A 69-year-old woman with hypertension had undergone total arch replacement with an open stent graft 7 years prior. She was referred to our hospital for evaluation after experiencing fever (>38 °C) and cough. Chest radiography revealed a prominent aortic arch, and contrast-enhanced computed tomography demonstrated aortic arch enlargement and peri-graft fluid collection containing air. These findings indicated graft infection and prompted immediate intervention. Blood cultures grew Streptococcus equi subspecies zooepidemicus, a zoonotic pathogen associated with horses. Notably, the patient worked as a horse trainer. On hospital day 6, she developed severe hemoptysis due to an aortobronchial fistula caused by stent graft infection and underwent emergency re-replacement of the aortic arch. Intraoperative specimens also yielded the same pathogen. Consequently, she was treated with ampicillin, and her postoperative course was uneventful. Although rare, zoonotic pathogens can cause vascular graft infections.
{"title":"Zoonotic aortic graft infection by Streptococcus equi","authors":"Haruka Karaushi , Akihiro Yoshitake , Yuta Kanazawa , Noriyuki Watanabe , Mieko Tokano , Masafumi Seki , Kotaro Mitsutake","doi":"10.1016/j.jiac.2025.102900","DOIUrl":"10.1016/j.jiac.2025.102900","url":null,"abstract":"<div><div>A 69-year-old woman with hypertension had undergone total arch replacement with an open stent graft 7 years prior. She was referred to our hospital for evaluation after experiencing fever (>38 °C) and cough. Chest radiography revealed a prominent aortic arch, and contrast-enhanced computed tomography demonstrated aortic arch enlargement and peri-graft fluid collection containing air. These findings indicated graft infection and prompted immediate intervention. Blood cultures grew <em>Streptococcus equi</em> subspecies <em>zooepidemicus</em>, a zoonotic pathogen associated with horses. Notably, the patient worked as a horse trainer. On hospital day 6, she developed severe hemoptysis due to an aortobronchial fistula caused by stent graft infection and underwent emergency re-replacement of the aortic arch. Intraoperative specimens also yielded the same pathogen. Consequently, she was treated with ampicillin, and her postoperative course was uneventful. Although rare, zoonotic pathogens can cause vascular graft infections.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102900"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781349","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}
Antibiotic-associated encephalopathy (AAE) is a rare but significant neurological complication of β-lactam antibiotics, particularly in patients with renal impairment. While cefepime, ceftazidime, and ceftriaxone are well-documented causes, cefmetazole (CMZ) has not been widely recognized for neurotoxicity. We report an 82-year-old Japanese man with end-stage renal disease on chronic hemodialysis who developed altered mental status and myoclonus five days after starting intravenous CMZ for prostatic abscess. Electroencephalography (EEG) revealed triphasic waves consistent with non-convulsive status epilepticus. Neuroimaging and cerebrospinal fluid analysis showed no evidence of infection or stroke. Symptoms resolved within 48 hours of CMZ discontinuation. A Naranjo score of 5 supported a diagnosis of CMZ-induced AAE. This case underscores the potential neurotoxicity of CMZ and emphasizes the importance of early recognition of AAE in patients with renal dysfunction.
{"title":"Antibiotic-associated encephalopathy induced by cefmetazole in a hemodialysis patient: Case report","authors":"Toshiyuki Nakanishi , Taku Harada , Satoshi Kutsuna","doi":"10.1016/j.jiac.2025.102882","DOIUrl":"10.1016/j.jiac.2025.102882","url":null,"abstract":"<div><div>Antibiotic-associated encephalopathy (AAE) is a rare but significant neurological complication of β-lactam antibiotics, particularly in patients with renal impairment. While cefepime, ceftazidime, and ceftriaxone are well-documented causes, cefmetazole (CMZ) has not been widely recognized for neurotoxicity. We report an 82-year-old Japanese man with end-stage renal disease on chronic hemodialysis who developed altered mental status and myoclonus five days after starting intravenous CMZ for prostatic abscess. Electroencephalography (EEG) revealed triphasic waves consistent with non-convulsive status epilepticus. Neuroimaging and cerebrospinal fluid analysis showed no evidence of infection or stroke. Symptoms resolved within 48 hours of CMZ discontinuation. A Naranjo score of 5 supported a diagnosis of CMZ-induced AAE. This case underscores the potential neurotoxicity of CMZ and emphasizes the importance of early recognition of AAE in patients with renal dysfunction.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102882"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696048","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}
Pub Date : 2026-01-01Epub Date: 2025-11-21DOI: 10.1016/j.jiac.2025.102867
Tokio Hoshina , Tomomi Miyamoto , Makiko Miyajima , Kwangyole Lee , Tetsuya Horino , Hirotaka Kanuka , Masaki Yoshida
Introduction
While the decline of Toxoplasma gondii IgG (TpIgG) titers over time has been documented in HIV-negative populations, the long-term trajectory of TpIgG in people with HIV (PWH) receiving antiretroviral therapy (ART) remains poorly understood. Moreover, potential associations with ART and CD4-positive lymphocyte count have not yet been clarified.
