文献

Introduction: Gut colonisation by multidrug-resistant Gram-negative bacilli (MDR-GNB) is a common precursor to bacteraemia in haematological patients with malignancies. This study evaluates the efficacy of ceftazidime/avibactam (CAZ/AVI) and ceftolozane/tazobactam (C/T) in eradicating gut MDR-GNB colonisation.

Methods: This retrospective cohort included haematologic patients admitted to a tertiary hospital (2020-2023), colonised with carbapenem-resistant Enterobacterales (CRE) or difficult-to-treat resistant (DTR) Pseudomonas aeruginosa and treated with CAZ/AVI or C/T. Decolonisation was defined as clearance of baseline MDR-GNB in two consecutive post-treatment rectal swabs.

Results: Twenty treatment episodes were analysed. At the first post-treatment rectal swab, the previously identified colonising MDR-GNB was not detected in 15/20 episodes (75.0%). The same colonising MDR-GNB was re-identified in 3/15 cases (20.0%) on subsequent rectal swabs after a median of 8.0 days (IQR 7.5-11.0). Overall, 12/20 episodes (60.0%) achieved decolonisation. Median follow-up was 327.0 days (IQR 225.0-480.8); sustained decolonisation (≥180 days of follow-up) was documented in 9 episodes, while 5/12 episodes (41.7%) were recolonised with a different MDR-GNB. Among the eight episodes that remained colonised post-treatment, seven involved <7 days of therapy or DTR P. aeruginosa infection. Gut decolonisation was more frequently observed in low-inoculum infections and in episodes treated for ≥7 days.

Conclusion: CAZ/AVI and C/T may facilitate gut MDR-GNB decolonisation in haematological patients. Sustained decolonisation rates suggest a potential role in mitigating infection risks, warranting confirmation in larger cohorts.

Background: Acute encephalitis caused by human parvovirus B19 (PVB19) is an uncommon clinical manifestation observed in both immunocompetent and immunocompromised individuals. Angioimmunoblastic T-cell lymphoma (AITL) is a distinct subtype of lymphoma characterized by aberrant immune dysregulation, predisposing patients to opportunistic infections even in the absence of chemotherapy.

Case presentation: A 66-year-old woman with newly diagnosed, treatment-naïve AITL presented with acute confusion, dysarthria, and severe anemia. Cerebrospinal fluid (CSF) analysis and neuroimaging findings were non-specific. PVB19 DNA was subsequently detected in both the CSF and serum. A bone marrow biopsy confirmed PVB19-associated pure red cell aplasia (PRCA). Intravenous immunoglobulin therapy resulted in a declining viral load and clinical improvement. The patient's clinical course was complicated by multiple subsequent infections, and she ultimately died five months after discharge.

Conclusion: This case highlights the immunodeficiency caused by AITL, which predisposes patients to opportunistic infections. PVB19 infection should be considered for patients presenting with unexplained encephalitis, particularly in those with underlying immunocompromised conditions.

Objective: To evaluate the value of cell-free DNA (cfDNA) in plasma and genomic DNA (gDNA) in nucleated cell layer of whole blood samples detected by metagenomic next-generation sequencing (mNGS) in the diagnosis of bloodstream infection in patients with hematological diseases.

Methods: Whole blood samples collected from hematologic patients with suspected bloodstream infections were divided into the plasma and nucleated cell layers. The DNA of plasma and nucleated cell layers was extracted for mNGS. The pathogenic results were compared between whole blood (plasma plus nucleated cell layers) and plasma layer. In addition, the factors influencing the prognosis at discharge were analyzed.

Results: Totally 92 patients were included. The positive rate of mNGS in whole blood was higher than those of the single plasma layer (58.70% vs. 53.26%) and the culture layer (58.70% vs. 17.39%). The consistency of plasma and nucleated cell layers was 57.6%. The proportion of fungi detected in nucleated cell layer was higher than that in plasma layer (30.2% vs. 17.0%). Ten patients had extra pathogens detected in whole blood compared with the single plasma layer, and the positive rate of mNGS increased by 10.87%. gDNA microbe reads and non-host ratios in the extra-detection group were significantly higher than those in the non-extra detection group. cfDNA microbe reads, non-host ratios and microbe percent showed no significant differences between the two groups. The maximum Sequential Organ Failure Assessment (SOFA) score and age in the death group were significantly higher, while cfDNA/gDNA species richness was significantly lower compared with the survival group. The maximum SOFA score and cfDNA Shannon diversity index were found as risk factors for improved prognosis. The maximum SOFA score and cfDNA concentration were combined for the diagnosis of poor prognosis at discharge, with the highest area under the curve of 0.95.

Conclusion: Simultaneous metagenomic sequencing of plasma layer and nucleated cell layer contributes to the detection of pathogens in patients with bloodstream infection. cfDNA detection has a certain significance in predicting the prognosis of patients with bloodstream infection.

