Journal of Infection and Public Health最新文献_第7页

How does hypervirulent Klebsiella pneumoniae influence the risk and visual outcomes of endogenous endophthalmitis in Klebsiella pneumoniae pyogenic liver abscess? A systematic review and meta analysis 高毒力肺炎克雷伯菌如何影响肺炎克雷伯菌化脓性肝脓肿并发内源性眼内炎的风险和视力结果？系统回顾和荟萃分析

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-05 DOI: 10.1016/j.jiph.2025.103090

Kai-Yang Chen , Hoi-Chun Chan , Chi-Ming Chan

Background

Klebsiella pneumoniae pyogenic liver abscess (KP-PLA) is increasingly recognized as a cause of endogenous endophthalmitis (EE), particularly in East and Southeast Asia. Hypervirulent K. pneumoniae (hvKP) strains have been implicated in severe ocular complications, yet comprehensive data on incidence, risk factors, and visual outcomes are limited.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. We searched PubMed, Google Scholar, Cochrane Library, Science Direct for studies reporting KP-PLA-associated EE up to March 2025. Data on patient demographics, comorbidities, microbiological features, treatments, and visual outcomes were extracted. Pooled event rates and odds ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models.

Results

Seventeen studies encompassing 219 patients met inclusion criteria. Diabetes mellitus was common among KP PLA associated EE cases (pooled event rate 0.674; 95 % CI: 0.585–0.751; p < 0.001). hvKP strains, identified by positive string tests and virulence genes including rmpA, magA, and aerobactin, predominated in EE cases. Regional differences were observed, with higher prevalence in East and Southeast Asia. Despite aggressive systemic and ocular treatment, visual prognosis was poor: 77.9 % of patients had final visual acuity worse than 3/60. Early pars plana vitrectomy with silicone oil tamponade was associated with fewer postoperative interventions (p < 0.05).

Conclusions

EE is a devastating complication of KP-PLA, particularly in diabetic patients infected with hvKP. Early recognition of at-risk patients and prompt intervention, including early vitrectomy, are crucial to improve visual outcomes. These findings highlight the clinical importance of hvKP in the pathogenesis of EE and reinforce the need for vigilant ophthalmic monitoring in KP-PLA cases.

背景肺炎克雷伯菌化脓性肝脓肿（KP-PLA）越来越被认为是内源性眼内炎（EE）的原因，特别是在东亚和东南亚。高毒力肺炎克雷伯菌（hvKP）菌株与严重的眼部并发症有关，但有关发病率、危险因素和视力结果的综合数据有限。方法按照PRISMA指南进行系统评价和荟萃分析。我们检索了PubMed， b谷歌Scholar， Cochrane Library, Science Direct，检索了截至2025年3月报告与kp - pla相关的EE的研究。提取了患者人口统计学、合并症、微生物学特征、治疗和视觉结果的数据。使用随机效应模型计算95 %置信区间（CI）的合并事件发生率和优势比（OR）。结果17项研究219例患者符合纳入标准。糖尿病在KP - PLA相关EE病例中较为常见（合并事件率0.674;95 % CI: 0.585-0.751; p <； 0.001）。hvKP菌株，通过阳性串试验和毒力基因（包括rmpA、magA和有氧肌动蛋白）鉴定，在EE病例中占主导地位。观察到区域差异，东亚和东南亚的患病率较高。尽管进行了积极的全身和眼部治疗，但视力预后较差：77.9% %的患者最终视力低于3/60。早期玻璃体睫状体切除加硅油填塞与较少的术后干预相关（p <； 0.05）。结论see是KP-PLA的一种破坏性并发症，尤其是糖尿病患者感染hvKP时。早期识别高危患者并及时干预，包括早期玻璃体切除术，对改善视力至关重要。这些发现强调了hvKP在EE发病机制中的临床重要性，并加强了KP-PLA病例警惕眼科监测的必要性。

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引用次数: 0

Comparative analysis of colistin and polymyxin B minimal inhibitory concentrations in Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa 肠杆菌、鲍曼不动杆菌和铜绿假单胞菌对粘菌素和多粘菌素B最低抑菌浓度的比较分析

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-05 DOI: 10.1016/j.jiph.2025.103091

Yu-Shan Huang , Jann-Tay Wang , Yu-Chung Chuang , Wang-Huei Sheng , Shan-Chwen Chang

Background

Studies comparing colistin and polymyxin B minimum inhibitory concentrations (MICs), as well as their correlation and agreement, using non-commercial broth microdilution methods, remain limited. This study evaluated the in vitro susceptibilities of two polymyxins against clinically important Gram-negative bacteria.

Methods

Between 2018 and 2022, 891 Enterobacterales, 100 Acinetobacter baumannii, and 100 Pseudomonas aeruginosa clinical isolates from a tertiary hospital were tested for MICs of colistin and polymyxin B using broth microdilution. MIC correlation, categorical agreement (CA), essential agreement (EA), and directional discrepancies were assessed.