Methods
This single-center, cross-sectional study was conducted between 2021 and 2022 at Jikei University Hospital. TpIgG titers were measured by ELISA in PWH who visited the hospital during the study period and were compared with results from our previous cross-sectional survey performed in 2015–2016. Clinical information, including CD4 profiles and duration of ART, was extracted from medical records to evaluate correlations with longitudinal changes in TpIgG titers. In addition, historical TpIgG measurements recorded outside of the 2015–2016 and 2021–2022 surveys were retrieved from medical records to provide extended longitudinal observations.
Results
Among 416 PWH enrolled, 7.2 % (30/416) tested positive for TpIgG in 2021–2022, with no significant demographic differences between TpIgG-positive and -negative groups. In 22 participants with paired measurements from 2015 to 2016 and 2021–2022, TpIgG titers showed a significant decline over time (p = 0.00593). While antibody trajectories were generally downward, correlation analyses revealed no significant associations between TpIgG changes and nadir CD4 count, CD4 recovery, or ART duration.
Conclusions
TpIgG titers significantly declined during long-term ART, with no clear correlation to immunological parameters. Continued monitoring and further research are warranted to clarify the clinical implications of these antibody dynamics.
{"title":"Longitudinal monitoring of Toxoplasma gondii antibodies in people with HIV in Japan","authors":"Tokio Hoshina , Tomomi Miyamoto , Makiko Miyajima , Kwangyole Lee , Tetsuya Horino , Hirotaka Kanuka , Masaki Yoshida","doi":"10.1016/j.jiac.2025.102867","DOIUrl":"10.1016/j.jiac.2025.102867","url":null,"abstract":"<div><h3>Introduction</h3><div>While the decline of <em>Toxoplasma gondii</em> IgG (TpIgG) titers over time has been documented in HIV-negative populations, the long-term trajectory of TpIgG in people with HIV (PWH) receiving antiretroviral therapy (ART) remains poorly understood. Moreover, potential associations with ART and CD4-positive lymphocyte count have not yet been clarified.</div></div><div><h3>Methods</h3><div>This single-center, cross-sectional study was conducted between 2021 and 2022 at Jikei University Hospital. TpIgG titers were measured by ELISA in PWH who visited the hospital during the study period and were compared with results from our previous cross-sectional survey performed in 2015–2016. Clinical information, including CD4 profiles and duration of ART, was extracted from medical records to evaluate correlations with longitudinal changes in TpIgG titers. In addition, historical TpIgG measurements recorded outside of the 2015–2016 and 2021–2022 surveys were retrieved from medical records to provide extended longitudinal observations.</div></div><div><h3>Results</h3><div>Among 416 PWH enrolled, 7.2 % (30/416) tested positive for TpIgG in 2021–2022, with no significant demographic differences between TpIgG-positive and -negative groups. In 22 participants with paired measurements from 2015 to 2016 and 2021–2022, TpIgG titers showed a significant decline over time (p = 0.00593). While antibody trajectories were generally downward, correlation analyses revealed no significant associations between TpIgG changes and nadir CD4 count, CD4 recovery, or ART duration.</div></div><div><h3>Conclusions</h3><div>TpIgG titers significantly declined during long-term ART, with no clear correlation to immunological parameters. Continued monitoring and further research are warranted to clarify the clinical implications of these antibody dynamics.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102867"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587592","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}
We encountered a case of chronic pulmonary coccidioidomycosis complicated with meningitis in a 53-year-old African-American veteran with a history of staying in Arizona, United States of America. The patient was referred from another hospital with complaints of cough, blood-stained phlegm, hemoptysis, and headache. Chronic pulmonary coccidioidomycosis was suspected based on the presence of multiple pulmonary cavity lesions on computed tomography (CT) and a relevant exposure history, and the diagnosis was confirmed by serological antibody tests (coccidioidomycosis IgG, positive; coccidioidomycosis IgM, negative). Treatment was initiated with oral fluconazole (FLCZ) 400 mg daily, but there was no improvement in symptoms, and CT revealed gradual enlargement of the pulmonary cavitary lesions. Therefore, the oral FLCZ dose was increased to 800 mg; however, the patient developed worsening headache, and subsequent cerebrospinal fluid analysis revealed a slight increase in cell count with positive IgG, negative IgM, and negative polymerase chain reaction results. Suspecting meningitis, the oral FLCZ dose was further increased to 1200 mg, leading to marked improvement in symptoms at the following visit. In coccidioidomycosis, an increase in any antibody titer should be considered an indicator of active infection. In addition, if headache develops during the course of the disease, appropriate treatment for meningitis should be initiated even if cerebrospinal fluid findings are minimal.
