International Journal of Infectious Diseases最新文献

Objectives: To evaluate susceptibilities of novel antibiotics against imipenem-non-susceptible Escherichia coli (INS-EC), Klebsiella pneumoniae (INS-KP), Acinetobacter baumannii (INS-AB), Pseudomonas aeruginosa (INS-PA) in Taiwan, and the potential resistance mechanisms.

Methods: The minimum inhibitory concentrations of 387 INS isolates (2020-2022) were determined by broth microdilution. Resistance genes were detected using multiplex PCR. Whole-genome sequencing and plasmid curing were conducted to identify potential resistance mechanisms.

Results: Cefiderocol showed >90% susceptibility across all species. The susceptibilities of meropenem-xeruborbactam (XEM), cefepime-taniborbactam (FTB), and aztreonam-avibactam (AZA) were 72-96% for 29 INS-EC; 95-97% for 138 INS-KP; and 0-95% for 135 INS-AB; and 32-70% for 85 INS-PA. Sulbactam-durlobactam (SUD) was active against 93% of INS-AB. Cefiderocol, XEM, and AZA retained >80% activity against class B carbapenemase-producing INS-EC/KP. Cefiderocol, XEM, and SUD showed > 90% activity against bla_{OXA-23/24-like} INS-AB. Reduced FTB activity in INS-EC was associated with both YRIK/YRIN insertion in penicillin-binding protein 3 (PBP3) and carbapenemase genes or bla_IMP alone, whereas reduced AZA activity was linked to PBP3 alteration or bla_CMY-42. CONCLUSIONS: Cefiderocol was highly effective, whereas novel β-lactam/β-lactamase inhibitors activity varied by species and carbapenemase types. PBP3 alterations reduced FTB and AZA activity in INS-EC.

Background: Antiretroviral therapy (ART) has been associated with components of metabolic syndrome (MetS), including glucose intolerance, weight gain, and dyslipidemia. However, with the advent of newer agents such as dolutegravir (DTG), evidence on the burden of MetS remains limited. Therefore, this study aimed to assess the prevalence of MetS and its determinants among people living with HIV (PLWH) receiving DTG-based ART at Debre Markos Comprehensive Specialized Hospital (DMCSH), Northwest Ethiopia.

Methods: An institution-based cross-sectional study was conducted from December 1, 2021, to February 28, 2022, among 422 randomly selected participants using face-to-face interviews, anthropometric assessments, medical chart reviews, and biochemical measurements. MetS was defined based on the 2009 harmonized criteria. Epi-Data version 4.6 and SPSS version 26 were used for data entry and statistical analysis, respectively. Bivariable and multivariable logistic regression analyses were employed to identify factors associated with MetS. A statistical significance was decided at p ≤ 0.05.

Results: The prevalence of MetS was 27.7% (95% CI: 23.7-32.2), with reduced high-density lipoprotein cholesterol (60.9%) was the most prevalent component. In adjusted analysis, alcohol use (AOR: 1.92; 95% CI: 1.02-3.6), inadequate physical activity (AOR: 1.7; 95% CI: 1.08-2.67), body mass index (BMI) ≥ 25 kg/m² (AOR: 1.75; 95% CI: 1.1-2.76), and CD4+ T-cell count ≥500 cell/mm³ (AOR: 1.73; 95% CI: 1.1-2.73) were significantly associated with MetS.

Conclusion: Overall, our study showed that MetS (27.7%) was relatively common among PLWH receiving DTG-based ART. Alcohol use, inadequate physical activity, BMI ≥25 kg/m², and CD4 T-cell count ≥500 cell/mm³ were significantly associated with MetS. Routine clinical monitoring and assessment of all MetS components are recommended for PLWH receiving DTG-based ART, with particular attention to those who consume alcohol, have inadequate physical activity, elevated BMI, or higher CD4+ T-cell count.

Background: Long-acting injectable cabotegravir (CAB-LA) offers an alternative to oral PrEP, with potential benefits for adherence and stigma reduction. We investigated behavioral and psychosocial factors among early CAB-LA adopters in Italy, focusing on mental health, stigma, and prevention practices.

Material and method: In a multicentre study, participants initiating CAB-LA completed baseline and follow-up questionnaires (weeks 4-20) assessing mental health, stigma, and prevention behaviors. Descriptive statistics summarized findings.

Results: Of the 388 respondents, most (302, 89.2%) had prior experience with injectable medications, and 256 (75.9%) described these experiences positively. About half (198, 58.7%) reported recreational drug use, while 42 (12.4%) and 72 (21.3%) reported depressive and anxiety symptoms. Nearly one in four (78, 23.2%) were actively engaged in psychotherapy, while an additional 98 (28.9%) reported past engagement. Consistent condom use declined over time, with selective strategies increasing. A strong preference for biannual injections emerged (235, 69.8%), primarily administered in clinical settings (103, 30.5%). PrEP-related stigma was reported by 72 (21.3%) (strangers and friends as the most common sources), though some decline was observed during follow-up.

Conclusion: CAB-LA PrEP shows high acceptability, adherence, and evolving prevention practices. Although its discreet delivery may alleviate some concerns about visibility and disclosure, integration with mental health support and stigma-sensitive care is essential.

Introduction: Bacterial meningitis caused by anaerobes, particularly Fusobacterium, is highly unusual. Fusobacterium necrophorum is the most significant pathogen; however, information regarding F. nucleatum meningitis is extremely scarce. We present a case confirmed by culture, complicated by cavernous sinus thrombosis.

