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The therapeutic effect of continuous blood purification on sepsis in children: A systematic review and meta-analysis 持续血液净化对儿童败血症的治疗效果:系统回顾和荟萃分析。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-20 DOI: 10.1016/j.jiac.2024.07.016
Minghai Zhang , Zhijie Ling , Wei Zhang , Qing Huang

Background

Previous meta-analyses have systematically assessed the therapeutic effect of continuous blood purification (CBP) in adult patients with sepsis. Considering infection etiology and host response of sepsis is different in children, this systematic review and meta-analysis aims to evaluate the clinical efficacy of CBP in children with sepsis.

Methods

Studies were searched from the Pubmed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases. Outcomes included vital signs, coagulation markers, organ function markers, immune markers, inflammatory markers, and prognostic markers. Heterogeneity was evaluated by the I-square statistic (I2), and sensitivity analysis was performed.

Results

24 studies were included in this meta-analysis. Pooled results showed that CBP decreased levels of alanine transaminase (ALT) (weighted mean difference [WMD] = −44.867, 95%CI: 64.809 to −24.926), aspartate aminotransferase (AST) (WMD = −55.373, 95%CI: 73.286 to −37.460), blood urea nitrogen (BUN) (WMD = −2.581, 95%CI: 4.539 to −0.622), and serum creatinine (Scr) (WMD = −11.567, 95%CI: 19.509 to −3.625). The percentage of CD3+ cells (WMD = 8.242, 95%CI: 3.339 to 13.144) and CD4+ cells (WMD = 4.278, 95%CI: 3.252 to 5.303, I2 = 3.1 %) were increased in the CBP group. C-reaction protein (CRP) (WMD = −20.699, 95%CI: 34.740 to −6.657) and tumor necrosis factor-α (TNF-α) (WMD = −19.185, 95%CI: 34.133 to −4.237) were reduced after CBP treatment. Pediatric critical illness score (PCIS) was increased (WMD = 7.916, 95%CI: 4.317 to 11.516) and the risk of 28-day mortality (risk ratio [RR] = 0.781, 95%CI: 0.632 to 0.965) was lower in the CBP group.

Conclusions

CBP reduced the level of inflammatory markers, increased the level of immune markers, and improved organ function and prognosis, which may provide evidence for the use of CBP in sepsis children patients.
背景:以往的荟萃分析系统地评估了持续血液净化(CBP)对脓毒症成人患者的治疗效果。考虑到儿童败血症的感染病因和宿主反应不同,本系统综述和荟萃分析旨在评估 CBP 对儿童败血症患者的临床疗效:方法:从 Pubmed、Embase、Cochrane Library、Web of Science、中国国家知识基础设施(CNKI)、万方数据库和 VIP 数据库中检索研究。研究结果包括生命体征、凝血指标、器官功能指标、免疫指标、炎症指标和预后指标。用 I 平方统计量(I2)评估异质性,并进行敏感性分析。汇总结果显示,CBP 可降低丙氨酸转氨酶(ALT)(加权平均差 [WMD] = -44.867,95%CI:-64.809 至 -24.926)、天冬氨酸转氨酶(AST)(WMD = -55.373,95%CI:-73.286 至 -37.460)、血尿素氮(BUN)(WMD = -2.581,95%CI:-4.539 至 -0.622)和血清肌酐(Scr)(WMD = -11.567,95%CI:-19.509 至 -3.625)。CD3+ 细胞(WMD = 8.242,95%CI:3.339 至 13.144)和 CD4+ 细胞(WMD = 4.278,95%CI:3.252 至 5.303,I2 = 3.1%)的百分比在 CBP 组中有所增加。CBP 治疗后,C 反应蛋白(CRP)(WMD = -20.699,95%CI:-34.740 至 -6.657)和肿瘤坏死因子-α(TNF-α)(WMD = -19.185,95%CI:-34.133 至 -4.237)降低。CBP组的小儿危重病评分(PCIS)增加(WMD = 7.916,95%CI:4.317 至 11.516),28天死亡风险(风险比 [RR] = 0.781,95%CI:0.632 至 0.965)降低:CBP降低了炎症标志物的水平,提高了免疫标志物的水平,改善了器官功能和预后,为在败血症儿童患者中使用CBP提供了证据。
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引用次数: 0
Effects of meropenem supply restriction: A multicenter retrospective study. 限制美罗培南供应的影响:一项多中心回顾性研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-18 DOI: 10.1016/j.jiac.2024.07.015
Yoshimichi Koutake, Yoji Nagasaki, Ryosuke Hirata, Keiji Soejima, Hiromi Nishi, Hiroko Tsukada, Shohei Hamasaki, Masashi Hashimoto

