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The efficacy and safety of a quadrivalent live attenuated influenza nasal vaccine in Japanese children: A phase 3, randomized, placebo-controlled study. 日本儿童接种四价流感鼻腔减毒活疫苗的有效性和安全性:3 期随机安慰剂对照研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-02 DOI: 10.1016/j.jiac.2024.06.023
Tetsuo Nakayama, Takuya Hayashi, Kentaro Makino, Keiji Oe

Background: Vaccination is the primary method of preventing influenza infection and complications in young children. We evaluated the efficacy and safety of a single dose of MEDI3250 (intranasal, quadrivalent, live attenuated influenza vaccine) in healthy Japanese children during the 2016/17 influenza season.

Methods: In this multicenter, randomized, double-blind, phase 3 study (jRCT2080223345), participants aged 2-18 years received MEDI3250 or placebo (2:1), stratified by age (2-6 years, 7-18 years). The primary and secondary endpoints were the incidence of confirmed symptomatic onset of influenza caused by a circulating wild-type strain or by a vaccine-matched strain, respectively. Safety outcomes included the incidence of adverse events (AEs) and vaccine-related AEs.

Results: Overall, 910 participants received MEDI3250 (n = 608) or placebo (n = 302). For the primary endpoint (regardless of the influenza subtype), the incidence of influenza onset was 25.5 % (MEDI3250) and 35.9 % (placebo); relative risk reduction, 28.8 % (95 % confidence interval, 12.5 %-42.0 %). For the secondary endpoint (vaccine-matched strain), the incidence was 10.9 % (MEDI3250) and 17.2 % (placebo); relative risk reduction, 36.6 % (95 % confidence interval, 6.5 %-56.8 %). Solicited AEs occurred in 67.6 % (MEDI3250) and 63.6 % (placebo). Most events were mild; nasal discharge was most common (59.2 % [MEDI3250] and 52.6 % [placebo]). Unsolicited AEs occurred in 36.0 % (MEDI3250) and 33.1 % (placebo). The most common unsolicited vaccine-related AE was diarrhea (2.3 %, both groups).

Conclusions: MEDI3250 had a greater preventive effect against influenza onset in Japanese children than placebo; no new safety signals were observed relative to previous clinical and post-marketing studies of MEDI3250.

背景:接种疫苗是预防幼儿感染流感和并发症的主要方法。我们评估了2016/17年流感季节在日本健康儿童中接种单剂MEDI3250(鼻内用四价流感减毒活疫苗)的有效性和安全性:在这项多中心、随机、双盲、3期研究(jRCT2080223345)中,2-18岁的参与者按年龄分层(2-6岁、7-18岁)接种MEDI3250或安慰剂(2:1)。主要和次要终点分别是由循环野生型菌株或疫苗匹配菌株引起的确诊无症状流感发病率。安全性结果包括不良事件(AE)和疫苗相关不良事件的发生率:共有 910 人接受了 MEDI3250(608 人)或安慰剂(302 人)治疗。在主要终点(不考虑流感亚型)方面,流感发病率为25.5%(MEDI3250)和35.9%(安慰剂);相对风险降低28.8%(95%置信区间为12.5%至42.0%)。次要终点(疫苗匹配株)的发生率为10.9%(MEDI3250)和17.2%(安慰剂);相对风险降低36.6%(95%置信区间为6.5%至56.8%)。67.6%的患者(MEDI3250)和63.6%的患者(安慰剂)发生了自诉AE。大多数事件是轻微的;最常见的是流鼻涕(59.2% [MEDI3250]和 52.6% [安慰剂])。36.0%(MEDI3250)和33.1%(安慰剂)发生了非主动AE。最常见的非主动疫苗相关不良反应是腹泻(两组均为2.3%):结论:与安慰剂相比,MEDI3250对日本儿童流感发病的预防效果更好;与MEDI3250之前的临床和上市后研究相比,没有观察到新的安全性信号。
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引用次数: 0
Incidence and potential risk factors of human cytomegalovirus infection in patients with severe and critical coronavirus disease 2019. 2019 年严重和危重冠状病毒病患者巨细胞病毒感染的发病率和潜在风险因素。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-27 DOI: 10.1016/j.jiac.2024.06.015
Waki Imoto, Takumi Imai, Ryota Kawai, Yasutaka Ihara, Yuta Nonomiya, Hiroki Namikawa, Koichi Yamada, Hisako Yoshida, Yukihiro Kaneko, Ayumi Shintani, Hiroshi Kakeya

