Journal of Infection and Chemotherapy最新文献_第3页

Comprehensive genomic analysis of ESBL- and carbapenemase-producing Escherichia coli ST131 in Japan: Genetic characteristics of pandemic clade C 日本产ESBL-和碳青霉烯酶大肠杆菌ST131的综合基因组分析：大流行进化支C的遗传特征

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-24 DOI: 10.1016/j.jiac.2026.102915

Akihiro Nakamura , Tatsuya Nakamura , Makoto Niki , Tomokazu Kuchibiro , Katsutoshi Yamasaki , Masaru Komatsu , The Study of Bacterial Resistance in the Kinki region of Japan (SBRK) group

Introduction

The global dissemination of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Escherichia coli sequence type 131 (ST131), particularly clade C, represents a major public health concern. However, the clade-specific genomic features underlying the long-term persistence and international spread of this lineage remain incompletely understood.

Methods

We performed whole-genome sequencing and comparative genomic analyses of 121 clinical E. coli isolates, including 83 ST131 and 38 non-ST131 strains, collected from 24 healthcare-associated facilities in Japan between 2001 and 2018. Plasmid replicon types, antimicrobial resistance genes, virulence factors, quinolone resistance–determining region (QRDR) mutations, and chromosomal structural variations were analyzed across ST131 clades.

Results

ST131 isolates, particularly clade C, showed a significantly higher prevalence of IncF plasmid replicons, QRDR mutations, and uropathogenic virulence genes such as iha, papA, kpsM, and usp compared with non-ST131 isolates. In contrast, dfrA family genes were less frequent in clade C, suggesting potential retained susceptibility to trimethoprim–sulfamethoxazole. Phylogenetic analysis demonstrated long-term persistence of clade C subclades (C1-nM27, C1-M27, and C2) in Japan. A clade-specific chromosomal region, M27PP1, encoding an ATP-binding protein with a conserved AAA + ATPase domain within a clade-specific genomic island, was identified exclusively in C1-M27 isolates.

Conclusions

Our findings highlight distinct clade-specific genomic characteristics of ST131 clade C in Japan, particularly in C1-M27. While the biological function of M27PP1 remains to be experimentally determined, its lineage-restricted distribution suggests a potential role in the long-term persistence and dissemination of this subclade. Continued genomic surveillance is essential for understanding and controlling high-risk E. coli lineages.

产生β-内酰胺酶（ESBL）和碳青霉烯酶的大肠杆菌序列131型（ST131）的全球传播，特别是C支，是一个主要的公共卫生问题。然而，这一谱系长期存在和国际传播背后的进化支特异性基因组特征仍然不完全清楚。方法：我们对2001年至2018年间从日本24家医疗保健相关机构收集的121株临床大肠杆菌进行了全基因组测序和比较基因组分析，其中包括83株ST131和38株非ST131菌株。分析了ST131分支的质粒复制子类型、耐药基因、毒力因子、喹诺酮类药物耐药决定区（QRDR）突变和染色体结构变异。结果：与非ST131分离株相比，ST131分离株，特别是进化支C，显示出显著更高的IncF质粒复制子、QRDR突变和尿路致病毒力基因（如iha、papA、kpsM和usp）的患病率。相比之下，dfrA家族基因在C进化支中较少出现，表明可能保留对甲氧苄啶-磺胺甲恶唑的易感性。系统发育分析表明，日本的C亚支（C1-nM27、C1-M27和C2）长期存在。在C1-M27分离株中发现了一个进化枝特异性染色体区域M27PP1，该区域编码一个具有保守AAA+ atp酶结构域的atp结合蛋白，该区域位于进化枝特异性基因组岛中。结论：我们的研究结果突出了日本ST131进化支C的独特进化支特异性基因组特征，特别是C1-M27。虽然M27PP1的生物学功能仍有待实验确定，但其谱系限制的分布表明其在该亚支系的长期持续和传播中具有潜在作用。持续的基因组监测对于了解和控制高风险的大肠杆菌谱系至关重要。

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引用次数: 0

Identification of the genetic basis of a CO2-dependent Staphylococcus aureus small-colony variant isolated from pacemaker leads 从起搏器导联分离的co2依赖性金黄色葡萄球菌小菌落变异的遗传基础鉴定。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-27 DOI: 10.1016/j.jiac.2026.102917

