International Journal of Infectious Diseases最新文献

Objectives: To evaluate the impact of a phased, multifaceted intervention on reducing central line-associated bloodstream infection (CLABSI) rates in a large pediatric referral hospital in Vietnam.

Methods: A multi-year quality improvement study conducted in six intensive care units at the Vietnam National Children's Hospital. The intervention was implemented in three phases: baseline surveillance (2018-2019), CLABSI prevention bundle implementation (2020-2021), and compliance monitoring with data-driven quality improvement (2021-2024). Primary outcome was CLABSI incidence per 1,000 central line-days. Bundle compliance was assessed using structured checklists. Descriptive methods were used to examine trends in CLABSI and compliance rates. Associations between bundle compliance and CLABSI rates were explored.

Results: The pooled CLABSI rate declined from 5.8 per 1,000 central line-days at baseline to 0.9 per 1,000 in 2024, representing an 84.5% reduction. Among 12,189 observed central line insertions, compliance with all prevention bundle elements was 89.7%, increasing from 84.6% in 2021 to 93.1% in 2024 (p<0.001). Higher quarterly compliance correlated with lower quarterly CLABSI rates (r=-0.555; p=0.039).

Conclusions: A sustained reduction in CLABSI rates was achieved through a multifaceted approach integrating standardized surveillance, evidence-based bundles, and continuous audit-and-feedback. This study demonstrates the feasibility of adapting and sustaining infection prevention strategies in a pediatric low- and middle-income country setting.

Objective: Effective adaptive immune responses are essential for immune protection against SARS-CoV-2. We investigated the impact of various forms of acquired or iatrogenic immunodeficiency on anti-SARS-CoV-2 humoral and cellular immune responses among children.

Study design: We analyzed anti-Spike IgG levels, neutralizing activities, and the magnitude and polyfunctionality of anti-Spike T-cell responses in immunocompromised children compared to immunocompetent children, prospectively recruited between June and October 2021, prior to vaccination.

Results: We observed marked quantitative and functional alterations in anti-Spike humoral immune response in children with inflammatory bowel diseases treated with anti-TNFα. In children living with HIV and children after kidney transplantation, the production of anti-Spike antibody was conserved but with a decrease of their neutralizing activity against SARS-CoV-2 strains. Regarding anti-Spike cellular immune response, immunocompetent and immunocompromised children similarly harbored a low anti-Spike response, predominantly displaying a CD4⁺ phenotype, with a preserved CD4⁺ T cell polyfunctionality.

Conclusion: The intensity and the nature of the anti-viral immune alterations depend on the type and the degree of the immune impairment. Evaluating the specific host immune actors responsible for maintaining a protective response appears essential to adapt vaccine strategy in these patients, opening the door to new, more personalized vaccination approaches.

Objectives: This study investigated emergence of Visceral Leishmaniasis (VL) in 2021, in Kajiado County in Kenya, representing a newly recognized region of endemic transmission.

Methods: The investigation involved community sensitization, medical camps, and entomological surveys across eight villages. We screened 100 individuals with indicative symptoms of leishmaniasis, and also carried out an entomological survey.

Results: We found 10 patients of VL, predominantly in children under 15. Of 22 suspected cutaneous leishmaniasis (CL) cases, eight were confirmed with Leishmania tropica. Entomological surveys identified 4,781 sandflies, with Sergentomyia species being most abundant. DNA of Leishmania donovani was detected in multiple Sergentomyia species and Phlebotomus saevus, while L. tropica DNA was found in P. saevus. Blood meal analysis revealed a strong preference for human blood, followed by goats, indicating high human-vector contact.

Conclusions: The study highlights the value of a multisectoral approach to ourbreak responses, which resulted establishment of two new treatment centers in Kajiado enhancing continuing access to care, and associated surveillance. The study confirmed L. donovani and L. tropica as the causative agents for VL and CL, respectively, in Kajiado. The unusual co-occurrence of both forms complicates treatment and raises concerns about potential genetic recombination.

