International Journal of Infectious Diseases最新文献

Objectives: Second-line therapy for relapsed or refractory acute myeloid leukemia (R/R AML) involves either intensive chemotherapy (ICT) or azacitidine and venetoclax (AZAVEN), but their comparative infectious risks are not well established.

Methods: This retrospective multicenter study evaluated infectious complications in 246 adult R/R AML patients eligible for allogeneic hematopoietic stem-cell transplantation (HSCT) across five French centers from 2015 to 2023.

Results: Of these, 163 received ICT and 83 received AZAVEN, with similar baseline characteristics except for more frequent antifungal prophylaxis in the AZAVEN group (55% vs. 28%). A total of 358 infectious events were documented, predominantly during hospitalization (90%). Most infections were severe (grade 3 or 4), with no significant difference in fatal infections between groups. Bloodstream infections without organ involvement (38%) and bacterial infections (49%) were most common. By day 100, the cumulative incidence of a first infection was significantly lower with AZAVEN (37%, 95%CI:26-47%) than on ICT (82%, 95%CI:76-87%) compared to ICT (HR=0.23, p<0.001), confirmed by multivariate analysis. Leukemia control rates were similar between groups.

Conclusions: These results suggest that AZAVEN is associated with lower infectious burden than ICT, while maintaining equivalent anti-leukemic efficacy, supporting its use as a bridging therapy before HSCT in fit R/R AML patients.

Objectives: Using real-world data from Japan, this study aimed to examine disease risks in COVID-19 patients before and after infection.

Methods: We used the Japanese Health Insurance Database to identify hospitalized patients in Japan aged 60 years who were newly diagnosed with COVID-19 by December 31, 2020. To form the study population, these patients were matched 1:1 with individuals without COVID-19 on the basis of age, sex, and index date. Two analytical approaches were employed: a case-control study using conditional logistic least absolute shrinkage and selection operator (LASSO) regression to identify risk factors for COVID-19 infection and a retrospective cohort study using time-to-event analysis to evaluate the risk of developing sequelae following infection.

Results: Overall, 8,072 patients were included (4,036 in each group). Organic, including symptomatic mental disorders demonstrated the strongest association (odds ratio, 2.276). Following infection, behavioral syndromes associated with physiological disturbances and physical factors exhibited the highest risk of developing new conditions (hazard ratio [HR], 3.523; 95% confidence interval [CI], 2.101-5.907), followed by pulmonary heart disease and diseases of the pulmonary circulation (HR, 2.954; 95% CI, 1.360-6.420).

Conclusion: Our findings suggest an association between COVID-19 and mental and behavioral disorders.

Background: Appropriate antibiotic use is crucial in intensive care units (ICUs) where patients are highly vulnerable to infection and antimicrobial resistance. This study evaluated the effect of a stepwise antimicrobial stewardship program (ASP) on antibiotic utilization and clinical outcomes in an open medical ICU.

Methods: The ASP was implemented in two sequential stages. From July 2023, infectious disease specialists reviewed electronic records three times weekly for patients receiving meropenem or imipenem and suggested recommendations (record-based ASP). From September 2024, physician assistants (PA) joined these rounds, extending stewardship to all antibiotic users (round-based ASP). Study periods were pre-ASP (June 2022-June 2023, Period 1), record-based ASP (August 2023-August 2024, Period 2), and round-based ASP (October 2024-June 2025, Period 3). Outcomes included antibiotic utilization (days of therapy [DOT] per 1,000 patient-days), multidrug-resistant organism isolation, and ICU mortality.

Results: Total antibiotic use decreased from 1,462.6 DOT/1,000 patient-days in Period 1 to 1,335.4 (Incidence rate ratio, IRR 0.91, 95% CI 0.89-0.94) in Period 2 and 1,088.5 (0.82, 95% CI 0.79-0.85) in Period 3. Meropenem/imipenem use declined from 228.2 to 176.0 (0.77, 95% CI 0.71-0.84) and 132.6 (0.75, 95% CI 0.68-0.84), and antipseudomonal β-lactam use from 655.5 to 592.2 (0.90, 95% CI 0.86-0.95) and 448.8 (0.76, 95% CI 0.72-0.80). Acinetobacter baumannii isolation and patient mortality also decreased between Periods 2 and 3.

Conclusions: Stepwise ASP implementation significantly reduced antibiotic consumption and multidrug-resistant organism isolation. PA-supported stewardship rounds were feasible and associated with improved outcomes in an open ICU setting.

Introduction: Surveillance of surgical site infections (SSIs) is a key component of prevention. Semi-automated approaches have emerged to reduce the workload of full chart reviews. This study evaluated the sensitivity, specificity, positive and negative predictive values (PPV, NPV) of a postoperative antibiotic therapy (POAT-SSI) semi-automated algorithm in lumbar spine surgery.

Method: All patients who underwent lumbar spine surgery in our institution under the French National SSI surveillance program (FNP-SSI) during 2023-2024 were included. Complete chart review served as the gold standard and was compared with FNP-SSI algorithms and the POAT-SSI approach identifying suspected cases. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC curve analysis.

Results: The POAT-SSI algorithm showed higher sensitivity (100% vs. 62%) and similar specificity (96% vs. 97%) compared to the FNP-SSI method, with both showing excellent NPV (≥99%). The POAT-SSI approach achieved a superior Youden index (0.96 vs. 0.59) and a significantly better AUC (0.978 vs. 0.795, p = 0.046). PPV remained modest due to low SSI prevalence.