Results

Non-resistant rates of colistin for Enterobacterales, A. baumannii, and P. aeruginosa were 90.2 %, 99 %, and 98 %, respectively; those of polymyxin B were 90.5 %, 99 %, and 100 %. Carbapenem-resistant Enterobacterales had higher resistance to both agents (26 %). Colistin and polymyxin B showed identical MIC₅₀/MIC₉₀ values against Enterobacterales (0.25/2 mg/L) and A. baumannii (0.25/1 mg/L). Regarding P. aeruginosa, MIC₅₀/MIC₉₀ values were 1/1 mg/L and 0.5/1 mg/L, respectively. MICs were highly correlated (Spearman’s ρ=0.669, p < 0.001), with CA and EA ≥ 96 % across species. Using colistin to predict polymyxin B susceptibility yielded low very major error (VME) and major error (ME) rates. Conversely, elevated VMEs occurred when using polymyxin B to infer colistin susceptibility, particularly in A. baumannii (100 %) and P. aeruginosa (50 %), though these reflected very small numbers of colistin-resistant isolates (A. baumannii, n = 1; P. aeruginosa, n = 2).

Conclusions

Colistin and polymyxin B showed comparable in vitro activity and high MIC correlation. Colistin reliably predicted polymyxin B susceptibility, but caution is needed when inferring colistin susceptibility from polymyxin B results.

使用非商业肉汤微量稀释法比较粘菌素和多粘菌素B最低抑制浓度（mic），以及它们的相关性和一致性的研究仍然有限。本研究评估了两种多粘菌素对临床重要革兰氏阴性菌的体外敏感性。方法2018 - 2022年，对某三级医院临床分离的891株肠杆菌、100株鲍曼不动杆菌和100株铜绿假单胞菌进行肉汤微量稀释检测粘菌素和多粘菌素B的mic。评估MIC相关性、分类一致性（CA）、基本一致性（EA）和方向差异。结果肠杆菌、鲍曼不动杆菌和铜绿假单胞菌的粘菌素非耐药率分别为90.2 %、99 %和98 %；多粘菌素B分别为90.5 %、99 %和100% %。耐碳青霉烯肠杆菌对两种药物均有较高的耐药性（26% %）。粘菌素和多粘菌素B对肠杆菌（0.25/2 mg/L）和鲍曼杆菌（0.25/1 mg/L）显示相同的MIC₅0 /MIC₉0值。对于铜绿假单胞菌，MIC₅₀/MIC₉₀值分别为1/1 mg/L和0.5/1 mg/L。mic高度相关（Spearman 's ρ=0.669, p <； 0.001），CA和EA在物种间≥ 96 %。使用粘菌素预测多粘菌素B的药敏率具有较低的非常严重错误（VME）和严重错误（ME）率。相反，当使用多粘菌素B推断粘菌素敏感性时，VMEs升高，特别是在鲍曼假单胞菌（100 %）和铜绿假单胞菌（50 %）中，尽管这些反映了非常少量的粘菌素耐药菌株（鲍曼假单胞菌，n = 1；铜绿假单胞菌，n = 2）。结论猪肝菌素与多粘菌素B具有相当的体外活性和较高的MIC相关性。粘菌素可靠地预测了多粘菌素B的敏感性，但从多粘菌素B的结果推断粘菌素敏感性时需要谨慎。

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引用次数: 0

Risk factors and outcomes of bloodstream infection with multidrug-resistant bacteria in adult patients with acute leukemia 成年急性白血病患者血液感染多药耐药菌的危险因素和结局

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-05 DOI: 10.1016/j.jiph.2025.103088

Si-Min Deng, Wen-Jia Wei, Tian-Jing Duan, Zhi-Ping Jiang

Background

Bloodstream infection(BSI) caused by multidrug-resistant(MDR) strains is associated with high mortality rates. Notably, there remains a lack of research data addressing the resistance profiles, risk factors, and clinical outcomes of multidrug-resistant bacterial bloodstream infection(MDR-BSI) in acute leukemia(AL) patients. This study aims to analyze mortality, risk factors for death, and causative bacterial characteristics in AL patients with MDR-BSI.

Methods

This study retrospectively analyzed data from patients hospitalized at a tertiary hospital in China between January 2020 and December 2024, diagnosed with AL and concurrent MDR-BSI. Bacterial distribution was summarized. Kaplan-Meier survival curves and Logistic regression analysis were employed to assess 30-day mortality and identify risk factors for death following MDR-BSI onset.