Background: Human cytomegalovirus (HCMV) infection occurs in immunosuppressed individuals and is known to increase mortality. Patients with coronavirus disease 2019 (COVID-19) are often treated with steroids, require intensive care unit (ICU) treatment, and may therefore be at risk for HCMV infection. However, which factors predispose severely ill patients with COVID-19 to HCMV infection and the prognostic value of such infections remain largely unexplored. This study aimed to examine the incidence and potential risk factors of HCMV infection in patients with severe or critical COVID-19 and evaluate the relationship between HCMV infection and mortality.

Methods and findings: We used administrative claims data from advanced treatment hospitals in Japan to identify and analyze patients with severe or critical COVID-19. We explored potential risk factors for HCMV infection using multivariable regression models and its contribution to mortality in patients with COVID-19. Overall, 33,151 patients who progressed to severe or critical COVID-19 illness were identified. The incidence of HCMV infection was 0.3-1.7 % depending on the definition of HCMV infection. Steroids, immunosuppressants, ICU admission, and blood transfusion were strongly associated with HCMV infection. Furthermore, HCMV infection was associated with patient mortality independent of the observed risk factors for death.

Conclusions: HCMV infection is a notable complication in patients with severe or critical COVID-19 who are admitted to the ICU or receive steroids, immunosuppressants, and blood transfusion and can significantly increase mortality risk.

背景:人类巨细胞病毒(HCMV)感染发生在免疫抑制人群中,已知会增加死亡率。2019年冠状病毒病(COVID-19)患者通常接受类固醇治疗,需要重症监护室(ICU)治疗,因此可能有感染HCMV的风险。然而,哪些因素会导致冠状病毒病2019-02-19重症患者感染HCMV,以及此类感染的预后价值在很大程度上仍未得到探讨。本研究旨在探讨重症或危重 COVID-19 患者 HCMV 感染的发生率和潜在风险因素,并评估 HCMV 感染与死亡率之间的关系:我们利用日本高级治疗医院的行政报销数据,对重症或危重 COVID-19 患者进行了识别和分析。我们使用多变量回归模型探讨了 HCMV 感染的潜在风险因素及其对 COVID-19 患者死亡率的影响。我们共发现了 33151 名进展为 COVID-19 重症或危重症的患者。根据 HCMV 感染的定义,HCMV 感染的发生率为 0.3-1.7%。类固醇、免疫抑制剂、入住 ICU 和输血与 HCMV 感染密切相关。此外,HCMV 感染还与患者死亡率相关,与观察到的死亡风险因素无关:HCMV感染是重症或危重COVID-19患者入住重症监护室或接受类固醇、免疫抑制剂和输血时的一种明显并发症,可显著增加死亡风险。
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引用次数: 0
Association between post-COVID-19 conditions and male semen quality in Japan: A descriptive investigation 日本 COVID-19 后条件与男性精液质量之间的关系:一项描述性调查。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-27 DOI: 10.1016/j.jiac.2024.06.021

Some reports suggest that coronavirus disease 2019 (COVID-19) may affect male reproductive function. There is also concern in Japan that COVID-19 may contribute to the pre-existing decline in male fertility; however, no studies have investigated the effects of COVID-19 on male reproductive function. In this study, we aimed to analyze the semen quality of men who had recovered from COVID-19. Male patients who had recovered from COVID-19 between February 2020 and September 2021 were recruited for this study. Participants were sent a semen collection kit; they were asked to collect semen at home and deliver it to a laboratory at Osaka University. We used these samples to analyze sperm concentration, total sperm count, and semen volume. In total, 125 participants were included in this study. The median age of all patients was 46 years (interquartile range (IQR): 38–52 years). The severity of COVID-19 was mild in 80 patients; 19 were moderate I, 22 were moderate II, and four were severe. The median semen volume was 2.5 mL (IQR: 1.8–3.1), the median sperm concentration was 98.9 million/mL (IQR: 43.8–162.2), and the median total sperm count was 212.1 million (IQR: 89.7–368.2). In a previous study in Japan, the median sperm count in adult men was reported to be 201 million. Participants in our study did not have lower sperm counts than this, despite their older age. Our results suggest that the long-term effects of COVID-19 on spermatogenesis are minimal.