Tatsuya Negishi , Yuuki Higuma , Aika Takeda , Ayaka Hachiro , Tatsuya Natori , Kazuki Horiuchi , Nau Ishimine , Takeshi Uehara , Takehisa Matsumoto

Purpose

Small-colony variants (SCVs) are a slow-growing subset of bacteria that exhibit unusual colony morphology and unique biochemical characteristics. They are associated with chronic and persistent infections. CO₂-dependent SCVs of Staphylococcus aureus have been rarely isolated from clinical specimens. This study aimed to characterize the CO₂-dependent phenotype of S. aureus SCV isolated from pacemaker leads and to determine the genetic basis underlying this trait.

Methods

CO₂-dependent S. aureus SCV-5700 isolated from pacemaker leads of a patient with a pacemaker infection was used in this study. Phenotypic testing, antimicrobial susceptibility testing, and mecA polymerase chain reaction of the isolate were performed. Moreover, whole-genome sequencing was conducted for multilocus sequence typing and comparative genomic analysis.

Results

CO₂-dependent S. aureus SCV-5700 grew poorly under ambient air conditions; however, tiny colonies formed after 48 h incubation. The isolate was sequence type 45 and did not harbor the mecA. The isolate was identified as S. aureus by biochemical characterization in a 5 % CO₂ atmosphere. Comparative genomic analysis revealed that the isolate had a nonsense mutation (c.565C>T) in the mpsB; however, the revertant strain, Rev-5700, had no such mutation.

Conclusion

The CO₂-dependent phenotype of clinical S. aureus isolates can be attributed, in part, to loss of MpsB function.

目的：小菌落变异（scv）是一种生长缓慢的细菌，具有不同寻常的菌落形态和独特的生化特征。它们与慢性和持续性感染有关。二氧化碳依赖性金黄色葡萄球菌scv很少从临床标本中分离出来。本研究旨在表征从起搏器导联中分离的金黄色葡萄球菌SCV的二氧化碳依赖性表型，并确定该性状的遗传基础。方法：本研究使用从起搏器感染患者的起搏器导联中分离的二氧化碳依赖性金黄色葡萄球菌SCV-5700。对分离物进行表型检测、药敏试验和mecA聚合酶链反应。进行全基因组测序，进行多位点序列分型和比较基因组分析。结果：co2依赖性金黄色葡萄球菌SCV-5700在环境空气条件下生长较差；然而，孵育48小时后形成微小菌落。分离物为序列45型，不含mecA。在5% CO2气氛中经生化鉴定为金黄色葡萄球菌。比较基因组分析显示，该分离物在mpsB中有一个无义突变（c.565C>T）；然而，逆转录菌株Rev-5700没有这种突变。结论：临床金黄色葡萄球菌分离株的co2依赖表型可部分归因于MpsB功能的丧失。

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引用次数: 0

Adjunctive and supportive strategies to mitigate drug toxicities in the treatment of nontuberculous mycobacterial disease with future directions 减轻非结核分枝杆菌疾病治疗中药物毒性的辅助和支持策略及其未来发展方向

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-13 DOI: 10.1016/j.jiac.2026.102908

Ho Won Kim , Hoe Sun Yoon , Jake Whang , Jong-Seok Kim

Nontuberculous mycobacteria (NTM), particularly Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC), are increasingly recognized as major opportunistic pathogens. Standard therapy requires prolonged multidrug regimens, often extending for more than 12 months, yet treatment success remains limited, especially for MABC. One of the greatest barriers to effective therapy is not antimicrobial resistance alone but also the high burden of drug-related toxicities. Hepatotoxicity, ototoxicity, nephrotoxicity, myelosuppression, neuropathy, gastrointestinal intolerance, and dermatologic complications frequently lead to dose reduction, interruption, or discontinuation, undermining therapeutic efficacy and patient adherence.

This review summarizes current standard regimens for MAC and MABC, details the spectrum of toxicities associated with commonly used agents, and evaluates emerging supportive and adjunctive strategies. Hepatoprotective agents such as ursodeoxycholic acid, silymarin, and N-acetylcysteine, antioxidants and aspirin for aminoglycoside-related ototoxicity, liposomal inhaled amikacin as an alternative to intravenous administration, dose optimization and pyridoxine supplementation for linezolid, and prophylactic antiemetics for tigecycline represent pragmatic approaches with varying levels of evidence. While most supportive measures are extrapolated from tuberculosis cohorts or small pilot studies, they collectively highlight the potential to improve tolerability and adherence.