Results

152 patients were enrolled, yielding 152 MDR bacteria isolates. Gram-negative bacteria(GNB) predominate in MDR-BSI. The overall 30-day mortality rate for MDR-BSI patients was 23.0 %, while the mortality rate specifically for carbapenem-resistant Enterobacteriaceae(CRE) BSI patients was significantly higher at 42.9 %. Univariate analysis identified the following factors associated with 30-day mortality: male sex, smoking history, CRE colonization, Intensive Care Unit(ICU)admission, inappropriate antibiotic therapy, septic shock, relapsed/refractory disease status, pulmonary infection, prior carbapenem use, hypoalbuminemia, and elevated procalcitonin(PCT) levels. Multivariate analysis subsequently demonstrated that CRE colonization(OR=5.938,95 %CI:1.547–22.790,p =0.009), Smoking history(OR=6.532,95 %CI:1.658–25.729,p = 0.007), and Septic shock(OR=50.599, 95 %CI:14.670–174.525, p ＜0.001) were independent risk factors for mortality in MDR-BSI patients.

Conclusions

Adult AL patients with MDR-BSI face elevated mortality, where smoking, CRE colonization, and septic shock constitute critical risk factors; consequently, Smoking cessation counseling, screening for intestinal CRE colonization, early recognition of septic shock, and judicious antibiotic therapy may significantly reduce 30-day Mortality in AL Patients with MDR-BSI.

多药耐药（MDR）菌株引起的血流感染（BSI）与高死亡率相关。值得注意的是，目前仍缺乏关于急性白血病（AL）患者耐多药细菌血流感染（MDR-BSI）的耐药谱、危险因素和临床结果的研究数据。本研究旨在分析AL合并耐多药bsi患者的死亡率、死亡危险因素和致病菌特征。方法本研究回顾性分析了2020年1月至2024年12月在中国某三级医院住院的诊断为AL并并发耐多药bsi的患者数据。总结细菌分布。采用Kaplan-Meier生存曲线和Logistic回归分析评估耐多药bsi发病后30天死亡率，并确定死亡危险因素。结果纳入152例患者，分离出152株耐多药细菌。革兰氏阴性菌（GNB）在耐多药bsi中占主导地位。耐多药BSI患者的总30天死亡率为23.0% %，而碳青霉烯耐药肠杆菌科（CRE） BSI患者的死亡率显著高于42.9% %。单因素分析确定了以下与30天死亡率相关的因素：男性、吸烟史、CRE定殖、重症监护病房（ICU）入院、不适当的抗生素治疗、感染性休克、复发/难治性疾病状态、肺部感染、既往碳青霉烯类药物使用、低白蛋白血症和降钙素原（PCT）水平升高。随后的多因素分析表明，CRE定殖（OR=5.938,95 %CI: 1.547-22.790,p =0.009）、吸烟史（OR=6.532,95 %CI: 1.658-25.729,p = 0.007）和感染性休克（OR=50.599, 95 %CI:14.67 - 174.525, p <0.001）是耐多药bsi患者死亡的独立危险因素。结论成年AL伴MDR-BSI患者死亡率升高，其中吸烟、CRE定植和感染性休克是关键危险因素；因此，戒烟咨询、筛查肠道CRE定植、早期识别感染性休克和明智的抗生素治疗可能显著降低耐多药bsi AL患者的30天死亡率。

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引用次数: 0

Genomic insights and molecular epidemiology through whole genome sequencing in clinical Serratia marcescens ST-367 isolated from the Kingdom of Bahrain 通过巴林王国分离的粘质沙雷菌ST-367临床全基因组测序的基因组见解和分子流行病学

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-05 DOI: 10.1016/j.jiph.2025.103087

Nayeem Ahmad , Ronni Mol Joji , Nermin Kamal Saeed , Mohammad Shahid

Background

Serratia marcescens may cause rare central nervous system infections. The growing antibiotic resistance in these isolates makes treatment challenging. S. marcescens (MIID-C14) was isolated from the cerebrospinal fluid of a 56-year-old female patient admitted to Salmaniya Medical Complex, Bahrain. Due to the virulence and multidrug resistance exhibited by this bacterium, we aimed to analyse the genetic makeup of this isolate.

Methods

The isolate was identified via MALDI-TOF mass spectrometry, antimicrobial susceptibility was performed by VITEK-2 system, and whole-genome sequencing (WGS) was conducted on the Illumina Novoseq 6000 S4 platform. The genome was annotated using the Prokaryotic Genome Annotation Pipeline (NCBI). In-silico predictions of antibiotic resistance genes, virulence genes, and multilocus sequence typing were performed using curated bioinformatics tools.

Results

MIID-C14 showed resistance to cefotaxime, ceftazidime, cefepime, and ertapenem, and was sensitive to gentamicin, ciprofloxacin, and trimethoprim/sulfamethoxazole. The complete genome of MIID-C14 was 4983,593 bp with 60.2 % GC content, and a Benchmarking Universal Single-Copy Orthologs score of 100. Molecular analysis identified antibiotic resistance genes for aminoglycosides (aac(6′)), fluoroquinolones (oqxB), Diaminopyrimidine/Sulfonamides (sul), and a chromosomal beta-lactamase (SRT-2). Multilocus sequence typing identified the sequence type as ST-367. Additionally, the genome harbored 218 mobile genetic elements, including 98 instances of horizontal gene transfer, and two virulence genes (fliM and rcsB). WGS data of this strain are available in the NCBI database under the BioProject: PRJNA1113219, BioSample: SAMN41450192, GenBank Accession: JBDXSY000000000.