一些报告表明,冠状病毒病 2019(COVID-19)可能会影响男性生殖功能。日本也有人担心,COVID-19 可能会导致男性生育能力下降;但是,还没有研究调查过 COVID-19 对男性生殖功能的影响。在本研究中,我们旨在分析从 COVID-19 中康复的男性的精液质量。本研究招募了 2020 年 2 月至 2021 年 9 月期间从 COVID-19 中康复的男性患者。我们向参与者发送了精液采集工具包,要求他们在家中采集精液并将其送到大阪大学的实验室。我们使用这些样本分析精子浓度、精子总数和精液量。共有 125 名参与者参与了这项研究。所有患者的中位年龄为 46 岁(四分位距(IQR):38-52 岁)。80 名患者的 COVID-19 严重程度为轻度;19 名为中度 I,22 名为中度 II,4 名为重度。精液量中位数为 2.5 毫升(IQR:1.8-3.1),精子浓度中位数为 9890 万/毫升(IQR:43.8-162.2),精子总数中位数为 2.121 亿(IQR:89.7-368.2)。此前在日本进行的一项研究显示,成年男性精子数量的中位数为 2.01 亿。在我们的研究中,尽管参与者的年龄较大,但他们的精子数量并没有低于这个数字。我们的研究结果表明,COVID-19 对精子生成的长期影响微乎其微。
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引用次数: 0
Effectiveness and safety of the simulation-based first-dose design of voriconazole. 基于模拟的伏立康唑首次剂量设计的有效性和安全性。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-27 DOI: 10.1016/j.jiac.2024.06.016
Takumi Umemura, Hiromi Kakizaki, Yoshikazu Mutoh, Takahito Mizuno, Yuki Ito, Tatsuya Hioki, Hideo Kato, Mao Hagihara, Tetsuya Yamada, Yoshiaki Ikeda, Hiroshige Mikamo, Toshihiko Ichihara, Yukihiro Hamada

Background: We investigated whether the initial voriconazole (VRCZ) dosing design, as determined using simulation software with a population pharmacokinetic model of Japanese patients, impacts the effectiveness and safety when compared with VRCZ initiation according to the package insert.

Methods: In this single-center retrospective observational study, we employed records from Tosei General Hospital (a 633-bed hospital), dated April 2017 to September 2023. Eligible patients were divided into the software-based simulation group, comprising patients administered initial VRCZ dosage adjustment by pharmacists using software-based simulation, and the standard therapy group, whose dosage was administered by a physician following the package insert recommendations without simulation. The primary objective of this study was to determine the efficacy of VRCZ first-dose design in reducing the incidence of hepatotoxicity and visual symptoms.

Results: The median ages of enrolled participants (n = 93) were 75 (68-79) and 72 (65-78) years in the software-based simulation and standard therapy groups, respectively. Regardless of formulation, initial trough concentrations were lower in the VRCZ software-based first dosage adjustment group and higher rate within the appropriate range (1-4 μg/mL). The incidence of all-grade hepatotoxicity or visual symptoms was significantly lower in the software-based simulation group. The log-rank test revealed a significant impact on the occurrence of ≥grade 2 hepatotoxicity in the software-based first dosage adjustment group compared to that in the standard therapy group.

Conclusions: The initial VRCZ dosing design using simulation software improved the achievement of appropriate initial trough concentrations and resulted in fewer occurrences of hepatotoxicity (≥grade 2) when compared with the standard therapy.