Future research should prioritize prospective, NTM-specific trials to validate these interventions and develop structured toxicity management frameworks. By embedding supportive strategies alongside antimicrobial regimens, NTM care can move toward a more holistic paradigm that not only enhances microbiological outcomes but also improves patient quality of life.

非结核分枝杆菌（NTM），特别是鸟分枝杆菌复合体（MAC）和脓肿分枝杆菌复合体（MABC），越来越被认为是主要的条件致病菌。标准治疗需要延长多药方案，通常超过12个月，但治疗成功仍然有限，特别是对于MABC。有效治疗的最大障碍之一不仅是抗菌素耐药性，而且是药物相关毒性的高负担。肝毒性、耳毒性、肾毒性、骨髓抑制、神经病变、胃肠不耐受和皮肤并发症经常导致剂量减少、中断或停药，破坏治疗效果和患者依从性。本综述总结了目前MAC和MABC的标准方案，详细介绍了常用药物的毒性谱，并评估了新出现的支持和辅助策略。肝保护剂，如熊去氧胆酸、水飞草素和n -乙酰半胱氨酸，抗氧化剂和阿司匹林治疗氨基糖苷类相关耳毒性，脂体吸入阿米卡星替代静脉给药，利奈唑胺的剂量优化和吡哆醇补充，替加环素的预防性止泻剂代表了具有不同证据水平的实用方法。虽然大多数支持性措施是从结核病队列或小型试点研究中推断出来的，但它们共同强调了提高耐受性和依从性的潜力。未来的研究应优先考虑前瞻性的ntm特异性试验，以验证这些干预措施并开发结构化的毒性管理框架。通过将支持性策略与抗菌方案结合起来，NTM护理可以朝着更全面的范式发展，不仅可以提高微生物学结果，还可以提高患者的生活质量。

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引用次数: 0

An infected aneurysm in the internal carotid artery caused by Salmonella enterica subsp. enterica serovar Enteritidis 由肠道沙门氏菌亚种引起的颈内动脉感染动脉瘤。肠炎

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-20 DOI: 10.1016/j.jiac.2026.102912

Kazuki Maegawa , Hikari Tomita , Ami Masaoka , Hiroaki Nishioka

An infected aneurysm in the carotid artery is a rare but life-threatening condition. The most common cause of such infections is Staphylococcus aureus; however, Salmonella is a possible but uncommon cause. We report the case of an elderly man with an infected aneurysm in the left internal carotid artery caused by Salmonella enterica subsp. Enterica serovar Enteritidis despite the absence of gastrointestinal symptoms. Following confirming the absence of neurological symptoms after blood flow disruption through balloon test occlusion (BTO), the patient underwent coil embolization of the aneurysm and aneurysmectomy without neurological complications. Antibiotics were administered for 8 weeks and full recovery was achieved. Non-typhoidal Salmonella spp. can cause infected aneurysms in the carotid artery, even in the absence of gastrointestinal symptoms. Additionally, BTO may be beneficial for determining the treatment strategy for infected aneurysms in the carotid artery.

颈动脉感染动脉瘤是一种罕见但危及生命的疾病。这种感染最常见的原因是金黄色葡萄球菌；然而，沙门氏菌是一种可能但不常见的病因。我们报告的情况下，老年男子感染动脉瘤在左颈内动脉引起的肠炎沙门氏菌亚。血清型肠炎，尽管没有胃肠道症状。在通过球囊试验阻断（BTO）确认血流中断后没有神经系统症状后，患者接受了动脉瘤线圈栓塞和动脉瘤切除术，无神经系统并发症。抗生素治疗8周，患者完全康复。即使在没有胃肠道症状的情况下，非伤寒沙门氏菌也能引起颈动脉感染动脉瘤。此外，BTO可能有助于确定颈动脉感染动脉瘤的治疗策略。

引用次数: 0

Structured framework for the application of metagenomic next-generation sequencing in the whole-process management of lower respiratory tract infections 新一代宏基因组测序在下呼吸道感染全流程管理应用的结构化框架。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 10.1016/j.jiac.2026.102910

Meihua Zhao , Xisheng Yu , Meizeng Zhao , Guoqing Zhang

Objectives

This study aims to assess the impact of metagenomic next-generation sequencing (mNGS) on optimizing diagnostic-therapeutic pathways for lower respiratory tract infections (LRTIs).