Conclusion

To our knowledge, this is the first report of S. marcescens ST-367 in the Gulf Cooperation Council. The genetic diversity and mechanisms of virulence and antibiotic resistance in this isolate shed light on the evolution of high-risk isolates. Additionally, this will serve as a foundation for future extensively drug-resistant isolates.

背景：粘质沙雷菌可引起罕见的中枢神经系统感染。这些分离株日益增长的抗生素耐药性使治疗具有挑战性。粘质链球菌（mid - c14）从巴林Salmaniya医疗中心收治的一名56岁女性患者的脑脊液中分离出来。由于该细菌表现出的毒力和多药耐药性，我们旨在分析该分离物的遗传组成。方法：采用MALDI-TOF质谱法对分离物进行鉴定，VITEK-2系统进行药敏试验，在Illumina Novoseq 6000 S4平台上进行全基因组测序。使用原核基因组注释管道（Prokaryotic genome Annotation Pipeline， NCBI）对基因组进行注释。使用精心设计的生物信息学工具进行抗生素耐药基因、毒力基因和多位点序列分型的计算机预测。结果：mid - c14对头孢噻肟、头孢他啶、头孢吡肟、厄他培南耐药，对庆大霉素、环丙沙星、甲氧苄啶/磺胺甲恶唑敏感。mid - c14的全基因组为4983,593 bp， GC含量为60.2 %，Benchmarking Universal Single-Copy Orthologs评分为100。分子分析鉴定出氨基糖苷类（aac(6')）、氟喹诺酮类（oqxB）、二氨基嘧啶/磺胺类（sul）和染色体β -内酰胺酶（SRT-2）的抗生素耐药基因。多位点序列分型鉴定序列类型为ST-367。此外，基因组还包含218个可移动的遗传元件，包括98个水平基因转移的实例，以及两个毒力基因（fliM和rcsB）。该菌株的WGS数据已在NCBI数据库中获取，BioProject: PRJNA1113219, BioSample: SAMN41450192， GenBank登录：JBDXSY000000000。结论：据我们所知，这是海湾合作委员会首次报道S. marcesens ST-367。该分离株的遗传多样性和毒力和抗生素耐药性机制揭示了高风险分离株的进化。此外，这将作为未来广泛耐药分离株的基础。

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引用次数: 0

The impact of sodium-glucose co-transporter 2 inhibitors on the incidence of non-tuberculous mycobacteria infection in diabetes populations 钠-葡萄糖共转运蛋白2抑制剂对糖尿病人群非结核分枝杆菌感染发生率的影响

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-04 DOI: 10.1016/j.jiph.2025.103089

Ping-Huai Wang , Chung-Han Ho , Kuang-Ming Liao , Chung-Shu Lee , Yu-Cih Wu , Chin-Chung Shu

Purpose

Sodium glucose co-transporter 2 inhibitors (SGLT2i) not only control blood sugar but also exhibit cardiovascular and renal protection via inflammation modulation. But there is scarce information about the impact of SGLT2i on infections, especially non-tuberculous mycobacteria (NTM) infection.

Methods

This retrospective study screened the Taiwan National Health Insurance Research Database from 2016 to 2021, and enrolled subjects aged more than 20 years with initial diagnoses of type 2 diabetes mellitus (T2DM) in 2017–2021. The subjects were categorized into two groups based on whether SGLT2i were used (SGLT2i and non-SGLT2i users).

Results

A total of 853720 subjects were enrolled. Of these, 91181 individuals were identified as the SGLT2i users, while the remaining 762539 were classified as the non-SGLT2i users. The prevalence of NTM infection was lower in the SGLT2i users than in the non-SGLT2i (0.05 % v. 0.14 %, p < 0.001). Multivariable analysis of factors associated with NTM infection showed that SGLT2i use was associated with a lower risk of NTM infection (adjusted hazard ratio: 0.44, p < 0.001), whereas male, age of 35 years or more, cancer and chronic airway diseases were associated with a higher risk of NTM infection. Diabetes complication tended to be associated with NTM infection only when the diabetes complications severity index (DCSI) was ≧ 3 ( p = 0.050).

Conclusions

SGLT2i use was less associated with NTM infection. In addition, adequate management of co-morbidities and good glycemic control to avoid complications were also associated with reduced risk of NTM infection.