Background: In Japan, the supply of one generic meropenem product was restricted from August 2022 to March 2023.

Objective: To determine the effects of meropenem (MEPM) restriction.

Methods: We conducted a multicenter retrospective study comparing antimicrobial use, bacteremia mortality, and drug-resistant bacteria detected before the restriction of MEPM (control period), from September 2021 to February 2022, and after the restriction of MEPM (MEPM supply restriction period), from September 2022 to February 2023, in five institutions.

Results: The number of carbapenem days of therapy (DOTs) were decreased in all five institutions. Fourth-generation cephalosporin DOTs increased in all facilities, and piperacillin/tazobactam DOTs increased in four facilities. The 30-day and 90-day mortality rates were significantly higher during the MEPM supply restriction period than those during the control period. Moreover, survival time was significantly shorter during the MEPM supply restriction period than that during the control period. Multivariable analysis revealed that MEPM supply restriction, age >80 years, Pitt Bacteremia Score ≥4, platelet count <10 × 104/μL, serum albumin level <2.5 g/dL, and methicillin-resistant Staphylococcus aureus bloodstream infection were independent risk factors for 30-day mortality. The detection rates of carbapenem-resistant Pseudomonas aeruginosa and Enterobacteriaceae did not differ significantly between the two periods.

Conclusions: MEPM supply restriction decreased the use of carbapenems and increased the use of other broad-spectrum antimicrobial agents, which worsened the prognosis of bacteremia. Overall, carbapenems are important drugs for the treatment of infectious diseases and are difficult to replace in unforeseen situations such as drug supply outages.

背景:日本从 2022 年 8 月至 2023 年 3 月限制供应一种美罗培南仿制药日本从 2022 年 8 月至 2023 年 3 月限制一种美罗培南仿制药的供应:确定美罗培南(MEPM)限制的影响:我们进行了一项多中心回顾性研究,比较了2021年9月至2022年2月美罗培南限制前(对照期)和2022年9月至2023年2月美罗培南限制后(美罗培南供应限制期)五家机构的抗菌药物使用情况、菌血症死亡率和耐药菌检出情况:结果:所有五家机构的碳青霉烯类药物治疗天数(DOT)均有所减少。所有机构的第四代头孢菌素 DOT 天数均有所增加,4 家机构的哌拉西林/他唑巴坦 DOT 天数有所增加。在限制 MEPM 供应期间,30 天和 90 天的死亡率明显高于对照期间。此外,限制 MEPM 供应期间的存活时间明显短于对照期间。多变量分析显示,限制 MEPM 供应、年龄大于 80 岁、皮特菌血症评分≥ 4、血小板计数小于 10×104/μL、血清白蛋白水平小于 2.5 g/dL、耐甲氧西林金黄色葡萄球菌血流感染是 30 天死亡率的独立风险因素。耐碳青霉烯类铜绿假单胞菌和肠杆菌科细菌的检出率在两个时期没有显著差异:结论:限制 MEPM 的供应减少了碳青霉烯类药物的使用,增加了其他广谱抗菌药物的使用,从而恶化了菌血症的预后。总之,碳青霉烯类是治疗感染性疾病的重要药物,在药物供应中断等意外情况下难以替代。
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引用次数: 0
Overview of anaerobic infections in children and their treatment 儿童厌氧菌感染及其治疗概述。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-18 DOI: 10.1016/j.jiac.2024.07.014
Itzhak Brook