Methods

This retrospective observational study analyzed 42 consecutive LRTI patients at Jiading Branch of Shanghai General Hospital (June 2023–October 2024). Comprehensive clinical data were evaluated including demographic features, laboratory result, radiological findings, mNGS interpretation, treatment modifications, and outcomes.

Results

The mNGS detected pathogens in 37/42 patients (88.1 %), despite the fact that 38 patients (90.5 %) had received ineffective empirical antibiotic therapy prior to mNGS testing. More than half the patients (22/42, 52.4 %) had comorbidities and about half the cases were within the normal range in the level of inflammatory biomarker. Pathognomonic CT features suggesting specific pathogens were observed in 33.3 % (14/42) of cases. With regard to the interpretation of mNGS reports combaining the clinical characteristics, the results were consistent with the final diagnosis in 30 (30/42, 71.4 %) patients. Crucially, 92.9 % (39/42) underwent treatment modifications: 66.7 % (28/42) transitioned to targeted/narrower-spectrum antibiotics and 26.2 % (11/42) discontinued antimicrobial therapy following infection exclusion. Patients receiving targeted regimens demonstrated universal clinical improvement with radiological resolution, particularly in complex infections.

Conclusion

While mNGS provides robust pathogen detection, its clinical application requires integration with multidimensional patient data. The standardized protocol proposed in this study has the potential to enhances diagnostic efficiency and resource utilization in LRTI management.

目的：本研究旨在评估新一代宏基因组测序（mNGS）对优化下呼吸道感染（LRTIs）诊断治疗途径的影响。方法：本回顾性观察研究分析了上海总医院嘉定分院（2023年6月- 2024年10月）连续42例LRTI患者。综合临床资料进行评估，包括人口统计学特征、实验室结果、放射学表现、mNGS解释、治疗修改和结果。结果：42例患者中有37例（88.1%）在mNGS检测中检出病原菌，38例（90.5%）患者在mNGS检测前接受过无效的经验性抗生素治疗。超过一半的患者（22/42,52.4%）存在合并症，约一半的患者炎症生物标志物水平在正常范围内。在33.3%（14/42）的病例中观察到特异性病原体的病理特征。结合临床特征对mNGS报告的解释，30例（30/ 42,71.4%）患者的结果与最终诊断一致。关键是，92.9%（39/42）的患者接受了治疗调整：66.7%（28/42）的患者改用靶向/窄谱抗生素，26.2%（11/42）的患者在排除感染后停止了抗菌药物治疗。接受靶向治疗方案的患者表现出普遍的临床改善和放射学解决，特别是在复杂感染中。结论：虽然mNGS提供了强大的病原体检测，但其临床应用需要与多维患者数据集成。本研究提出的标准化方案有可能提高LRTI治疗的诊断效率和资源利用率。

{"title":"Structured framework for the application of metagenomic next-generation sequencing in the whole-process management of lower respiratory tract infections","authors":"Meihua Zhao , Xisheng Yu , Meizeng Zhao , Guoqing Zhang","doi":"10.1016/j.jiac.2026.102910","DOIUrl":"10.1016/j.jiac.2026.102910","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to assess the impact of metagenomic next-generation sequencing (mNGS) on optimizing diagnostic-therapeutic pathways for lower respiratory tract infections (LRTIs).</div></div><div><h3>Methods</h3><div>This retrospective observational study analyzed 42 consecutive LRTI patients at Jiading Branch of Shanghai General Hospital (June 2023–October 2024). Comprehensive clinical data were evaluated including demographic features, laboratory result, radiological findings, mNGS interpretation, treatment modifications, and outcomes.</div></div><div><h3>Results</h3><div>The mNGS detected pathogens in 37/42 patients (88.1 %), despite the fact that 38 patients (90.5 %) had received ineffective empirical antibiotic therapy prior to mNGS testing. More than half the patients (22/42, 52.4 %) had comorbidities and about half the cases were within the normal range in the level of inflammatory biomarker. Pathognomonic CT features suggesting specific pathogens were observed in 33.3 % (14/42) of cases. With regard to the interpretation of mNGS reports combaining the clinical characteristics, the results were consistent with the final diagnosis in 30 (30/42, 71.4 %) patients. Crucially, 92.9 % (39/42) underwent treatment modifications: 66.7 % (28/42) transitioned to targeted/narrower-spectrum antibiotics and 26.2 % (11/42) discontinued antimicrobial therapy following infection exclusion. Patients receiving targeted regimens demonstrated universal clinical improvement with radiological resolution, particularly in complex infections.</div></div><div><h3>Conclusion</h3><div>While mNGS provides robust pathogen detection, its clinical application requires integration with multidimensional patient data. The standardized protocol proposed in this study has the potential to enhances diagnostic efficiency and resource utilization in LRTI management.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 2","pages":"Article 102910"},"PeriodicalIF":1.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998288","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