Background: Galactomannan index (GMI) is established as a diagnostic tool for invasive aspergillosis (IA), while its utility in monitoring antifungal treatment (AFT) response and prognostic value remains unclear. This study evaluated the validity of serum GM as a biomarker for AFT monitoring and its prognostic significance by correlating GMI with clinical response and survival of IA.

Objectives: Patients with IA and at least two sequential serum GMI measurements were identified from the FungiScope® registry. Joint models of event-time and longitudinal outcome were used for imputing missing GMI to account for the relationship between GMI and time to death, as well as GMI and time to drop-out for the survival analysis and AFT response analysis, respectively. Cox proportional hazards models and logistic regression models assessed survival and clinical response on GMI changes at day 7, with baseline log GMI as an adjustment covariate.

Results: Among 66 patients with IA, correlation between day 7 GMI predictions and observed values was 92% and 88% in the survival and AFT analysis, respectively. GMI decreased in both patients who died within 42 days and those who survived but maintained higher in patients who died. GMI increased or declined less in patients who died within 42 days whereas in survivors, a continuous decline of GMI was observed. Patients with a baseline GMI < 1 had a higher survival rate until day 42 (17/21, 81.0%) compared to those with GMI ≥ 1 (31/45, 68.9%) with a risk of death twice as high as with GMI < 1 (HR=2.107, p=0.19).

Conclusion: Serum GMI is a non-invasive, predictive tool for estimating survival probability at onset of IA. Early GMI changes correlate with survival and could prompt timely AFT adjustment, potentially improving clinical outcomes. Additionally, GMI could serve as surrogate endpoint in clinical trials, facilitating development of new antifungal strategies.

Background: The 2024-2025 season had the highest intensity of influenza-like-illness (ILI) in thirteen seasons, and severe influenza B disease was reported by hospital physicians among children. These, and the absence of influenza B/Yamagata after the COVID-19 pandemic, prompted the evaluation of the 2024-2025 influenza cases by age-group and influenza type, compared with previous seasons.

Methods: Influenza-positive hospital and community cases for the 2024-2025 season and four previous seasons with influenza B circulation were retrieved from several data sources. Raw numbers and relative percentages of cases, including intensive or enhanced care unit (ICU or ECU), and 30-day mortality were evaluated by age-group and influenza type. Molecular characterization of influenza viruses of the 2024-2025 season was compared with other seasons.

Results: The 2024-2025 B/Victoria demonstrated molecular resemblance to the 2024-2025 vaccine. During the 2024-2025 season and other seasons with circulating and vaccine influenza B/lineage match, influenza B predominantly affected younger age-groups. During seasons with circulating and vaccine influenza B/lineage mismatch, the percentage of influenza B cases among older age-groups, was not substantially different that the younger age-groups. Influenza vaccination rates among children have been low throughout the evaluation period.

Conclusion: Increasing influenza vaccination among young age-groups is paramount for reducing influenza morbidity.

Objectives: The SARS-CoV-2 pandemic has resulted in millions of deaths worldwide. However, the risk of transmission from COVID-19 corpses remain unclear, posing challenges for forensic medicine in establishing effective infection control measures during autopsies. This study aimed to investigate the presence of infectious SARS-CoV-2 in corpses and identify factors affecting viral infectivity.

Methods: External examinations of 76 corpses with COVID-19 were performed, and nasopharyngeal, perioral, hand swabs, serum, cerebrospinal fluid (CSF), and urine samples were collected. Viral RNA was quantified by using digital PCR, and infectious viruses were assessed via isolation. Multivariate logistic regression analysis was used to identify factors associated with viral infectivity.

Results: Infectious viruses were isolated from the nasopharynx (51%), perioral region (10.3%), and hands (1.8%). Common predictive factors for nasopharyngeal and perioral viral infectivity were a higher viral load and shorter time from symptom onset. Detectable viral RNA in serum was also associated with nasopharyngeal infectivity. No infectious viruses were detected in serum, CSF, or urine samples.

Conclusions: Infectious SARS-CoV-2 was detected in the nasopharynx and on the surface of COVID-19 corpses. Viral infectivity correlated with viral load and time from symptom onset, highlighting the importance of strict infection control when handling COVID-19 corpses.