{"title":"Chronic pulmonary coccidioidomycosis complicated with meningitis: A case report","authors":"Ryo Mizushima , Yuki Moriyama , Akira Watanabe , Keigo Ueno , Takayuki Shinohara , Yoshitsugu Miyazaki , Norio Ohmagari","doi":"10.1016/j.jiac.2025.102870","DOIUrl":"10.1016/j.jiac.2025.102870","url":null,"abstract":"<div><div>We encountered a case of chronic pulmonary coccidioidomycosis complicated with meningitis in a 53-year-old African-American veteran with a history of staying in Arizona, United States of America. The patient was referred from another hospital with complaints of cough, blood-stained phlegm, hemoptysis, and headache. Chronic pulmonary coccidioidomycosis was suspected based on the presence of multiple pulmonary cavity lesions on computed tomography (CT) and a relevant exposure history, and the diagnosis was confirmed by serological antibody tests (coccidioidomycosis IgG, positive; coccidioidomycosis IgM, negative). Treatment was initiated with oral fluconazole (FLCZ) 400 mg daily, but there was no improvement in symptoms, and CT revealed gradual enlargement of the pulmonary cavitary lesions. Therefore, the oral FLCZ dose was increased to 800 mg; however, the patient developed worsening headache, and subsequent cerebrospinal fluid analysis revealed a slight increase in cell count with positive IgG, negative IgM, and negative polymerase chain reaction results. Suspecting meningitis, the oral FLCZ dose was further increased to 1200 mg, leading to marked improvement in symptoms at the following visit. In coccidioidomycosis, an increase in any antibody titer should be considered an indicator of active infection. In addition, if headache develops during the course of the disease, appropriate treatment for meningitis should be initiated even if cerebrospinal fluid findings are minimal.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102870"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596680","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}
Pub Date : 2026-01-01Epub Date: 2025-12-27DOI: 10.1016/j.jiac.2025.102902
Nesrin Türker , Ozge Eren Korkmaz , Figen Kaptan Aydogmus , Nur Miray Ayhan Geniş , Tuba Müderris , Murat Aksun
Background
Carbapenem-resistant Gram-negative bloodstream infections (CR-GNB BSIs) are increasingly prevalent in intensive care units (ICUs) and associated with high mortality. Accurate early risk stratification tools are lacking.
Objectives
To develop and internally validate a nomogram-based model predicting 30-day mortality in ICU patients with CR-GNB BSIs.
Methods
We conducted a retrospective cohort study of adult ICU patients with CR-GNB BSIs at a tertiary hospital in western Turkey (January 2020–October 2024). Demographic, clinical, laboratory, and microbiological data were collected. Patients were randomly split into training (70 %) and validation (30 %) cohorts. Univariable and multivariable logistic regression analyses identified independent mortality predictors, which were incorporated into a nomogram. Model discrimination, calibration, and decision-curve utility were evaluated.
Results
A total of 281 patients were included (median age 66 years; 60.9 % male); 30-day mortality was 58 %. Acinetobacter spp. predominated (51.6 %), followed by Klebsiella spp. (42.3 %) and Pseudomonas spp. (6.1 %). Independent predictors of 30-day mortality included older age, immunosuppression, hypoalbuminemia, elevated white blood cell count, and absence of microbiological cure. The nomogram demonstrated excellent discrimination (AUC 0.895 training; 0.854 validation), good calibration (mean absolute error 0.022–0.059), and meaningful clinical net benefit across intermediate risk thresholds.