Clinical and Microbiological Characteristics of macrolide-resistant Bordetella pertussis Infection: A case series in Osaka, Japan (2024–2025) 日本大阪地区2024-2025年大环内酯耐药百日咳博德泰菌感染临床及微生物学特征分析

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-27 DOI: 10.1016/j.jiac.2026.102916

Kimihiro Taniguchi , Takahiro Yamaguchi , Kenichi Isoda , Masashi Shiomi , Yasuhiro Kawasaki , Kiyoko Amo , Yuki Wakabayashi , Ryuji Kawahara , Masatoshi Nozaki

Background

Although macrolide antibiotics are an effective first-line treatment for pertussis, the global emergence and spread of macrolide-resistant Bordetella pertussis (MRBP) presents a significant threat to antimicrobial treatment strategies. However, the current status of MRBP in Japan remains unclear due to the lack of a surveillance system. This study aimed to highlight the emergence and clinical impact of MRBP in Osaka, Japan.

Methods

We retrospectively reviewed cases of patients with pertussis whose B. pertussis strains were analyzed at the Osaka Institute of Public Health between August 2024 and January 2025. Information on the patients’ clinical characteristics, therapeutic interventions, antimicrobial susceptibility, and molecular analysis of B. pertussis strains was collected. During the study period, eight B. pertussis strains were analyzed.

Results

Seven of the eight (87.5 %) B. pertussis strains were macrolide resistant. All of the MRBP strains were highly resistant to macrolide antibiotics and carried the A2047G mutation in domain V of the 23S rRNA gene. Seven of the patients were pediatric; four of whom had not been fully vaccinated due to their young age. One unvaccinated 31-day-old infant experienced clinical and microbiological treatment failure following macrolide administration, resulting in severe hypoxia and lymphocytosis.

Conclusions

This descriptive analysis of recent pertussis cases in Osaka identified a high proportion of macrolide-resistant strains among the analyzed cases. Notably, one infant developed severe disease despite macrolide treatment. These findings support the urgent need for nationwide surveillance of macrolide resistance in Japan and the establishment of an appropriate initial antimicrobial strategy for suspected MRBP.

尽管大环内酯类抗生素是治疗百日咳的一线有效药物，但耐大环内酯类百日咳博德tella百日咳（MRBP）的全球出现和传播对抗菌药物治疗策略构成了重大威胁。然而，由于缺乏监测系统，MRBP在日本的现状仍然不清楚。本研究旨在强调MRBP在日本大阪的出现和临床影响。方法回顾性分析2024年8月至2025年1月在大阪公共卫生研究所分析的百日咳患者的百日咳菌株。收集患者的临床特征、治疗干预、抗菌药物敏感性和百日咳菌株分子分析等信息。在研究期间，对8株百日咳菌株进行了分析。结果8株百日咳分枝杆菌中有7株（87.5%）对大环内酯耐药。所有MRBP菌株均对大环内酯类抗生素具有高度耐药性，并携带23S rRNA基因V结构域A2047G突变。其中7名患者为儿科；其中四人由于年龄太小而没有完全接种疫苗。1例未接种大环内酯疫苗的31日龄婴儿在服用大环内酯后出现临床和微生物治疗失败，导致严重缺氧和淋巴细胞增多。结论对大阪近期百日咳病例的描述性分析发现，在所分析的病例中，大环内酯耐药菌株的比例很高。值得注意的是，尽管大环内酯治疗，仍有一名婴儿出现严重疾病。这些发现支持日本迫切需要在全国范围内监测大环内酯类药物耐药性，并为疑似MRBP建立适当的初始抗微生物策略。