背景:我们研究了使用日本患者群体药代动力学模型模拟软件确定的伏立康唑(Voriconazole,VRCZ)初始剂量设计,与根据包装说明书开始使用 VRCZ 相比,是否会影响有效性和安全性:在这项单中心回顾性观察研究中,我们采用了东势综合医院(一家拥有 633 张病床的医院)2017 年 4 月至 2023 年 9 月的病历。符合条件的患者被分为基于软件的模拟组和标准治疗组,前者由药剂师使用基于软件的模拟对 VRCZ 进行初始剂量调整,后者则由医生根据包装说明书的建议进行剂量调整,无需进行模拟。本研究的主要目的是确定 VRCZ 首次剂量设计在降低肝毒性和视觉症状发生率方面的疗效:基于软件的模拟治疗组和标准治疗组参与者(n = 93)的中位年龄分别为 75(68-79)岁和 72(65-78)岁。无论配方如何,基于 VRCZ 软件的首次剂量调整组的初始谷浓度较低,在适当范围(1-4 μg/mL)内的比率较高。基于软件的模拟组的全级肝毒性或视觉症状发生率明显较低。对数秩检验显示,与标准疗法组相比,基于软件的首次剂量调整组对≥2级肝毒性的发生率有显著影响:结论:与标准疗法相比,使用模拟软件进行 VRCZ 初始剂量设计可提高适当初始谷浓度的达标率,并减少肝毒性(≥2 级)的发生。
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引用次数: 0
Sorbicillinoid HSL-2 inhibits the infection of influenza A virus via interaction with the PPAR-γ/NF-κB pathway 山梨酸类HSL-2通过与PPAR-γ/NF-κB途径相互作用抑制甲型流感病毒的感染。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-26 DOI: 10.1016/j.jiac.2024.06.013

Background

Drug resistance is an important factor in the fight against influenza A virus (IAV). Natural products offer a rich source of lead compounds for the discovery of novel antiviral drugs. In a previous study, we isolated the sorbicillinoid polyketide HSL-2 from the mycelium of fungus Trichoderma sp. T-4-1. Here, we show that this compound exerts strong antiviral activity against a panel of IAVs.

Methods

The immunofluorescence and qRT-PCR assays were used to detect the inhibitory effect of HSL-2 toward the replication of influenza virus and IAV-induced expression of the pro-inflammatory cytokines such as TNF-α, IL-6, and IL-1β.

Results

The results indicated that HSL-2 inhibited influenza virus replication, and it significantly inhibited IAV-induced overexpression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β through modulating the PPAR-γ/NF-κB pathway. Notably, this effect was decreased when cells were transfected with PPAR-γ siRNA or treated with the PPAR-γ inhibitor T0070907. In addition, HSL-2 was able to attenuate lung inflammatory responses and to improve lung lesions in a mouse model of IAV infection.

Conclusions

In this paper, we identified a microbial secondary metabolite, HSL-2, with anti-influenza virus activity. This report is the first to describe the antiviral activity and mechanism of action of HSL-2, and it provides a new strategy for the development of novel anti-influenza virus drugs from natural sources.
背景:抗药性是抗击甲型流感病毒(IAV)的一个重要因素。天然产物为发现新型抗病毒药物提供了丰富的先导化合物来源。在之前的研究中,我们从真菌毛霉 T-4-1 的菌丝体中分离出了山梨酸类多酮化合物 HSL-2。在这里,我们证明了这种化合物对一系列 IAVs 具有很强的抗病毒活性:方法:采用免疫荧光和 qRT-PCR 检测 HSL-2 对流感病毒复制和 IAV 诱导的促炎细胞因子(如 TNF-α、IL-6 和 IL-1β)表达的抑制作用:结果表明:HSL-2能抑制流感病毒的复制,并通过调节PPAR-γ/NF-κB途径显著抑制IAV诱导的促炎细胞因子TNF-α、IL-6和IL-1β的过表达。值得注意的是,用 PPAR-γ siRNA 转染细胞或用 PPAR-γ 抑制剂 T0070907 处理细胞时,这种作用会减弱。此外,HSL-2 还能减轻肺部炎症反应,并改善 IAV 感染小鼠模型的肺部病变:本文发现了一种具有抗流感病毒活性的微生物次级代谢产物 HSL-2。本报告首次描述了 HSL-2 的抗病毒活性和作用机制,为从天然来源开发新型抗流感病毒药物提供了新策略。
{"title":"Sorbicillinoid HSL-2 inhibits the infection of influenza A virus via interaction with the PPAR-γ/NF-κB pathway","authors":"","doi":"10.1016/j.jiac.2024.06.013","DOIUrl":"10.1016/j.jiac.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Drug resistance is an important factor in the fight against influenza A virus<span> (IAV). Natural products offer a rich source </span></span>of lead compounds<span> for the discovery of novel antiviral drugs. In a previous study, we isolated the sorbicillinoid polyketide </span></span><strong>HSL-2</strong><span> from the mycelium of fungus </span><span><span>Trichoderma</span></span><span> sp. T-4-1. Here, we show that this compound exerts strong antiviral activity against a panel of IAVs.</span></div></div><div><h3>Methods</h3><div>The immunofluorescence and qRT-PCR assays were used to detect the inhibitory effect of <strong>HSL-2</strong> toward the replication of influenza virus and IAV-induced expression of the pro-inflammatory cytokines such as TNF-α, IL-6, and IL-1β.</div></div><div><h3>Results</h3><div>The results indicated that <strong>HSL-2</strong><span><span> inhibited influenza virus replication, and it significantly inhibited IAV-induced overexpression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β through modulating the PPAR-γ/NF-κB pathway. Notably, this effect was decreased when cells were transfected with PPAR-γ siRNA or treated with the PPAR-γ inhibitor </span>T0070907. In addition, </span><strong>HSL-2</strong><span> was able to attenuate lung inflammatory responses<span><span> and to improve lung lesions in a mouse model of </span>IAV infection.</span></span></div></div><div><h3>Conclusions</h3><div><span>In this paper, we identified a microbial secondary metabolite, </span><strong>HSL-2</strong><span>, with anti-influenza virus activity. This report is the first to describe the antiviral activity and mechanism of action of </span><strong>HSL-2</strong>, and it provides a new strategy for the development of novel anti-influenza virus drugs from natural sources.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Characteristics and outcomes of urinary tract infections caused by Enterococci: A multicenter retrospective study from two tertiary hospitals in Saudi Arabia 由肠球菌引起的尿路感染的特征和结果:一项来自沙特阿拉伯两家三级医院的多中心回顾性研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-26 DOI: 10.1016/j.jiac.2024.06.019