目的葡萄糖共转运蛋白2抑制剂（SGLT2i）不仅控制血糖，而且通过炎症调节表现出心血管和肾脏保护作用。但是关于SGLT2i对感染，特别是非结核分枝杆菌（NTM）感染的影响的信息很少。方法本研究回顾性筛选2016 - 2021年台湾全民健康保险研究数据库，纳入2017-2021年初诊为2型糖尿病（T2DM）、年龄在20岁以上的受试者。根据是否使用SGLT2i将受试者分为两组（SGLT2i和非SGLT2i使用者）。结果共纳入受试者853720例。其中，91181人被确定为SGLT2i用户，而其余762539人被归类为非SGLT2i用户。SGLT2i使用者的NTM感染率低于非SGLT2i使用者（0.05 % vs . 0.14 %,p <； 0.001）。对NTM感染相关因素的多变量分析显示，使用SGLT2i与NTM感染风险较低相关（校正风险比：0.44,p <； 0.001），而男性、35岁及以上、癌症和慢性气道疾病与NTM感染风险较高相关。只有当糖尿病并发症严重程度指数(DCSI)≧ 3时，糖尿病并发症才与NTM感染相关（p = 0.050）。结论ssglt2i的使用与NTM感染的相关性较小。此外，适当的合并症管理和良好的血糖控制以避免并发症也与NTM感染风险降低有关。

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引用次数: 0

HCV infection, risk factors and PrEP use among HIV-negative MSM and TW at a community health centre 社区卫生中心艾滋病毒阴性男男性行为者和同性恋者的丙型肝炎病毒感染、风险因素和预防措施使用情况

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-04 DOI: 10.1016/j.jiph.2025.103086

Àngel Rivero , Albert Dalmau-Bueno , Félix Pérez , P. Coll , José M. Cabrera , Mariusz Łucejko , Javier Fernandez , Joan Reguant , Jorge Calderon , Jaume Romero , Federico Caballero , Giovanni Marazzi , Carlos Oro , Daniel Michael Jacobs , Horacio Vicioso , Lisandro Moises , Héctor Taboada , Jorge Saz , Ferran Pujol , Michael Meulbroek , Roger Paredes

Background

Sexually transmitted hepatitis C virus (HCV) infection is widely reported in urban cohorts of HIV-positive men who have sex with men (MSM), with less data on HIV-negative MSM. High HCV incidence has been reported in cohorts of HIV-negative MSM using HIV pre-exposure prophylaxis (PrEP), but no previous studies have systematically offered HCV screening to PrEP users and non-PrEP users.

Methods

We offered point-of-care serology and/or PCR HCV screening to HIV-negative MSM and transgender women (TW) attending a peer-led community sexual health centre in Barcelona, Spain. We estimated HCV prevalence ratios using log-binomial models of sexual and drug-use behaviors and conducted descriptive analyses linking infection, PrEP use, and behavior patterns. The trial was registered with ClinicalTrials.gov (NCT06847958).

Findings

HCV screening was provided to 13,089 HIV-negative MSM and TW, including 3039 (23·1 %) current PrEP users. HCV prevalence was similar in PrEP users (0·10 %, 3/3039) and non-PrEP users (0·12 %, 12/10,122). We identified one case of acute infection; no HCV cases were identified among TW. HCV infection was associated with several behaviours including slamming, group sex, sharing syringes, fisting, and using drugs related to chemsex.

Interpretation

We found a relatively low prevalence of active HCV, and only one case of acute infection, among HIV-negative MSM and TW attending a community centre. At a descriptive level, HCV-infected PrEP and non-PrEP users show markedly higher risk behaviors than PrEP and non-PrEP users without HCV, yet low prevalence render these findings exploratory and warrants larger analytic studies.

Funding

Gilead Sciences.

性传播丙型肝炎病毒（HCV）感染在城市男男性行为者（MSM） hiv阳性人群中被广泛报道，而hiv阴性男男性行为者（MSM）的数据较少。据报道，在使用HIV暴露前预防（PrEP）的HIV阴性MSM人群中，HCV发病率较高，但此前没有研究系统地向PrEP使用者和非PrEP使用者提供HCV筛查。方法我们对在西班牙巴塞罗那的一个同伴领导的社区性健康中心参加hiv阴性的男男性行为者和变性妇女（TW）提供即时血清学和/或PCR HCV筛查。我们使用性行为和药物使用行为的对数二项模型估计HCV患病率，并进行了将感染、PrEP使用和行为模式联系起来的描述性分析。该试验已在ClinicalTrials.gov注册（NCT06847958）。结果：对13089名hiv阴性的MSM和TW进行了shcv筛查，其中包括3039名（23.1 %）当前PrEP使用者。PrEP使用者（0.10 %,3/3039）和非PrEP使用者（0.12 %,12/ 10122）的HCV患病率相似。我们确定了一个急性感染病例；TW中未发现HCV病例。HCV感染与几种行为有关，包括重击、群性行为、共用注射器、拳头和使用与化学性交相关的药物。我们发现在社区中心参加hiv阴性的MSM和TW中，活动性HCV患病率相对较低，只有一例急性感染。在描述水平上，感染丙型肝炎病毒的PrEP和非PrEP使用者比未感染丙型肝炎病毒的PrEP和非PrEP使用者表现出明显更高的风险行为，但低患病率使得这些发现具有探索性，值得进行更大规模的分析研究。FundingGilead科学。