Conclusions
We developed and internally validated a nomogram using routine clinical and laboratory variables to predict 30-day mortality in ICU patients with CR-GNB BSIs. This tool may support early prognostic assessment at bedside and guide individualized management. Prospective multicenter validation is warranted.
{"title":"Carbapenem resistant gram negative bacteremia in intensive care unit patients: Development and validation of a nomogram-based 30-day mortality risk prediction model","authors":"Nesrin Türker , Ozge Eren Korkmaz , Figen Kaptan Aydogmus , Nur Miray Ayhan Geniş , Tuba Müderris , Murat Aksun","doi":"10.1016/j.jiac.2025.102902","DOIUrl":"10.1016/j.jiac.2025.102902","url":null,"abstract":"<div><h3>Background</h3><div>Carbapenem-resistant Gram-negative bloodstream infections (CR-GNB BSIs) are increasingly prevalent in intensive care units (ICUs) and associated with high mortality. Accurate early risk stratification tools are lacking.</div></div><div><h3>Objectives</h3><div>To develop and internally validate a nomogram-based model predicting 30-day mortality in ICU patients with CR-GNB BSIs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adult ICU patients with CR-GNB BSIs at a tertiary hospital in western Turkey (January 2020–October 2024). Demographic, clinical, laboratory, and microbiological data were collected. Patients were randomly split into training (70 %) and validation (30 %) cohorts. Univariable and multivariable logistic regression analyses identified independent mortality predictors, which were incorporated into a nomogram. Model discrimination, calibration, and decision-curve utility were evaluated.</div></div><div><h3>Results</h3><div>A total of 281 patients were included (median age 66 years; 60.9 % male); 30-day mortality was 58 %. <em>Acinetobacter spp</em>. predominated (51.6 %), followed by <em>Klebsiella spp</em>. (42.3 %) and <em>Pseudomonas spp</em>. (6.1 %). Independent predictors of 30-day mortality included older age, immunosuppression, hypoalbuminemia, elevated white blood cell count, and absence of microbiological cure. The nomogram demonstrated excellent discrimination (AUC 0.895 training; 0.854 validation), good calibration (mean absolute error 0.022–0.059), and meaningful clinical net benefit across intermediate risk thresholds.</div></div><div><h3>Conclusions</h3><div>We developed and internally validated a nomogram using routine clinical and laboratory variables to predict 30-day mortality in ICU patients with CR-GNB BSIs. This tool may support early prognostic assessment at bedside and guide individualized management. Prospective multicenter validation is warranted.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102902"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856988","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}
Pub Date : 2026-01-01Epub Date: 2025-12-11DOI: 10.1016/j.jiac.2025.102892
Yusuke Okubo , Risa Honjo , Shinya Tsuzuki
Background
Respiratory syncytial virus (RSV) is a major cause of pediatric lower respiratory tract infections worldwide, leading to substantial morbidity, hospitalizations, and healthcare costs. Maternal RSV vaccination has recently been introduced in several countries, yet in Japan its uptake remains unclear, particularly given the high out-of-pocket costs and potential socioeconomic disparities.
Methods
We conducted a nationwide survey of women who had given birth between July 2024 and August 2025. The questionnaire assessed maternal RSV vaccination status, its affordability, and related attitudes including the 5C model for vaccine hesitancy together with demographic characteristics. Vaccination coverage was estimated, and factors associated with uptake were analyzed using multivariable modified Poisson regression.
Results
Among 1279 respondents, 11.6 % had received maternal RSV vaccination. Coverage showed a clear income gradient within education strata. Uptake was lower in areas outside Kanto and among multiparous participants, and higher among those with infertility treatment, and vaccination with influenza or diphtheria-pertussis-tetanus during pregnancy. In 5C domains, confidence and collective responsibility aligned with higher uptake, whereas calculation aligned with lower uptake. Among vaccinated people, 87.2 % rated the cost as expensive. Among unvaccinated people, leading barriers were lack of awareness of benefit (28.9 %) and the vaccine itself (27.3 %); 77.5 % would accept vaccination only if no out-of-pocket payment were required.