Enterococci are Gram-positive coccus bacteria that are normally present in the gastrointestinal tract and ordinarily function commensally with humans. Very few studies have investigated the characteristics of enterococcal infections. We aimed to characterize patients with urinary tract infections (UTIs) due to Enterococci and their outcomes. This was a retrospective cohort study between June 2012–November 2022. Patients who had clinically and microbiologically confirmed Enterococcal UTI based on a urine culture positive for E. faecalis or E. faecium with a count of ≥105 CFU/mL and having urinary tract symptoms were included. A total of 396 patients were eligible and included. The patients had a median age of 61 years and were mostly females (56.8 %). The most common characteristics were hospitalization in a non-ICU ward, having a urinary catheter, and recent use of antibiotics within the last 3 months (66.4 %, 59.3 %, and 51.8 %, respectively). Infection with E. faecalis was more common than E. faecium (77.3 % vs. 22.7 %). However, the latter exhibited higher rates of antibiotic resistance (P < 0.001 to several antibiotics) and was associated with significantly higher median C-reactive protein level (26.7 vs. 13 mg/dL; P = 0.025), mortality (23 % vs. 10.1 %; P = 0.002), and median length of stay (25 vs. 11.5 days; P < 0.001). We found that most patients with enterococcal UTIs had a history of having a urinary catheter and recent antibiotic use and were mostly females and hospitalized in non-ICU wards. E. faecium-infected patients experienced more severe episodes and poorer outcomes compared to patients infected with E. faecalis; thus, would need more aggressive therapy.