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引用次数: 0

Promoting COVID-19 vaccination: Results of a 2024 Japanese survey of outpatient intention to vaccinate 促进COVID-19疫苗接种：2024年日本门诊疫苗接种意向调查结果

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-19 DOI: 10.1016/j.jiac.2026.102911

Takuma Bando, Hideyuki Ikematsu, Kazuya Hamada, Masako Negami, Hiroyuki Fujii, Ken-ichi Doniwa, Naoki Kawai

Objectives

This study aimed to examine outpatient perceptions of voluntary, routine coronavirus disease (COVID-19) vaccinations scheduled for fall and winter of 2024.

Methods

A questionnaire was administered to the patients of five Japanese general medicine clinics.

Results

A total of 692 questionnaires were returned. Of the respondents, 38.5 % intended to receive vaccination. The intention to be vaccinated was significantly higher among respondents aged ≥60 years and those with high-risk underlying conditions, and was lower among those with a history of COVID-19. Intention increased as the number of past vaccinations increased. Multivariable logistic regression analysis revealed a significantly lower intention for women than for men. A higher number of past vaccinations was significantly associated with greater intention. The most frequently cited reason for hesitancy was concerns about adverse reactions, particularly among women (44.3 %). Of the respondents, >90 % preferred a vaccination fee of <3000 JPY.

Conclusion

To encourage COVID-19 vaccination, it is essential to provide clear information on adverse effects, particularly for women and individuals with fewer prior vaccinations. Reducing the out-of-pocket cost of vaccination to 3000 to 5000 JPY or less through public subsidies would likely improve coverage.

目的：本研究旨在调查门诊患者对计划于2024年秋冬进行的自愿常规冠状病毒病（COVID-19）疫苗接种的看法。方法：对日本5家全科门诊的患者进行问卷调查。结果：共回收问卷692份。在应答者中，38.5%的人打算接种疫苗。在年龄≥60岁和有高危基础疾病的受访者中，接种疫苗的意愿明显较高，而在有COVID-19病史的受访者中，接种意愿较低。意向随着过去疫苗接种次数的增加而增加。多变量逻辑回归分析显示，女性的意愿明显低于男性。过去接种疫苗的次数越多，意愿越高。最常见的犹豫原因是担心不良反应，尤其是女性（44.3%）。结论：为了鼓励接种COVID-19疫苗，必须提供关于不良反应的明确信息，特别是对妇女和之前接种疫苗较少的个人。通过公共补贴将疫苗的自付费用降低到3000至5000日元或更低，可能会提高覆盖率。

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引用次数: 0

Pneumonia in frail older adults: from diagnosis to optimized management 体弱老年人肺炎：从诊断到优化管理1。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-22 DOI: 10.1016/j.jiac.2026.102914

Kosaku Komiya , Yuki Yoshimatsu , Akihiko Hagiwara , Ryohei Kudoh , Hisayuki Shuto , Izumi Yamatani , Akihiko Goto

In the context of global population aging, pneumonia in older adults has become increasingly prevalent; frequently fatal; and remains challenging to diagnose, treat, and manage in alignment with patient goals. This narrative review synthesized contemporary evidence on pneumonia, particularly aspiration pneumonia, in older adults, integrating perspectives from diagnosis, antimicrobial management, prognosis, prevention, and end-of-life care. In this population, pneumonia often presents with atypical or nonspecific manifestations. Aspiration events are rarely directly observed, and current diagnostic definitions remain imprecise. Outcomes are predominantly driven by host-related factors, including frailty, dysphagia, multimorbidity, functional decline, and malnutrition, and conventional severity scores perform sub-optimally. Evidence from large observational studies indicated that early broad-spectrum or anaerobic-covering antibiotics provided limited survival benefit and may contribute to antimicrobial resistance, underscoring the importance of distinguishing colonization from true infection and adopting a stewardship-oriented approach. Preventive strategies include oral hygiene, postural and dietary modification, judicious medication review, and vaccination against major respiratory pathogens. In individuals with advanced frailty or recurrent pneumonia, multidisciplinary, ethically grounded, and shared decision-making on oral intake, eating and drinking with acknowledged risk, clinically assisted nutrition and hydration, and the role of antibiotics is required. Overall, pneumonia in older adults, particularly aspiration pneumonia, should be regarded as both an infectious disease and a clinical phenotype of age-associated vulnerability, which warrant a multidimensional approach that integrates geriatric assessment, antimicrobial stewardship, targeted prevention, and end-of-life care planning.