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引用次数: 0

Comparative overview of Aspergillus fumigatus, A. flavus, and A. niger: Pathogenicity, resistance, and public health significance 烟曲霉、黄曲霉和黑曲霉的比较综述：致病性、耐药性和公共卫生意义

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-03 DOI: 10.1016/j.jiph.2025.103070

Affan Rafique , Sabrina Sharmin , Asef Raj , Ammarah Laaika Mohiuddin , Md. Iftekhar Al Mahmud , Humair Bin Md Omer

Fungal diseases represent a major global health challenge, with Aspergillus species like A. fumigatus, A. flavus, and A. niger acting as key opportunistic pathogens. These fungi cause a spectrum of illness from allergy to life-threatening invasive aspergillosis in immunocompromised patients. This review synthesizes evidence (2000–2025) on their pathogenicity, resistance, and clinical impact, providing a comparative analysis of species-specific differences in conidial morphology, secondary metabolite production, and virulence factors such hydrophobins, galactosaminogalactan, melanin, siderophores, biofilms. The increasing threat of triazole resistance, fueled by environmental fungicide use and climate change, is critically examined. The review also summarizes the current antifungal therapies (polyenes, triazoles, echinocandins) and investigational drugs, highlighting the urgent need for improved surveillance, stewardship and diagnostics, particularly in low- and middle-income countries, to guide targeted management and reduce the global burden of aspergillosis.

真菌疾病是全球健康面临的主要挑战，烟曲霉、黄曲霉和黑曲霉等曲霉是主要的机会致病菌。这些真菌在免疫功能低下的患者中引起一系列疾病，从过敏到危及生命的侵袭性曲霉病。这篇综述综合了2000-2025年关于它们的致病性、耐药性和临床影响的证据，提供了分生孢子形态、次生代谢物产生和毒力因子（如疏水蛋白、半乳糖胺半乳糖、黑色素、铁载体、生物膜）的物种特异性差异的比较分析。环境杀菌剂的使用和气候变化加剧了三唑耐药性的威胁，并对其进行了严格审查。该综述还总结了目前的抗真菌疗法（多烯、三唑、棘白菌素）和研究药物，强调迫切需要改进监测、管理和诊断，特别是在低收入和中等收入国家，以指导有针对性的管理和减轻全球曲霉病负担。

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引用次数: 0

Clinical characteristics of seven dimorphic mycoses between 2015 and 2025 using a large global database 利用大型全球数据库分析2015年至2025年间7种二型真菌病的临床特征。

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-03 DOI: 10.1016/j.jiph.2025.103077

Taito Kitano , Sayaka Yoshida

Background

Dimorphic mycoses are often neglected or underestimated. This study aimed to evaluate the demographic and clinical characteristics of seven dimorphic mycoses.

Methods

This retrospective study used TriNetX, a global database of multicenter electronic medical records, to evaluate the clinical characteristics of dimorphic mycoses between 2015 and 2025. The mycoses included were blastomycosis, histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, talaromycosis, sporotrichosis, and lobomycosis.

Results

The number of identified cases was as follows: blastomycosis 3711, histoplasmosis 17,895, coccidioidomycosis 6629, paracoccidioidomycosis 301, talaromycosis 345, sporotrichosis 2973, and lobomycosis 76. Patients with talaromycosis had a high prevalence of diverse medical comorbidities. All-cause mortality within 90 days of diagnosis was 5.7 % for blastomycosis, 3.1 % for histoplasmosis, 3.5 % for coccidioidomycosis, 4.7 % for paracoccidioidomycosis, and 6.1 % for talaromycosis. Mortality rates for sporotrichosis and lobomycosis could not be assessed because of the small number of deaths. All-cause hospitalization rates ranged from 15.3 % in sporotrichosis to 61.7 % in talaromycosis, whereas intensive care unit admission rates ranged from 1.0 % in sporotrichosis to 16.7 % in talaromycosis.

Conclusion

Critical and fatal outcomes following diagnosis of dimorphic mycoses were not uncommon, highlighting the need for strengthened preventive and therapeutic interventions. Greater attention to these neglected mycoses is necessary to reduce their global disease burden.