肠球菌是革兰氏阳性球菌,通常存在于胃肠道中,通常与人类共生。很少有研究调查肠球菌感染的特征。我们的目的是了解肠球菌引起的尿路感染(UTI)患者的特征及其结果。这是一项回顾性队列研究,研究时间为 2012 年 6 月至 2022 年 11 月。研究对象包括经临床和微生物学确诊的肠球菌性UTI患者,这些患者的尿培养结果为粪肠球菌或粪肠球菌阳性,且计数≥ 105 CFU/mL,并伴有尿路症状。共有 396 名患者符合条件并被纳入。患者的中位年龄为 61 岁,大部分为女性(56.8%)。最常见的特征是在非重症监护病房住院、使用导尿管以及最近 3 个月内使用过抗生素(分别占 66.4%、59.3% 和 51.8%)。感染粪肠球菌比感染粪肠球菌更常见(77.3% 对 22.7%)。然而,后者表现出更高的抗生素耐药性(P
{"title":"Characteristics and outcomes of urinary tract infections caused by Enterococci: A multicenter retrospective study from two tertiary hospitals in Saudi Arabia","authors":"","doi":"10.1016/j.jiac.2024.06.019","DOIUrl":"10.1016/j.jiac.2024.06.019","url":null,"abstract":"<div><p><em>Enterococci</em> are Gram-positive coccus bacteria that are normally present in the gastrointestinal tract and ordinarily function commensally with humans. Very few studies have investigated the characteristics of enterococcal infections. We aimed to characterize patients with urinary tract infections (UTIs) due to <em>Enterococci</em> and their outcomes. This was a retrospective cohort study between June 2012–November 2022. Patients who had clinically and microbiologically confirmed Enterococcal UTI based on a urine culture positive for <em>E. faecalis</em> or <em>E. faecium</em> with a count of ≥10<sup>5</sup> CFU/mL and having urinary tract symptoms were included. A total of 396 patients were eligible and included. The patients had a median age of 61 years and were mostly females (56.8 %). The most common characteristics were hospitalization in a non-ICU ward, having a urinary catheter, and recent use of antibiotics within the last 3 months (66.4 %, 59.3 %, and 51.8 %, respectively). Infection with <em>E. faecalis</em> was more common than <em>E. faecium</em> (77.3 % vs. 22.7 %). However, the latter exhibited higher rates of antibiotic resistance (<em>P</em> &lt; 0.001 to several antibiotics) and was associated with significantly higher median C-reactive protein level (26.7 vs. 13 mg/dL; <em>P</em> = 0.025), mortality (23 % vs. 10.1 %; <em>P</em> = 0.002), and median length of stay (25 vs. 11.5 days; <em>P</em> &lt; 0.001). We found that most patients with enterococcal UTIs had a history of having a urinary catheter and recent antibiotic use and were mostly females and hospitalized in non-ICU wards. <em>E. faecium</em>-infected patients experienced more severe episodes and poorer outcomes compared to patients infected with <em>E. faecalis</em>; thus, would need more aggressive therapy.</p></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1341321X24001740/pdfft?md5=eb96cea5053e17eeb571ab6408904e59&pid=1-s2.0-S1341321X24001740-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring the efficacy of routine antimicrobial therapy in severe fever with thrombocytopenia syndrome: Overlap weighting analysis using a nationwide inpatient database. 探索严重发热伴血小板减少综合征常规抗菌治疗的疗效:利用全国住院患者数据库进行重叠加权分析。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-26 DOI: 10.1016/j.jiac.2024.06.020
Satoshi Kutsuna, Hiroyuki Ohbe, Hiroki Matsui, Hideo Yasunaga

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an infectious disease that presents a formidable challenge due to the absence of established therapeutic strategies that are explicitly tailored to its management. This study aimed to assess the impact of routine antimicrobial therapy on patients diagnosed with SFTS in Japan. We conducted a comprehensive retrospective cohort analysis using extensive data from a national inpatient database.

Methods: This study scrutinized data from adult patients with SFTS and categorized them based on whether they received antimicrobial treatment within the initial 2 days of hospital admission. A meticulous evaluation was carried out on a range of outcomes, such as in-hospital mortality rates, overall costs associated with hospitalization, and length of hospital stay. Overlap weighting was applied along with multivariate regression models to enhance the reliability of the findings through confounder adjustment. The outcomes showed no significant improvement in the prognosis of patients with SFTS who received routine antimicrobial therapy. The use of antimicrobials did not yield statistically significant improvements in in-hospital mortality rates or other secondary outcomes, suggesting that such therapeutic interventions may not be necessary during the early stages of hospital admission.

Conclusion: In our study, administration of antimicrobials within 2 days of admission for SFTS did not affect prognosis. The standard use of antimicrobial treatments may be an issue that should be reconsidered.