在全球人口老龄化的背景下，老年人肺炎越来越普遍；经常致命;根据患者的目标进行诊断、治疗和管理仍然具有挑战性。这篇叙述性综述综合了关于老年人肺炎，特别是吸入性肺炎的当代证据，整合了从诊断、抗菌药物管理、预后、预防和临终关怀等方面的观点。在这个人群中，肺炎通常表现为非典型或非特异性表现。吸入事件很少直接观察到，目前的诊断定义仍然不精确。结果主要由宿主相关因素驱动，包括虚弱、吞咽困难、多病、功能下降和营养不良，传统的严重程度评分表现不佳。来自大型观察性研究的证据表明，早期广谱或覆盖厌氧的抗生素提供有限的生存益处，并可能导致抗菌素耐药性，强调区分定植与真正感染的重要性，并采取以管理为导向的方法。预防策略包括口腔卫生、姿势和饮食改变、明智的药物审查以及针对主要呼吸道病原体的疫苗接种。对于患有晚期虚弱或复发性肺炎的个体，需要多学科、基于伦理的共同决策，包括口服摄入、已知风险的饮食、临床辅助营养和水合作用以及抗生素的作用。总体而言，老年人的肺炎，特别是吸入性肺炎，应被视为一种传染病和年龄相关易感性的临床表型，这需要一种多维方法，将老年评估、抗菌药物管理、有针对性的预防和临终关怀规划结合起来。

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引用次数: 0

Severe gastroenteritis caused by Vibrio cholerae serogroup O24 in an immunocompromised patient: A case report 免疫功能低下患者由O24血清群霍乱弧菌引起的严重胃肠炎1例报告

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/j.jiac.2026.102906

Tomoko Azuma , Yoshinori Takahashi , Megumi Oshima , Megumi Ikeda , Daiki Hayasi , Hatsumi Otani , Akiko Maekawa , Hiroyasu Oe , Aya Noguchi , Mika Mori , Hajime Kanamori

Non-O1 and non-O139 Vibrio cholerae (NOVC) strains rarely harbor the cholera toxin gene and are typically associated with mild, self-limiting gastroenteritis. However, an increasing number of reports in recent years have described severe gastroenteritis or extraintestinal infections with fatal outcomes, particularly in immunocompromised individuals, such as those with underlying conditions including cirrhosis. Here, we describe a case of severe gastroenteritis caused by V. cholerae serogroup O24, following the consumption of seafood during prolong prednisolone treatment for systemic lupus erythematosus. Stool culture upon admission yielded yellow colonies on thiosulfate-citrate-bile salt-sucrose agar, and Gram staining of the colonies revealed Gram-negative, curved, comma-shaped rods, suggestive of Vibrio species. Although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) yielded low-confidence identifications, suggesting either Vibrio mimicus or Vibrio albensis, the isolate was ultimately identified as NOVC based on its biochemical characteristics and salt tolerance. Subsequent genetic analysis confirmed the isolate as V. cholerae serogroup O24, a strain not included in the MALDI-TOF MS identification database. This case underscores the diagnostic value of conventional methods, such as biochemical profiling, in identifying V. cholerae strains not detectable by current mass spectrometry-based systems.

非o1型和非o139型霍乱弧菌（NOVC）菌株很少携带霍乱毒素基因，通常与轻度自限性肠胃炎有关。然而，近年来越来越多的报道描述了严重肠胃炎或肠外感染的致命结局，特别是在免疫功能低下的个体中，例如那些有肝硬化等基础疾病的个体。在这里，我们描述了一个由霍乱弧菌血清群O24引起的严重胃肠炎的病例，在长期强的松龙治疗系统性红斑狼疮期间食用海鲜。入院后的粪便培养在硫代硫酸盐-柠檬酸盐-胆汁盐-蔗糖琼脂上产生黄色菌落，革兰氏染色显示革兰氏阴性，弯曲，逗号形杆状，提示弧菌种类。虽然基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF MS）的鉴定结果可信度很低，可能是模拟弧菌或白弧菌，但根据其生化特性和耐盐性，该分离物最终被鉴定为NOVC。随后的遗传分析证实该分离物为霍乱弧菌血清群O24，该菌株未包括在MALDI-TOF MS鉴定数据库中。该病例强调了常规方法（如生化分析）在鉴定当前基于质谱的系统无法检测到的霍乱弧菌菌株方面的诊断价值。