Anaerobic bacteria can cause many infections in children. Because they predominant in the normal human skin and mucous membranes bacterial flora, they are often associated with bacterial infections that originate from these sites. They are difficult to isolate from infectious sites, and are frequently missed. Anaerobic infections can occur in all body sites, including the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Anaerobes colonize the newborn after birth and have been isolated in several types of neonatal infections. These include cellulitis of the site of fetal monitoring, neonatal aspiration pneumonia, bacteremia, conjunctivitis, omphalitis, and infant botulism. Management of anaerobic infection is challenging because of the slow growth of these bacteria, by their polymicrobial nature and by the growing antimicrobial resistance of anaerobic. Antimicrobial therapy may be the only treatment required, and may also be an adjunct to a surgical approach. Polymicrobial aerobic-anaerobic infection generally requires delivering antimicrobial therapy effective against all pathogens. The antibiotics with the greatest activity against anaerobes include carbapenems, beta-lactam/beta-lactamase inhibitor combinations, metronidazole, and chloramphenicol. Antimicrobial resistance is growing among anaerobic bacteria. The major increased in resistance have been reported with clindamycin, cephamycins, and moxifloxacin against Bacteroides fragilis group and related strains. Resistance patterns vary between different geographic areas and medical facilities.

厌氧菌可引起多种儿童感染。由于厌氧菌在正常人的皮肤和粘膜细菌群中占主导地位,因此它们往往与源自这些部位的细菌感染有关。它们很难从感染部位分离出来,因此经常被漏诊。厌氧菌感染可发生在身体的所有部位,包括中枢神经系统、口腔、头颈部、胸部、腹部、骨盆、皮肤和软组织。厌氧菌会在新生儿出生后定植,并在几种类型的新生儿感染中被分离出来。这些感染包括胎儿监护部位的蜂窝织炎、新生儿吸入性肺炎、菌血症、结膜炎、鹅口疮和婴儿肉毒中毒。厌氧菌感染的治疗具有挑战性,因为这些细菌生长缓慢,具有多菌性,而且厌氧菌对抗菌素的耐药性不断增强。抗菌治疗可能是唯一需要的治疗方法,也可能是手术治疗的辅助方法。需氧-厌氧菌多菌感染一般需要使用对所有病原体都有效的抗菌疗法。对厌氧菌活性最强的抗生素包括碳青霉烯类、β-内酰胺/β-内酰胺酶抑制剂复方制剂、甲硝唑和氯霉素。厌氧菌对抗菌素的耐药性正在增加。据报道,对克林霉素、头孢霉素和莫西沙星的耐药性主要是针对脆弱拟杆菌属和相关菌株。不同地区和医疗机构的耐药性模式各不相同。
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引用次数: 0
Dalbavancin for the treatment of bone and joint infections: A meta-analysis. 治疗骨关节感染的达巴万星:一项荟萃分析。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-17 DOI: 10.1016/j.jiac.2024.07.013
Thamer A Almangour, Marwan A Alrasheed

Background: Bone and joint infections are challenging infectious diseases to treat and require prolonged antimicrobial treatment. Dalbavancin demonstrated promising pharmacokinetic/pharmacodynamic properties for the treatment of these infections. The objective of this meta-analysis is to compare the effectiveness of dalbavancin to standard of care (SOC) for the treatment of bone and joint infections.

Methods: Two independent authors performed a comprehensive search through the major databases up to September 2023. Interventional and observational studies that compared the clinical success of dalbavancin to SOC for the treatment of osteoarticular infections (OAI) were included.

Results: A total of 6 studies and 581 patients were included, 282 in dalbavancin group and 299 in SOC group. Only one study was randomized clinical trial. When the data from the 6 studies were pooled in a meta-analysis, clinical success did not differ in those who received dalbavancin versus SOC (OR = 1.55, 95 % CI = 0.95-2.55, I-squared = 15.89 %) for the treatment of OAI infections. Four studies compared the two groups in terms of hospital length of stay and demonstrated a significant shorter length of stay in dalbavancin group compared to SOC group. Treatment-emergent adverse effects were reported in up to 21.4 % of patients in the dalbavancin group and up to 36.7 % of patients in the SOC group.

Conclusion: This meta-analysis showed that dalbavancin is as effective as SOC for the treatment of patients with OAI infections. More data are needed to validate these findings.