Case report: A 32-year-old man with a history of recent molar extraction, frequent alcohol intake, and cigarette smoking was enrolled in this study. The patient presented with pain in the left maxillary region, fever spikes, photophobia, and horizontal diplopia. Examination revealed left sixth cranial nerve palsy and positive jolt accentuation. Laboratory tests revealed a systemic inflammatory response, and lumbar puncture confirmed neutrophilic meningitis with Fusobacterium nucleatum isolation. Magnetic resonance imaging revealed left cavernous sinus thrombosis requiring anticoagulation. The patient was treated with ceftriaxone + metronidazole, and a follow-up lumbar puncture on day 14 showed biochemical improvement. A 28-day treatment was completed with full recovery.

Discussion: Meningitis is associated with high morbidity and mortality. Anaerobic bacteria account for only 2.4% of cases, usually in immunocompromised or chronically ill patients. Central nervous system infections due to F. nucleatum are rare, usually causing oral dissemination of abscesses. Cerebral venous thrombosis has been described as a complication but remains anecdotal. Metronidazole is the most widely accepted treatment, but evidence on its use as an anticoagulant is still debated.

Conclusion: F. nucleatum meningitis may cause cavernous sinus thrombosis in immunocompetent patients. Treatment with metronidazole and anticoagulation can be effective. Few similar cases have been reported.

Objectives: To quantify national trends in sepsis incidence, mortality, healthcare utilisation, and direct hospital costs in Switzerland from 2019 to 2023 using routine hospital discharge data.

Methods: We conducted a nationwide retrospective analysis of all acute care hospitalisations in Switzerland (2019-23) using discharge data linked to mortality and cost records. Sepsis was identified using explicit and implicit ICD-10 coding. Outcomes included incidence, in-hospital, 30-, 180- and 360-day mortality, resource use and direct hospital costs.

Results: From 2019 to 2023, 99,579 admissions (1·6%) met explicit and 410,498 (6·5%) implicit sepsis definitions. Incidence and mortality were stable, with highest rates in neonates and older adults. In 2023, age- and sex-standardised incidence was 238 per 100,000 population for explicit and 963 per 100,000 for implicit sepsis; in-hospital mortality for explicit sepsis was 189 per 1000 admissions. Annual direct hospital costs rose to CHF 1·07 billion, averaging CHF 51,000 per case.

Conclusions: Sepsis represents a significant and underestimated burden in Switzerland, marked by high mortality and rising costs. Reliance on explicit coding underestimates this burden. Integrated surveillance and harmonised definitions are needed to capture the true impact and guide policy.

Whipple's disease is a rare systemic infection that may mimic hematologic disorders. We report a case initially misdiagnosed as prefibrotic myelofibrosis based on systemic symptoms and bone marrow findings. Further investigations by PCR confirmed Tropheryma whipplei infection. Antibiotic therapy led to full clinical remission and resolution of bone marrow abnormalities. This case highlights the importance of considering infectious etiologies in patients with constitutional symptoms and bone marrow changes, to avoid misdiagnosis and inappropriate management.

Objectives: Klebsiella pneumoniae is an increasingly threatening global pathogen with high rates of antibiotic resistance and no licensed vaccines available. Despite its worldwide importance, little is known about the human adaptive immune response to K. pneumoniae infection.

Methods: Herein we observed the longitudinal antibody responses of three immunocompetent patients hospitalized with K. pneumoniae bacteremia. We analyzed the human serum for antibody titers and in vitro functionality. Further, serum function was evaluated via an in vivo mouse model.

Results: We found that in each case, anti-K. pneumoniae antibodies against the infecting strain were still detectable a year after the initial infection. Serum bactericidal assays revealed a wide spectrum of antibody functionality against the inciting strains in vitro. Finally, mice were passively immunized with three patients' sera; one of these sera protected mice from lethal bacteremia challenge with its matched K. pneumoniae strain.

Conclusions: These results highlight variability in the human humoral immune response to K. pneumoniae bacteremia and stress the importance of studying multiple aspects of antibody-mediated protection to inform vaccine design.

Objectives: We aimed to adapt the implementation of vaccination and infectious diseases and female genital mutilation/cutting (FGM/C) screening recommendations for migrants in two Spanish primary care settings, Catalonia and Almería.

Methods: We refined the ADAPTE framework and conducted a literature review of infectious diseases and FGM/C screening and vaccination guidelines (2003-2022) at international, national, and regional levels, two consensus workshops with multidisciplinary teams for recommendations alignment, and a survey to evaluate participants' level of agreement.

Results: The target migrant population was defined, and HIV, hepatitis B (HBV) and C virus (HCV), active tuberculosis (TB), schistosomiasis, strongyloidiasis, Chagas disease, and FGM/C were included in the screening recommendations. In Almería, syphilis, latent TB, and intestinal parasites were also included. However, vaccination was not included at either study site. Both settings agreed to test migrants from high-endemic countries for hepatitis B virus (prevalence ≥2%), schistosomiasis, strongyloidiasis, and FGM/C. The Catalonia team agreed to test migrants from high-endemic countries for HIV (prevalence >1%), HCV (prevalence ≥2%), and Chagas disease. In Almería, participants agreed to offer universal testing to all migrants for HIV, HCV, and syphilis, whereas Chagas disease was only offered to childbearing-age women and migrants at risk of immunosupression from endemic countries. Both regions recommended active TB screening for newly arrived migrants (<5 years) from TB-incidence countries with ≥50 cases/100,000 population. Almería added latent TB screening in 16-35-year-old migrants.

Conclusions: We tailored the implementation of the screening recommendations to the migrant profiles and health care contexts, which can enhance health care provision for migrants.