Purpose: This study characterizes the epidemiological trends and resistance profiles of respiratory tract infections (RTIs) in the United Arab Emirates (UAE) from 2010 to 2022, aiming to inform national control strategies.

Method: We conducted a retrospective observational study of RTI cases across 345 UAE healthcare settings using data from the national surveillance network. Pathogen identification and resistance profiling were performed using advanced diagnostics and standardized antimicrobial susceptibility testing, in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Lower respiratory tract infections (LRI) comprised most cases (73.1%; n=100,856), including 6,416 due to Mycobacterium tuberculosis, while upper respiratory infections made up 26.9%. LRI incidence was stable until 2014 but rose significantly from 2015-2022 (AAPC= 1.58; 95% CI 1.58 - 3.87), especially in the Northern Emirates. Carbapenem resistance among Enterobacterales was 22.5% (14.4% in K. pneumoniae), and third-generation cephalosporin resistance 30.1% (62.3% in E. coli). Resistance was highest in A. baumannii (61%) and P. aeruginosa (27.4%). Macrolide and MRSA resistance increased significantly. The majority (85%) of tuberculosis cases were identified among individuals from South Asian and East African regions, with a post-COVID surge, while drug resistance remained below 15%.

Conclusion: These findings underscore the urgent need for regionally tailored infection control strategies, enhanced antimicrobial stewardship, and expanded pathogen surveillance to prevent further escalation of AMR.

Objectives: To characterize the early spatiotemporal transmission dynamics of SARS-CoV-2 following the Chinese government's adjustment of the long-standing "zero-COVID" policy in December 2022, focusing on both overseas importation and subsequent domestic dissemination, and to identify key factors driving these transmission pathways.

Methods: We analyzed 55,142 high-quality SARS-CoV-2 genomes from the Chinese mainland, covering six predominant Omicron sublineages (BA.5, BF.7, DY, XBB, EG.5, and HK) circulating during the policy-adjustment period. Genomes were grouped into three phases according to temporal shifts in lineage predominance. Mutation-network approaches were applied to infer spatiotemporal transmission patterns, and international air travel data were integrated to assess the contribution of global mobility to viral importation.

Results: South Korea, the United States, Japan, and several Asia-Pacific regions were the major sources of overseas introductions, with international passenger volume identified as the primary driver. Beijing and Shanghai functioned as key domestic transmission hubs at different stages. Beijing was predominantly affected during the early introduction phase, whereas Shanghai became the main hub later due to the highest inflow of international travelers.

Conclusion: This study reveals the spatiotemporal dynamics and major drivers of SARS-CoV-2 transmission in the Chinese mainland in the post-"zero-COVID" period, underscoring the value of integrating genomic surveillance with mobility data to guide future preparedness and public health decision-making.

Background: Safety concerns might explain the low uptake of COVID-19 vaccination recently observed in several countries. This study compares COVID-19-unrelated mortality between vaccinated and unvaccinated people.

Methods: We conducted a retrospective cohort analysis over 2021-2025 among 735,473 residents ≥12 years in the Treviso province of Italy. We used Cox regression models, including vaccination as time-dependent exposure and adjusting for socio-demographic and clinical characteristics, to estimate the hazard ratios (HR) of COVID-19 related and unrelated death by number of doses and by time since administration of COVID-19 vaccines.

Results: Despite decreasing over time, the HR of COVID-19-related death in vaccinated compared to unvaccinated participants showed a significant vaccine-induced protection after the primary cycle or any booster dose. To a lesser extent, we also observed a reduced COVID-19-unrelated mortality associated with vaccination, with the HR ranging from 0.72 (95%CI: 0.69-0.75) after two or more booster doses to 0.83 (95%CI: 0.77-0.89) after the first dose. We estimated a lower HR of COVID-19-unrelated death ≤30 days after a vaccine dose (HR=0.48, 95%CI: 0.44-0.51) than >30 days later (HR=0.80, 95%CI: 0.77-0.83).

Conclusions: These results are reassuring about safety of COVID-19 vaccines and confirm their high effectiveness against COVID-19-related death, thus supporting seasonal COVID-19 vaccination campaigns.

Background: Optimal isavuconazole (ISA) dosing, trough concentrations (Cmin), and toxicity profiles in elderly patients with invasive pulmonary fungal disease (IFDs) remain unclear.

Methods: A multicenter retrospective study enrolled elderly IFDs inpatients treated with ISA at 5 tertiary hospitals in Beijing from October 2022 to June 2025. Serial Cmin monitoring and analysis of overexposure, toxicity, and efficacy were performed.

Results: 140 Cmin values were assessed in 42 patients. Dose-reduction group maintained Cmin consistently >1 mg/L, with a higher target concentration achievement (98.1% vs 64.4%, P<0.05) compared with conventional dosing. Conventional dosing showed 35.6% overexposure(daily Cmin increase is 0.033 mg/L, P=0.009), linked to reduced eGFR within 21 days (OR=0.955, P=0.028) and BMI at 60 and 90 days post-treatment (OR=0.788 and 0.780, both P<0.05). Gastrointestinal toxicity (threshold: 4.693 mg/L) and hepatotoxicity were more frequent in conventional group compared with dose-reduction group. Mortality and efficacy did not differ significantly between groups.