背景:骨与关节感染是一种治疗难度很大的感染性疾病,需要长时间的抗菌治疗。达巴万星在治疗这些感染方面具有良好的药代动力学/药效学特性。本荟萃分析旨在比较达巴万星与标准疗法(SOC)治疗骨关节感染的有效性:两位独立作者对截至 2023 年 9 月的主要数据库进行了全面检索。方法:两位独立作者对截至 2023 年 9 月的主要数据库进行了全面检索,纳入了比较达巴万星与标准疗法(SOC)在治疗骨关节感染(OAI)方面临床疗效的干预性和观察性研究:结果:共纳入了 6 项研究和 581 例患者,其中达巴万星组 282 例,SOC 组 299 例。只有一项研究是随机临床试验。将 6 项研究的数据汇总后进行荟萃分析,在治疗 OAI 感染方面,接受达巴万星治疗的患者与接受 SOC 治疗的患者在临床成功率上没有差异(OR = 1.55,95% CI = 0.95-2.55,I-squared = 15.89%)。四项研究比较了两组患者的住院时间,结果显示达巴万星组的住院时间明显短于SOC组。达巴万星组和SOC组分别有21.4%和36.7%的患者出现治疗突发不良反应:这项荟萃分析表明,达巴万星与SOC对治疗OAI感染患者同样有效。需要更多数据来验证这些发现。
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引用次数: 0
Concerns about vaccines and vaccination behavior among Japanese budget travelers to India. 前往印度的日本经济型旅行者对疫苗和接种行为的担忧。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-14 DOI: 10.1016/j.jiac.2024.07.011
Michiyo Yamakawa, Yuko Tanaka, Akiko Tokinobu, Toshihide Tsuda

Background: Low vaccination coverage among travelers poses a critical challenge to global health security. Indeed, public concerns regarding vaccines can lead to vaccine reluctance and refusal, but evidence about the impacts of concerns regarding vaccines on the uptake of travel vaccinations remains sparse. We examined the associations between concerns about vaccines and vaccination behavior among travelers.

Methods: Japanese travelers aged 18 years or older, who stayed at a guesthouse in New Delhi, India, were targeted (n = 153). We conducted cross-sectional surveys from August 23 to September 2, 2019, and from February 19 to March 5, 2020. We examined the associations of three concerns regarding vaccines (5-point scale)-serious side effects from vaccines, vaccine safety, and vaccine effectiveness-with the uptake of travel vaccinations.

Results: In total, 60 participants (39.2 %) had been vaccinated for this or a past trip. After adjusting for all potential confounding variables, concerns about serious side effects from vaccines and vaccine safety were negatively associated with the uptake of travel vaccinations. The ORs (95 % CIs) for 1-point increases in concerns about serious side effects from vaccines and vaccine safety were 0.72 (0.52, 0.99) and 0.71 (0.52, 0.96), respectively. Sensitivity analyses did not change the results substantially.

Conclusions: Concerns about vaccine safety issues were negatively associated with the uptake of travel vaccinations among the participants, with no corresponding association observed for vaccine effectiveness. Addressing concerns about vaccine safety issues, rather than vaccine effectiveness may contribute to an increased uptake of travel vaccinations.

背景:旅行者中疫苗接种覆盖率低对全球健康安全构成了严峻挑战。事实上,公众对疫苗的担忧会导致不愿接种和拒绝接种疫苗,但有关疫苗担忧对旅行接种率影响的证据仍然很少。我们研究了旅行者对疫苗的担忧与疫苗接种行为之间的关联:方法:我们以在印度新德里一家宾馆住宿的 18 岁或以上的日本旅行者为对象(n=153)。我们于 2019 年 8 月 23 日至 9 月 2 日和 2020 年 2 月 19 日至 3 月 5 日进行了横断面调查。我们研究了对疫苗的三种担忧(5 分制)--疫苗的严重副作用、疫苗的安全性和疫苗的有效性--与旅行疫苗接种率的关系:共有 60 名参与者(39.2%)在这次或过去的旅行中接种过疫苗。在对所有潜在混杂变量进行调整后,对疫苗严重副作用和疫苗安全性的担忧与旅行疫苗接种率呈负相关。对疫苗严重副作用和疫苗安全性的担忧增加 1 个百分点的 ORs(95% 置信区间)分别为 0.72 (0.52, 0.99) 和 0.71 (0.52, 0.96)。敏感性分析没有使结果发生重大变化:结论:对疫苗安全问题的担忧与参与者接种旅行疫苗的比例呈负相关,而对疫苗有效性的担忧与接种比例无相应关系。解决对疫苗安全性问题的担忧而非疫苗有效性问题可能有助于提高旅行疫苗的接种率。
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引用次数: 0
Development and validation of an automated antimicrobial surveillance system based on indications for antimicrobial administration. 开发并验证基于抗菌药使用适应症的自动抗菌药监控系统。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-14 DOI: 10.1016/j.jiac.2024.07.012
Mikiyasu Sakai, Takamasa Sakai, Toshitaka Watariguchi, Atsushi Kawabata, Fumiko Ohtsu