背景:严重发热伴血小板减少综合征(SFTS严重发热伴血小板减少综合征(SFTS)是一种传染性疾病,由于缺乏明确的治疗策略,该病的治疗面临巨大挑战。本研究旨在评估常规抗菌治疗对日本确诊的 SFTS 患者的影响。我们利用全国住院患者数据库中的大量数据进行了全面的回顾性队列分析:本研究仔细研究了 SFTS 成年患者的数据,并根据他们是否在入院最初 2 天内接受过抗菌治疗进行了分类。对一系列结果进行了细致评估,如院内死亡率、住院相关总费用和住院时间。研究采用了重叠加权法和多元回归模型,通过调整混杂因素来提高研究结果的可靠性。结果显示,接受常规抗菌治疗的 SFTS 患者的预后没有明显改善。抗菌药物的使用并未对院内死亡率或其他次要结果产生统计学意义上的显著改善,这表明在入院早期阶段可能没有必要采取此类治疗干预措施:在我们的研究中,SFTS 患者入院 2 天内使用抗菌药物不会影响预后。抗菌治疗的标准使用可能是一个需要重新考虑的问题。
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引用次数: 0
Can we predict bleeding at admission in Crimean-Congo hemorrhagic fever? 我们能否预测克里米亚-刚果出血热患者入院时的出血情况?
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-26 DOI: 10.1016/j.jiac.2024.06.014
Sinan Çetin, Ahmet Melih Şahin

Background: In Crimean-Congo hemorrhagic fever, bleeding has a significant impact on the prognosis of the disease. In our study, we aimed to identify independent risk factors for the development of bleeding in Crimean-Congo hemorrhagic fever and to contribute to the management of the disease.

Methods: Cases with a definitive diagnosis of Crimean-Congo hemorrhagic fever were divided into two groups: those who developed bleeding and those who did not. Demographic, clinical and laboratory parameters were subjected to logistic regression analysis in terms of risk factors for bleeding development. Cut-off values for numerical variables were determined by receiver operating characteristics.

Results: A total of 74 patients diagnosed with CCHF were included in the study. Bleeding occurred in at least one defined focus in 21 patients. In the multivariate logistic regression model, procalcitonin, days from symptom onset to admission, platelet count, and d-dimer were identified as independent risk factors for bleeding development. Procalcitonin had the most significant effect, with an approximately 5.3-fold increase in bleeding risk for each unit increase in its level. For discriminate bleeding, LDH and ferritin exhibited the highest sensitivity, while procalcitonin showed the highest specificity.

Conclusion: This study demonstrates the potential use of specific clinical and laboratory variables to predict bleeding development in CCHF patients. Procalcitonin elevation and the time from symptom onset to hospital admission have a significant effect in predicting bleeding.

背景:在克里米亚-刚果出血热中,出血对疾病的预后有重大影响。在我们的研究中,我们旨在确定克里米亚-刚果出血热出血的独立风险因素,并为该病的治疗做出贡献:方法:将确诊为克里米亚-刚果出血热的病例分为两组:发生出血和未发生出血。根据出血风险因素对人口统计学、临床和实验室参数进行逻辑回归分析。数值变量的临界值由接收器操作特征确定:研究共纳入了 74 名确诊为慢性阻塞性肺疾病的患者。21名患者中至少有一个明确的病灶发生了出血。在多变量逻辑回归模型中,降钙素原、从症状出现到入院的天数、血小板计数和d-二聚体被确定为出血发生的独立风险因素。降钙素原的影响最为显著,其水平每增加一个单位,出血风险就会增加约 5.3 倍。对于鉴别出血,LDH 和铁蛋白的灵敏度最高,而降钙素原的特异性最高:这项研究表明,可以利用特定的临床和实验室变量来预测慢性阻塞性肺疾病患者的出血情况。降钙素原升高和从症状出现到入院的时间对预测出血有显著影响。
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引用次数: 0
Severe mpox requiring colostomy in a patient with advanced HIV disease: A case report and literature review. 一名晚期艾滋病患者因严重便秘而需要进行结肠造口术:病例报告和文献综述。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-25 DOI: 10.1016/j.jiac.2024.06.017
So Yun Lim, Hong Soon Yim, Eun Jung Ahn, Euijin Chang, Jonghee Yoon, Ja-Hee Suh, Jihye Um, Hyang Su Kim, Min-Kyung Kim, Yeonjae Kim, Gayeon Kim, Jaehyun Jeon, Jun-Sun Park, BumSik Chin

This severe monkeypox case described a 23-year-old male with advanced HIV-1 disease presenting perirectal abscess, extensive anal ulcerative lesions requiring colostomy, and tecovirimat resistance. Radiologically non-liquefied perirectal abscess presented diagnostic challenges highlighting the complexity of aggressive monkeypox manifestations in immunocompromised individuals.