Conclusion: The POAT-SSI based algorithm showed superior diagnostic performance for SSI surveillance while reducing manual workload. These results support integrating such targeted digital strategies into routine infection control monitoring.

Objectives: To develop and evaluate a rapid, one-pot molecular assay for the detection of Treponema pallidum subspecies pallidum (TPA), addressing the limitations of current diagnostic methods influenced by sample type and pathogen load.

Methods: A one-pot assay integrating recombinase polymerase amplification (RPA) and Cas13a-based collateral cleavage activity was established for isothermal detection of TPA. The assay targeted the tpp47/tp0574 gene and was validated using 186 clinical specimens, including whole blood, lesion exudate, and cerebrospinal fluid (CSF) samples.

Results: The one-pot RPA-Cas13a assay demonstrated high analytical sensitivity and specificity for TPA detection. Clinical sensitivities were 58.97% in whole blood, 84.21% in lesion exudate, and 57.14% in CSF, with 100% specificity across all sample types.

Conclusions: This one-pot isothermal assay enables rapid and accurate detection of T. pallidum directly from diverse clinical samples. Its high specificity and field-friendly format make it a promising complementary tool to conventional diagnostic approaches, particularly for point-of-care testing and screening in resource-limited or high-risk settings.

Objectives: To develop a CT-based multimodal transformer model to precisely predict lymph node (LN) metastasis in hepatic alveolar echinococcosis (HAE) patients.

Methods: A total of 318 HAE patients from three centers were allocated to a training set, an internal validation set, and two external validation sets. Radiomics, 3D deep learning (3DDL), and 2D deep learning (2DDL) features were retrieved from contrast-enhanced CT images of the hepatic hilar LN. Random forest models were constructed utilizing various features. Ultimately, we developed and assessed a transformer-based multimodal fusion model. Model performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

Results: Compared with both the radiomics and the 2DDL models, the 3DDL model exhibited enhanced discriminative ability for LN status. The transformer model achieved the highest AUC (95%CI) of 0.951 (0.898-1.000), 0.927 (0.850-1.000), and 0.933 (0.847-1.000) for the three validation sets. DCA revealed that the transformer model produced the greatest net clinical advantage.

Conclusion: This study innovatively constructed a transformer-based multimodal fusion model, providing a practical and reliable tool for predicting LN metastasis in HAE patients. More importantly, this model provides a foundation for guiding LN dissection in HAE patients and is readily applicable in clinical settings.

Objectives: To estimate the prevalence of oncogenic oral HPV among sex workers in Brazil and examine socio-behavioral covariates.

Methods: A cross-sectional, multicenter study was conducted from 2019 to 2023 and recruited male and female sex workers from all Brazilian regions using respondent-driven sampling (RDS). Trained professionals conducted structured interviews assessing sociodemographic characteristics and sexual behaviors. Oral samples were tested for HPV genotypes using PCR-based methods. RDS-II estimation accounted for sampling design, with robust Poisson regression estimating crude and adjusted prevalence ratios.

Results: Most participants were female (84.2% [95% CI 78.1-90.4]), worked in commercial sex for under five years (54.2% [48.3-60.2]), and reported consistent condom use (53.4% [47.3-59.6]). Among 940 participants, high-risk HPV prevalence was 7.2% (95% CI 4.1-10.3), with significantly higher rates among sex workers in Central-west/Southeast/South regions (adjusted PR 4.39 [1.89-10.2]) and those with >15 weekly sexual partners (adjusted PR 4.11 [1.54-11.0]).

Conclusions: Disparities in oral HPV prevalence among Brazilian sex workers suggest that structural and behavioral factors influence infection risk. These findings highlight the need for interventions tailored for this high-risk population, including HPV vaccination and sexual health education.

Strongyloidiasis can persist lifelong through autoinfection and may abruptly progress to hyperinfection with disseminated disease. We report a 38-year-old woman from southwestern Colombia with two months of postprandial bilious vomiting, oral intolerance, abdominal pain and 19 kg weight loss, initially managed as upper gastrointestinal bleeding and constitutional syndrome with suspected malignancy. Endoscopy showed hemorrhagic/atrophic gastritis, a deformed pylorus and irregular duodenal mucosa. On day 4 she deteriorated with hypoxemia and refractory shock; intubation, vasopressors, broad-spectrum antibiotics and corticosteroids were instituted, but she died due to refractory septic shock and multiorgan failure. Histopathology of duodenal biopsies revealed numerous Strongyloides stercoralis larvae. Autopsy confirmed disseminated strongyloidiasis with hyperinfection, polymicrobial pulmonary and central nervous system infection, and multiorgan failure. This case illustrates a lethal gastrointestinal presentation mimicking gastric outlet obstruction without overt immunosuppression. In endemic settings, the combination of severe malnutrition, unexplained upper gastrointestinal symptoms and characteristic duodenal mucosal changes should prompt early testing for Strongyloides to avoid corticosteroid-triggered hyperinfection. Timely diagnosis and ivermectin-based therapy are essential to prevent catastrophic outcomes.

Antibiotic-resistant Salmonella infections pose a serious therapeutic challenge in children. We report two pediatric cases that were successfully treated with washed microbiota transplantation (WMT) as salvage therapy. Both patients achieved sustained clinical and microbiological remission, suggesting WMT is a promising option for refractory pediatric salmonellosis.