Introduction: We developed an antimicrobial and patient background surveillance system (APBSS), an automated surveillance system that can calculate surveillance data such as antimicrobial use and detection of antimicrobial resistance for each indication of antimicrobial administration. We evaluated the validity of the APBSS data.

Methods: Eligible patients were hospitalized at the Toyota Kosei Hospital on July 7, 2022. Evaluated surveillance data included antimicrobial administration, indications for antimicrobial administration, and diagnosis. In the APBSS, surveillance data were calculated using the Diagnosis Procedure Combination data and Japan Nosocomial Infections Surveillance laboratory data. Using surveillance data collected by the Point Prevalence Survey (PPS) as a reference standard, the agreement between the results calculated based on the APBSS was evaluated using Cohen's kappa coefficient. Indications for antimicrobial administration and diagnosis were analyzed in patients identified for antimicrobial administration in PPS or APBSS.

Results: A total of 582 patients were included in this study, 223 of whom were evaluated for indications for antimicrobial administration and diagnosis. For the indications of antimicrobial administration, the Cohen's kappa coefficient was almost perfect (0.81-1.00) for all items. Cohen's kappa coefficient for the diagnosis of healthcare-associated infections was low. However, in major diseases (pneumonia and intra-abdominal, and symptomatic upper urinary tract infections) among community-acquired infections (CAIs) diagnosis, Cohen's kappa coefficient was substantial (0.61-0.80).

Conclusions: The APBSS can identify indications for antimicrobial administration and major CAIs with high accuracy. Therefore, the APBSS can calculate surveillance data, such as antimicrobial use and detection of antimicrobial resistance, for each of these items.

介绍:我们开发了一个抗菌药物和患者背景监测系统(APBSS),这是一个自动监测系统,可以计算监测数据,如抗菌药物的使用和每个抗菌药物给药适应症的抗菌药物耐药性检测。我们对 APBSS 数据的有效性进行了评估:符合条件的患者于 2022 年 7 月 7 日在丰田佼成医院住院。评估的监控数据包括抗菌药物用量、抗菌药物用量适应症和诊断。在 APBSS 中,监测数据是通过诊断程序组合数据和日本非社会性感染监测实验室数据计算得出的。以点流行率调查(PPS)收集的监测数据为参考标准,使用科恩卡帕系数(Cohen's kappa coefficient)评估了根据 APBSS 计算出的结果之间的一致性。对在 PPS 或 APBSS 中确定需要使用抗菌药物的患者的抗菌药物使用指征和诊断进行了分析:本研究共纳入了 582 例患者,其中 223 例患者接受了抗菌药物治疗和诊断适应症评估。在抗菌药使用指征方面,所有项目的科恩卡帕系数几乎都是完美的(0.81-1.00)。医疗相关感染诊断的科恩卡帕系数较低。然而,在社区获得性感染(CAIs)诊断的主要疾病(肺炎、腹腔内感染和无症状上尿路感染)中,科恩卡帕系数很高(0.61-0.80):结论:APBSS能高度准确地识别抗菌药物使用指征和主要的社区获得性感染。因此,APBSS 可以计算每个项目的监测数据,如抗菌药物的使用和抗菌药物耐药性的检测。
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引用次数: 0
A case of herpes zoster secondary to monkeypox in a young man. 一名年轻人继发于猴痘的带状疱疹病例。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-11 DOI: 10.1016/j.jiac.2024.07.008
Li Lin, Zeyu Huang, Ruzhi Zhang