Objectives: Reassessing the impact of tattooing circumstances on hepatitis B (HBV) and hepatitis C (HCV) virus transmission to inform the World Health Organization's hepatitis strategy, which aims to reduce transmission by 90% by 2030.

Methods: Using data from the Cancer Risk Associated with the Body Art of Tattooing (CRABAT) study embedded in the French cohort Constances, we examined the associations of tattooing circumstances with history of HBV and/or HCV infections (self-reported and/or hospital records). Cross-sectional multivariate logistic regression models were fitted in the population aged 45 years and older, as well as retrospective cohort analyses restricted to a subsample of participants with confirmed first tattoo and infection date, all adjusted for known hepatitis risk factors.

Results: Of 77,826 questionnaire respondents, 7.4% (n = 5766) were tattooed, and 3330 (4.9%) answered a complementary tattoo exposure questionnaire in 2023. Tattooing was associated with an increased prevalence of any hepatitis in the multivariate (prevalence odds ratio: 1.49 [95% confidence interval: 1.16-1.91]) and Cox models (hazard ratio [HR]: 1.6 [1.22-2.08]). The strongest risks were found for HCV with tattooing outside studios (HR: 4.14 [2.33-7.35]) and for HBV with tattooing outside countries with regulations (HR: 3.22 [1.39-7.44]).

Conclusions: Unsafe tattooing practices as preventable risk factor for hepatitis transmissions could be underestimated.

Objective: COVID-19 vaccine surveillance detected thrombotic thrombocytopenia syndrome (TTS), a rare combination of thrombosis and thrombocytopenia, after COVID-19 vaccination. We evaluated TTS risk within 28 days of AZD1222 and BNT162b2 exposure.

Methods: Matched case-control (MCCS) and self-controlled case series (SCCS) studies used Oxford-Royal College of General Practitioners Research and Surveillance Centre data linked to immunisation, hospitalisation and death data. English patient records extracted from 2/12/2020 to 31/10/2022 were used to identify TTS cases and age, sex, and practice matched controls. Conditional logistic regression and conditional Poisson regression were used for MCCS and SCCS analyses, respectively.

Results: Of 666 TTS events identified, >90% happened without AZD1222/BNT162b2 exposure in the preceding 28 days. MCCS analyses showed no association between TTS and a composite of both first and second AZD1222 dose (adjusted odds ratio [aOR]: 1.45 [95% CI: 0.90-2.34]). Both studies showed increased TTS risk after AZD1222 first dose (MCCS, aOR: 2.12 [1.14-3.92]; SCCS, incidence rate ratio: 3.49 [2.22-5.49]). No association between TTS and BNT162b2 was observed.

Conclusions: Consistent with previous studies, we found an association between TTS and receiving a first dose of AZD1222. There were no associations of TTS with AZD1222 second dose and BNT162b2 first or second doses.

Objective: To develop and validate a critical risk prediction model for hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus.

Methods: Patients were randomly divided into a training group (n=344) and a validation group (n=226). Clinical data were gathered and analyzed. Logistic regression analysis was employed to construct a nomogram-based prediction model, which was subsequently simplified into a novel scoring scale. The calibration curve, receiver operating characteristic curve, and decision curve analysis were used to assess the model's calibration, discrimination, accuracy, and clinical applicability in both the training and validation cohorts.

Results: Hypotensive shock, myoglobin (Mb) and neutrophils counts were identified as independent predictors of critical risk. Based on these three predictors, a nomogram prediction model was developed and subsequently simplified into a scoring scale. The model demonstrated predictive performance in both the training cohort and the validation cohort (AUROC > 0.8). Furthermore, the calibration of the scoring scale and the nomogram was satisfactory (P > 0.05). Decision curve analysis revealed that the model provided significant net clinical benefit within the risk threshold range of 0% to 90%.

Conclusion: We developed and validated the first prediction model for critically-illed HFRS patients which will aid clinicians in clinical decision-making.