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引用次数: 0

Diagnostic utility of urinalysis parameters in predicting urine culture positivity: A gender-stratified evaluation 尿分析参数在预测尿培养阳性中的诊断效用：性别分层评价

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2026-02-01 Epub Date: 2026-01-05 DOI: 10.1016/j.jiac.2026.102904

Fatih Çubuk , Caner Öksüz , Murtaza Öz

Objective

A substantial proportion of urine cultures in patients with suspected urinary tract infections (UTIs) yield negative results. This study aimed to evaluate whether parameters from automated urinalysis could predict the likelihood of significant bacterial growth, thereby aiding in reducing unnecessary cultures.

Methods

A total of 696 patients (402 females, 294 males) undergoing urinalysis with the FUS-200 automated analyzer were evaluated. Urine cultures were processed using the BD Phoenix 100 system. Demographic data and urinalysis parameters were compared according to culture results.

Results

Among culture-negative patients, females were younger (median age: 45 vs. 58 years, p = 0.000) and had significantly higher leukocyte, erythrocyte, and bacterial counts (p = 0.000). In culture-positive cases, females were younger than males (55 vs. 72.5 years, p = 0.000), though they had lower leukocyte counts (p = 0.029). Gram-negative infections were associated with significantly higher leukocyte and bacterial counts compared to gram-positive infections (p < 0.05), along with increased nitrite and leukocyte esterase positivity. ROC analysis identified optimal cut-off values for predicting significant culture growth: leukocyte count ≥16.5 (sensitivity, 79.5 %; specificity, 79.9 %) and bacterial count ≥2.5 (sensitivity, 77.6 %; specificity, 79.3 %). Cut-off values were higher in females (leukocytes: 23.5, bacteria: 5.5) than in males (leukocytes: 11.5, bacteria: 0.5).

Conclusion

The practical utility of the defined normal range values for urinary leukocyte count is limited. The predictive power of urinalysis parameters for culture results is affected by patient gender. For predicting significant bacterial growth in males, we recommend leukocyte and bacteria cut-off values of 11.5/HPF and 0.5/HPF, respectively (with >85 % sensitivity and specificity). In females, leukocyte and bacterial counts in urine provide poor predictive value for culture positivity.

目的：在疑似尿路感染（uti）患者中，有相当比例的尿培养结果为阴性。本研究旨在评估自动化尿液分析的参数是否可以预测显著细菌生长的可能性，从而帮助减少不必要的培养。方法对696例患者（女性402例，男性294例）采用FUS-200全自动尿液分析仪进行分析。尿液培养用BD Phoenix 100系统处理。根据培养结果比较人口学资料和尿液分析参数。结果在培养阴性患者中，女性更年轻（中位年龄：45岁vs. 58岁，p = 0.000），白细胞、红细胞和细菌计数明显更高（p = 0.000）。在培养阳性病例中，女性比男性年轻（55岁对72.5岁，p = 0.000），尽管她们的白细胞计数较低（p = 0.029）。与革兰氏阳性感染相比，革兰氏阴性感染与白细胞和细菌计数显著升高相关（p < 0.05），同时亚硝酸盐和白细胞酯酶阳性升高。ROC分析确定了预测显著培养生长的最佳临界值：白细胞计数≥16.5（敏感性79.5%，特异性79.9%），细菌计数≥2.5（敏感性77.6%，特异性79.3%）。女性（白细胞：23.5，细菌：5.5）的临界值高于男性（白细胞：11.5，细菌：0.5）。结论尿白细胞计数正常范围值的实用价值有限。尿液分析参数对培养结果的预测能力受患者性别的影响。为了预测男性显著的细菌生长，我们推荐白细胞和细菌的临界值分别为11.5/HPF和0.5/HPF（敏感性和特异性为85%）。在女性中，尿液中的白细胞和细菌计数对培养阳性的预测价值很差。

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