A 19-year-old young man presented with prodromal symptoms including fever and sore throat, followed by the development of scattered rashes in the perianal and penile regions. Monkeypox (MPX) was confirmed using polymerase chain reaction (PCR) of lesions. On the third day after complete resolution of the initial rash, the patient developed a new rash, which was diagnosed as secondary herpes zoster (HZ). Therefore, clinicians should not only focus on the accurate diagnosis of monkeypox, but also be alert to secondary herpes zoster.

一名 19 岁的年轻男子出现发热和咽痛等前驱症状,随后在肛周和阴茎部位出现散在皮疹。通过病变部位的聚合酶链式反应(PCR)确诊为猴痘(MPX)。在最初的皮疹完全消退后的第三天,患者又出现了新的皮疹,被诊断为继发性带状疱疹(HZ)。因此,临床医生不仅要重视猴痘的准确诊断,还要警惕继发性带状疱疹。
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引用次数: 0
Severe mpox requiring colostomy in a patient with advanced HIV disease: Correspondence 一名晚期艾滋病患者因严重便血而需要进行结肠造口术:通信。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-11 DOI: 10.1016/j.jiac.2024.07.010
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
A retrospective observational study on disseminated herpes zoster in immunocompetent patients. 关于免疫功能正常患者播散性带状疱疹的回顾性观察研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-11 DOI: 10.1016/j.jiac.2024.07.009
Hideya Itagaki, Jun Suzuki, Haruka Imai, Tomoyuki Endo, Shiro Endo, Mitsuo Kaku

Introduction: Disseminated herpes zoster (DHZ) is a severe infection associated with high incidences and mortality rates in immunocompromised patients. Although studies have shown its occurrence in immunocompetent patients, its epidemiology, clinical presentation, and treatment outcomes in this cohort remain unknown. Thus, this study aimed to examine the clinical presentation, treatment, complications, and outcomes of DHZ in immunocompetent patients and compare these findings with previous studies.

Methods: We included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients.

Results: Patients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower.

Conclusions: This study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.

导言:播散性带状疱疹(DHZ)是一种严重感染,在免疫力低下的患者中发病率和死亡率都很高。虽然有研究表明免疫功能正常的患者也会患上这种疾病,但这种疾病的流行病学、临床表现和治疗效果仍不为人所知。因此,本研究旨在探讨免疫功能正常患者中 DHZ 的临床表现、治疗、并发症和治疗效果,并将这些结果与之前的研究进行比较:方法:我们纳入了本院 20 例免疫功能正常的 DHZ 患者,并回顾了之前发表的 42 例病例。然后,我们调查了所有病例的临床特征、致病因素、实验室检查结果、治疗和预后,包括院内死亡率、出院时的神经功能障碍和带状疱疹后遗神经痛。我们将免疫功能正常的DHZ患者与免疫功能低下的DHZ患者进行了比较:患者的中位年龄为 71.5 岁,以男性为主。三叉神经区域是最常见的初始皮疹部位,平均扩散时间为 6.5 天。疼痛是最常见的症状,其次是发热(约占 40%);阿昔洛韦是最常用的治疗方法。此外,院内死亡率为0%,约10%的患者出院时出现神经病变,约40%的患者出现带状疱疹后遗神经痛。在免疫力低下的病例中,死亡率为 12%,高于我们的病例;但神经病变和带状疱疹后遗神经痛的发生率较低:本研究为免疫功能正常患者 DHZ 病例的临床表现、治疗和预后提供了新的视角,强调了尽管 DHZ 病死率较低,但仍有残留神经损伤的倾向。
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引用次数: 0
Clinical characteristics and COVID-19-related outcomes of immunocompromised patients receiving tixagevimab/cilgavimab pre-exposure prophylaxis in Japan. 日本接受替沙吉单抗/西格维单抗暴露前预防治疗的免疫功能低下患者的临床特征和 COVID-19 相关结果。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-07-08 DOI: 10.1016/j.jiac.2024.07.007
Toshibumi Taniguchi, Tomoyuki Homma, Yoichi Tamai, Yoshifumi Arita, Masakazu Fujiwara, Naho Kuroishi, Keiji Sugiyama, Shinichi Kanazu, Atsushi Maruyama