这例重症猴痘病例描述了一名23岁男性晚期HIV-1感染者,患者出现直肠周围脓肿、广泛的肛门溃疡,需要进行结肠造口术,并对替考韦酯产生耐药性。放射学上不液化的直肠周围脓肿给诊断带来了挑战,凸显了猴痘在免疫力低下人群中侵袭性表现的复杂性。
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引用次数: 0
Clinical impact of a change in antibiotics or the addition of glycopeptide antibiotics for persistent febrile neutropenia after autologous stem cell transplantation. 自体干细胞移植后持续发热性中性粒细胞减少症患者更换抗生素或添加糖肽类抗生素的临床影响。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-06-24 DOI: 10.1016/j.jiac.2024.06.018
Nozomu Yoshino, Shun-Ichi Kimura, Koji Kawamura, Yuya Nakata, Akari Matsuoka, Takuto Ishikawa, Tomohiro Meno, Yuhei Nakamura, Masakatsu Kawamura, Shunto Kawamura, Junko Takeshita, Yukiko Misaki, Kazuki Yoshimura, Ayumi Gomyo, Yosuke Okada, Masaharu Tamaki, Machiko Kusuda, Kazuaki Kameda, Yu Akahoshi, Miki Sato, Aki Tanihara, Hideki Nakasone, Shinichi Kako, Yoshinobu Kanda

Background: A change in empirical antibiotics or the addition of glycopeptide antibiotics is often applied in cases of persistent febrile neutropenia (FN) despite the administration of broad-spectrum antibiotics. However, the clinical benefit of these approaches remains unclear.

Methods: We conducted a retrospective study to evaluate the effectiveness of a change in antibiotics or the addition of glycopeptide antibiotics for persistent FN after autologous hematopoietic cell transplantation (auto-HCT). We retrospectively reviewed the records of 208 patients who received auto-HCT at our institution between 2007 and 2019. FN that lasted for 4 days or longer was defined as persistent FN. We compared the time to defervescence between patients whose initial antibiotics were changed and/or who additionally received glycopeptide antibiotics, and those without these antibiotic modifications.

Results: Among patients who fulfilled the criteria of persistent FN (n = 125), changes in antibiotics were not significantly associated with the time to defervescence in a multivariate analysis (hazard ratio [HR] 0.72, p = 0.27). On the other hand, the addition of glycopeptide antibiotics was paradoxically associated with a delay in defervescence (HR 0.56, p = 0.033).

Conclusions: Although there may be differences in patient backgrounds, no significant differences were observed in either a univariate or multivariate analysis. Since neither a change in antibiotics nor the addition of glycopeptide antibiotics was associated with earlier defervescence in persistent FN after auto-HCT, routine antibiotic modifications might not be necessary in this setting.

背景:在使用广谱抗生素后仍出现发热性中性粒细胞减少症(FN)的病例中,通常会更换经验性抗生素或添加糖肽类抗生素。然而,这些方法的临床疗效仍不明确:我们进行了一项回顾性研究,以评估自体造血细胞移植(auto-HCT)后更换抗生素或添加糖肽类抗生素治疗持续发热性中性粒细胞减少症的效果。我们回顾性审查了 2007 年至 2019 年期间在本院接受自体血细胞移植的 208 名患者的病历。持续4天或更长时间的FN被定义为持续性FN。我们比较了更换初始抗生素和/或额外使用糖肽类抗生素的患者与未更换抗生素的患者的消退时间:在符合顽固性 FN 标准的患者中(n = 125),抗生素的改变与延期时间的多变量分析无显著相关性(危险比 [HR] 0.72,p = 0.27)。另一方面,添加糖肽类抗生素却与延缓衰竭时间有矛盾关系(HR 0.56,p = 0.033):尽管患者背景可能存在差异,但在单变量或多变量分析中均未观察到显著差异。由于无论是更换抗生素还是添加糖肽类抗生素都与自体肝移植后顽固性 FN 的提前衰退无关,因此在这种情况下可能没有必要对抗生素进行常规调整。
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Journal of Infection and Chemotherapy
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