背景：二型真菌病经常被忽视或低估。本研究旨在评估7种二型真菌病的人口学和临床特征。方法：本回顾性研究使用TriNetX全球多中心电子病历数据库，评估2015 - 2025年二型真菌病的临床特征。包括芽孢菌病、组织胞浆菌病、球孢子菌病、副球孢子菌病、talaromyosis、孢子毛菌病和额孢菌病。结果：鉴定病例数为：囊胚菌病3711例，组织胞浆菌病17895例，球孢子菌病6629例，副球孢子菌病301例，talaromyosis 345例，孢子毛菌病2973例，额孢菌病76例。talaromylosis的用法和样例：talaromylosis的用法和样例：talaromylosis的用法和样例：诊断90天内的全因死亡率：囊胚菌病为5.7% %，组织胞浆菌病为3.1 %，球虫菌病为3.5 %，副球虫菌病为4.7 %，talaromyosis为6.1 %。由于死亡人数少，孢子菌病和白质菌病的死亡率无法评估。孢子菌病的全因住院率从15.3% %到61.7 %不等，而重症监护病房的住院率从孢子菌病的1.0% %到孢子菌病的16.7 %不等。结论：二形真菌病诊断后的严重和致命结果并不罕见，强调需要加强预防和治疗干预。有必要更多地关注这些被忽视的真菌病，以减轻其全球疾病负担。

{"title":"Clinical characteristics of seven dimorphic mycoses between 2015 and 2025 using a large global database","authors":"Taito Kitano , Sayaka Yoshida","doi":"10.1016/j.jiph.2025.103077","DOIUrl":"10.1016/j.jiph.2025.103077","url":null,"abstract":"<div><h3>Background</h3><div>Dimorphic mycoses are often neglected or underestimated. This study aimed to evaluate the demographic and clinical characteristics of seven dimorphic mycoses.</div></div><div><h3>Methods</h3><div>This retrospective study used TriNetX, a global database of multicenter electronic medical records, to evaluate the clinical characteristics of dimorphic mycoses between 2015 and 2025. The mycoses included were blastomycosis, histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, talaromycosis, sporotrichosis, and lobomycosis.</div></div><div><h3>Results</h3><div>The number of identified cases was as follows: blastomycosis 3711, histoplasmosis 17,895, coccidioidomycosis 6629, paracoccidioidomycosis 301, talaromycosis 345, sporotrichosis 2973, and lobomycosis 76. Patients with talaromycosis had a high prevalence of diverse medical comorbidities. All-cause mortality within 90 days of diagnosis was 5.7 % for blastomycosis, 3.1 % for histoplasmosis, 3.5 % for coccidioidomycosis, 4.7 % for paracoccidioidomycosis, and 6.1 % for talaromycosis. Mortality rates for sporotrichosis and lobomycosis could not be assessed because of the small number of deaths. All-cause hospitalization rates ranged from 15.3 % in sporotrichosis to 61.7 % in talaromycosis, whereas intensive care unit admission rates ranged from 1.0 % in sporotrichosis to 16.7 % in talaromycosis.</div></div><div><h3>Conclusion</h3><div>Critical and fatal outcomes following diagnosis of dimorphic mycoses were not uncommon, highlighting the need for strengthened preventive and therapeutic interventions. Greater attention to these neglected mycoses is necessary to reduce their global disease burden.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"19 2","pages":"Article 103077"},"PeriodicalIF":4.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145722802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dynamic shifts in outpatient antibiotic prescribing for pediatric upper respiratory infections in South Korea, 2002–2019: A national cohort study 2002-2019年韩国儿科上呼吸道感染门诊抗生素处方的动态变化：一项国家队列研究

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-12-01 DOI: 10.1016/j.jiph.2025.103078

Jeewon Shin , Eunkyo Ha , Ju Hee Kim , Boeun Han , Eun Lee , Won Seok Lee , Man Yong Han

Background

Antibiotic resistance is a global health concern, driven by inappropriate use. Contemporary data on antibiotic prescribing patterns for pediatric upper respiratory infections (URIs) are needed to evaluate trends and guide stewardship efforts. We examined longitudinal trends in antibiotic prescribing for pediatric URIs in South Korea, stratified by antibiotic class and patient age group.

Methods

We conducted a retrospective study using the National Health Insurance Service (NHIS) pediatric sample cohort in South Korea (2002–2019). The dataset included 639,702 outpatient visits with a primary URI diagnosis among 369,702 children < 18 years. Children with complex chronic conditions were excluded, and antibiotic prescriptions were grouped into six classes. Primary outcomes were the antibiotic prescribing rate (per URI visit) and antibiotic exposure days (per 1000 person-years), stratified by age group and antibiotic class. Temporal trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC).

Results

The proportion of antibiotic prescriptions for pediatric URIs declined from 80.2 % to 49.1 % (APC −0.27 % per year; 95 % CI −0.62–0.04). Narrow-spectrum penicillin use decreased, macrolide remained relatively stable, and broad-spectrum penicillin initially increased and later stabilized. Antibiotic exposure days per 1000 person-years increased overall (AAPC 1.88 %, 95 % CI 1.59–2.21), with the highest exposure in children aged 1–5 years, peaking around 2008 before gradually declining. Other age groups were largely stable.