Objective: Tixagevimab/cilgavimab is a cocktail of two long-acting monoclonal antibodies approved for pre-exposure prophylaxis (PrEP) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection (cause of coronavirus disease 2019 [COVID-19]) in immunocompromised (IC) or high-risk patients. We investigated the patient characteristics and clinical outcomes of IC patients administered tixagevimab/cilgavimab for PrEP in real-world use in Japan.

Methods: This observational study used anonymous secondary data from Real-World Data Co., Ltd. for IC patients aged ≥12 years administered tixagevimab/cilgavimab between September 2022 and September 2023. We analyzed the baseline characteristics and event-rates of COVID-19-related clinical outcomes within 6 months of administration.

Results: Data were analyzed for 397 IC patients. About half (53.4 %) were male and the median age was 71.0 (interquartile range 61.0, 77.0) years. Malignancy (97.2 %), cardiovascular disease (71.3 %), and diabetes (66.5 %) were frequent comorbidities. Systemic corticosteroids and immunosuppressants were prescribed to 87.4 % and 24.9 %, respectively. The two most common target clinical conditions were active therapy for hematologic malignancies (88.2 %) and treatment with B cell-depleting therapies (57.4 %). The event-rates per 100 person-months (95 % confidence interval; number) for medically attended COVID-19, COVID-19 hospitalization, in-hospital mortality due to COVID-19, and all-cause death were 4.14 (3.06-5.48; n = 49), 1.74 (1.09-2.64; n = 22), 0.07 (0.00-0.42; n = 1), and 0.60 (0.26-1.17; n = 8), respectively.

Conclusion: This is the first report using a multicenter database to describe the clinical characteristics and COVID-19-related outcomes of IC patients administered with tixagevimab/cilgavimab in real-world settings in Japan. This cohort of IC patients who received tixagevimab/cilgavimab included many elderly patients with comorbidities.

研究目的Tixagevimab/cilgavimab是一种由两种长效单克隆抗体组成的鸡尾酒,已被批准用于免疫力低下(IC)或高风险患者的严重急性呼吸系统综合征冠状病毒-2(SARS-CoV-2)感染(冠状病毒病2019年病因[COVID-19])的暴露前预防(PrEP)。我们调查了在日本实际使用替沙吉单抗/西格维单抗进行 PrEP 的 IC 患者的特征和临床结果:本观察性研究使用了 Real-World Data Co., Ltd. 提供的匿名二手数据,研究对象为 2022 年 9 月至 2023 年 9 月期间接受替沙吉单抗/西格维单抗治疗的年龄≥12 岁的 IC 患者。我们分析了用药后6个月内COVID-19相关临床结果的基线特征和事件发生率:我们分析了 397 例 IC 患者的数据。约半数(53.4%)为男性,中位年龄为 71.0 岁(四分位距为 61.0 至 77.0)。恶性肿瘤(97.2%)、心血管疾病(71.3%)和糖尿病(66.5%)是常见的合并症。87.4%和24.9%的患者分别服用了全身性皮质类固醇和免疫抑制剂。两个最常见的目标临床条件是血液恶性肿瘤的积极治疗(88.2%)和 B 细胞消耗疗法的治疗(57.4%)。每百人月的COVID-19就诊率、COVID-19住院率、COVID-19导致的院内死亡率和全因死亡率分别为4.14(3.06-5.48;n=49)、1.74(1.09-2.64;n=22)、0.07(0.00-0.42;n=1)和0.60(0.26-1.17;n=8):这是第一份使用多中心数据库描述日本真实世界中使用替沙吉单抗/西格维单抗的IC患者的临床特征和COVID-19相关结果的报告。接受替沙吉单抗/西格维单抗治疗的IC患者队列中包括许多患有合并症的老年患者。
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Journal of Infection and Chemotherapy
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