Conclusions: TDM-guided ISA dose reduction enhances target concentration attainment, reduces overexposure and toxicity without compromising efficacy, and is recommended for elderly patients, particularly those with renal impairment or lower BMI.

Background: Osteoarticular infections (OAIs) in children is a significant diagnostic challenge for healthcare professionals. Traditional culture techniques are often time consuming and demonstrated low sensitivity. This systematic review aims to evaluate the diagnostic yield of metagenomic Next Generation Sequencing (mNGS) compared to standard culture for detecting pathogens in OAIs.

Methods: A systematic review (PROSPERO CRD420251131272) of three databases (2000-2025) was performed. Study quality was assessed using the QUADAS-2 tool. A meta-analysis was performed using a random-effects model to calculate pooled positive detection rate with 95% confidence intervals (95%CI). Heterogeneity was quantified (I²), and sensitivity analysis with leave-one-out and subgroups were performed.

Findings: From 35 included studies (>3000 patients), mNGS demonstrated a significantly higher pooled positive detection rate (81%; 95%CI:75 to 85%) than traditional culture (35%; 95%CI:29 to 41%) with high heterogeneity (>80%). mNGS performed consistently in pediatric (79%) and adult (81%) subgroups and was particularly effective for spinal infections (82%).

Interpretation: The mNGS demonstrates a significantly higher diagnostic yield than standard culture for pathogen detection in osteoarticular infections. Its simplicity of execution, its fast-processing methods and high sensitivity, are promising factors that could lead to a more reliable detection of the causative microorganism responsible for an osteoarticular infection.

Objectives: This study evaluates the clinical impact of an evidence-based intervention bundle.

Methods: We conducted a prospective, observational, before-and-after study from July'12 to February'22, including 378 patients with KPC-Kp infection. The intervention implemented structured quality-of-care indicators (QCIs), including colonization screening (weekly screening in high-risk wards and screening at admission for patients with prior KPC-Kp colonization and residents from long-term care facilities with high prevalence) and tailored antibiotic strategies (empirical treatment with ceftazidime-avibactam was permitted in colonized patients when clinically indicated). Primary outcome was 30-day all-cause mortality. Multivariate logistic regression and sensitivity analyses identified patient subgroups deriving the greatest benefit.

Results: The bundle intervention significantly reduced 30-day mortality (adjusted OR, 0.41; 95% CI, 0.24-0.73; P<0.01), particularly among patients with bacteremia (OR, 0.31; 95% CI, 0.12-0.84) and appropriate empirical therapy (OR, 0.36; 95% CI, 0.14-0.94). Mortality also decreased significantly in traditionally lower-risk groups, including patients without chronic kidney disease (OR, 0.42; 95% CI, 0.22-0.81), Pitt score ≤ 2 (OR, 0.12; 95% CI, 0.03-0.52), non-rapidly fatal underlying conditions (OR, 0.33; 95% CI, 0.14-0.77) and INCREMENT-CPE score < 8 (OR, 0.39; 95% CI, 0.18-0.82).

Conclusion: Implementing an evidence-based bundle significantly improved survival in patients with KPC-Kp infections.Proactive identification and early antibiotic treatment are essential.

Antimicrobial resistance (AMR) remains a critical global health threat, especially in low- and middle-income countries (LMICs). The Society of Antimicrobial Stewardship PractIces (SASPI) in India recently published 42 Integrated Antimicrobial Stewardship (IAS) Practice Statements- a unified framework spanning administrative, diagnostic, infection-prevention, and antimicrobial-use domains These statements translate national and global AMR strategies into actionable checkpoints suitable for hospitals in LMICs like India. Unlike conventional siloed models, IAS promotes coordinated accountability between hospital leadership, diagnostic laboratories, and prescribers. This editorial summarizes rationale, structure, and operational value of the 42 stewardship practices through a "PRESCRIBES" framework in the form of checkpoints and highlights it's relevance to LMICs. It is the right moment to initiate these checkpoints organized under the following subheadings 1) Policy for AMR containment, 2) Resource integration for IAS practice, 3) Education to different cadres of healthcare providers, 4) Surveillance of practices, 5) right Culture of sending and acting upon diagnostics, 6) Rational antimicrobial use, 7) Information updates through AMR dashboards, 8) attention to right Behavioral interventions driving appropriate practices, 9) Engagement with multiple sections and cadres, and10) Sustainability plans and actions With regular audits of facilities against 'PRESCRIBES' framework, we think a culture of self-evaluation by healthcare facilities can be fostered. Additionally, the periodic exchanges of experiences such as that done during National Conference of SASPI, a platform can be provided for learning and sharing of useful practices. Embedding such integrated frameworks is essential to achieve the targets of National Action Plan on AMR and the WHO Global Action Plan.