Conclusion

Antibiotic prescribing declined modestly overall, while broad-spectrum penicillin increased and narrow-spectrum agents decreased, with exposure highest in children aged 1–5 years. Sustained outpatient stewardship is needed to reduce unnecessary use and prioritize narrow-spectrum therapy when indicated.

抗生素耐药性是一个全球卫生问题，是由不当使用造成的。需要关于儿科上呼吸道感染（uri）抗生素处方模式的当代数据来评估趋势和指导管理工作。我们检查了韩国儿科泌尿系抗生素处方的纵向趋势，按抗生素类别和患者年龄组分层。方法采用韩国国民健康保险服务（NHIS）儿科样本队列（2002-2019）进行回顾性研究。该数据集包括639,702例门诊就诊，主要诊断为URI，涉及369,702名儿童<； 18岁。排除患有复杂慢性疾病的儿童，并将抗生素处方分为六类。主要结局是抗生素处方率（每次URI就诊）和抗生素暴露天数（每1000人年），按年龄组和抗生素类别分层。利用连接点回归估计年变化百分比（APC）和平均年变化百分比（AAPC）来评估时间趋势。结果儿科尿路感染的抗生素处方比例从80.2 %下降到49.1 % （APC - 0.27 % /年；95% % CI - 0.62-0.04）。窄谱青霉素用量减少，大环内酯保持相对稳定，广谱青霉素用量开始增加，后趋于稳定。每1000人年抗生素暴露天数总体增加（AAPC 1.88 %,95 % CI 1.59-2.21）， 1-5岁儿童的抗生素暴露最高，在2008年左右达到峰值，然后逐渐下降。其他年龄组的情况基本稳定。结论抗生素处方总体适度下降，广谱青霉素增加，窄谱药物减少，1-5岁儿童用药最多。需要持续的门诊管理，以减少不必要的使用，并在需要时优先考虑窄谱治疗。

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引用次数: 0

Implementation of an alert system for the care cascade of Hepatitis C infection in patients undergoing elective surgery 实施选择性手术患者丙型肝炎感染护理级联警报系统。

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health

Pub Date : 2025-11-29 DOI: 10.1016/j.jiph.2025.103076

Jae Seung Lee , Ho Soo Chun , Hye Won Lee , Mi Na Kim , Beom Kyung Kim , Jun Yong Park , Do Young Kim , Sang Hoon Ahn , Seung Up Kim

Background

A key barrier to an effective care cascade for Hepatitis C virus (HCV) is limited awareness, especially among patients undergoing elective surgery. To address this issue, we introduced an electronic medical record (EMR)-based automatic alert system in 2021 to enhance surgical healthcare providers’ awareness of HCV screening and referral rates.

Methods

The alert system was designed to alert surgeons to order preoperative HCV antibody testing for patients undergoing elective surgery before admission and, at discharge, recommend hepatology consultation for patients with positive HCV antibody testing.

Results

The system significantly improved the HCV screening rate by 73,834 (96.8 %) among 76,310 patients undergoing surgery after system implementation, compared to 106,854 (82.8 %) among 129,065 patients between 2016 and 2020 (P < 0.001). Among them, the system alerted 12,048 (16.3 %) cases, and 463 patients tested positive for HCV antibodies. However, only 42 (15.3 %) were referred out of 275 (59.4 %) who required hepatology consultation. Linkage failure was associated with other surgery departments than hepatobiliary and transplant surgery departments (odds ratio [OR]=5.940, 95 % confidence interval [CI], 3.080–12.410, P < 0.001) and shorter hospitalization duration (OR=0.980, 95 % CI, 0.950–0.990, P = 0.012).

Conclusion

The EMR-based automatic alert system effectively increased HCV screening for patients undergoing elective surgery before admission. However, it could not link them to care cascade in surgery departments. Combining more proactive approaches would be beneficial, such as reflex testing or a call-back strategy.

背景：对丙型肝炎病毒（HCV）进行有效级联治疗的一个关键障碍是认识有限，特别是在接受选择性手术的患者中。为了解决这一问题，我们于2021年推出了基于电子病历（EMR）的自动警报系统，以提高外科医疗保健提供者对HCV筛查和转诊率的认识。方法：预警系统旨在提醒外科医生在住院前安排接受择期手术的患者进行术前HCV抗体检测，并在出院时建议HCV抗体检测阳性的患者进行肝病会诊。结果：系统实施后，76,310例手术患者的HCV筛查率显著提高73,834例（96.8% %），而2016年至2020年期间，129,065例患者的HCV筛查率为106,854例（82.8 %）（P ）结论：基于emr的自动警报系统有效地提高了入院前择期手术患者的HCV筛查率。然而，它不能将它们与外科部门的护理级联联系起来。结合更主动的方法将是有益的，如反射测试或回调策略。

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引用次数: 0