Conclusions
Maternal RSV vaccination coverage in Japan was low and showed socioeconomic and regional disparities in uptake; limited awareness and high out-of-pocket payment were major barriers. Reducing out-of-pocket payments and standardizing provider recommendations could raise coverage and mitigate inequities.
{"title":"Coverage and determinants of maternal RSV vaccination in Japan: A nationwide survey","authors":"Yusuke Okubo , Risa Honjo , Shinya Tsuzuki","doi":"10.1016/j.jiac.2025.102892","DOIUrl":"10.1016/j.jiac.2025.102892","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory syncytial virus (RSV) is a major cause of pediatric lower respiratory tract infections worldwide, leading to substantial morbidity, hospitalizations, and healthcare costs. Maternal RSV vaccination has recently been introduced in several countries, yet in Japan its uptake remains unclear, particularly given the high out-of-pocket costs and potential socioeconomic disparities.</div></div><div><h3>Methods</h3><div>We conducted a nationwide survey of women who had given birth between July 2024 and August 2025. The questionnaire assessed maternal RSV vaccination status, its affordability, and related attitudes including the 5C model for vaccine hesitancy together with demographic characteristics. Vaccination coverage was estimated, and factors associated with uptake were analyzed using multivariable modified Poisson regression.</div></div><div><h3>Results</h3><div>Among 1279 respondents, 11.6 % had received maternal RSV vaccination. Coverage showed a clear income gradient within education strata. Uptake was lower in areas outside Kanto and among multiparous participants, and higher among those with infertility treatment, and vaccination with influenza or diphtheria-pertussis-tetanus during pregnancy. In 5C domains, confidence and collective responsibility aligned with higher uptake, whereas calculation aligned with lower uptake. Among vaccinated people, 87.2 % rated the cost as expensive. Among unvaccinated people, leading barriers were lack of awareness of benefit (28.9 %) and the vaccine itself (27.3 %); 77.5 % would accept vaccination only if no out-of-pocket payment were required.</div></div><div><h3>Conclusions</h3><div>Maternal RSV vaccination coverage in Japan was low and showed socioeconomic and regional disparities in uptake; limited awareness and high out-of-pocket payment were major barriers. Reducing out-of-pocket payments and standardizing provider recommendations could raise coverage and mitigate inequities.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102892"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734027","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}
Pub Date : 2026-01-01Epub Date: 2025-12-05DOI: 10.1016/j.jiac.2025.102886
Makoto Hayashi , Takuya Yokoe , Satoshi Matsukura
The clinical outcomes of nontuberculous mycobacterial pulmonary disease (NTM-PD) are largely influenced by nutritional status. However, specific nutritional intervention strategies for NTM-PD have not been established, making management challenging. This narrative review summarizes the immunopathology associated with mycobacterial infection and the effects of malnutrition on immune responses. It further examines the clinical impact of malnutrition and the nutritional characteristics of patients with NTM-PD, highlighting the significance of nutritional intervention. Additionally, we review the current knowledge on nutritional therapy for NTM-PD, drawing insights from approaches used in related conditions. Although nutritional support may improve patient outcomes and is clearly needed, evidence regarding its effectiveness remains limited. Consequently, incorporating nutritional assessment and individualized intervention into comprehensive care currently represents the best clinical practice.
{"title":"Nutrition in nontuberculous mycobacterial pulmonary disease: A narrative review","authors":"Makoto Hayashi , Takuya Yokoe , Satoshi Matsukura","doi":"10.1016/j.jiac.2025.102886","DOIUrl":"10.1016/j.jiac.2025.102886","url":null,"abstract":"<div><div>The clinical outcomes of nontuberculous mycobacterial pulmonary disease (NTM-PD) are largely influenced by nutritional status. However, specific nutritional intervention strategies for NTM-PD have not been established, making management challenging. This narrative review summarizes the immunopathology associated with mycobacterial infection and the effects of malnutrition on immune responses. It further examines the clinical impact of malnutrition and the nutritional characteristics of patients with NTM-PD, highlighting the significance of nutritional intervention. Additionally, we review the current knowledge on nutritional therapy for NTM-PD, drawing insights from approaches used in related conditions. Although nutritional support may improve patient outcomes and is clearly needed, evidence regarding its effectiveness remains limited. Consequently, incorporating nutritional assessment and individualized intervention into comprehensive care currently represents the best clinical practice.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102886"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701210","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}
Pub Date : 2026-01-01Epub Date: 2025-11-26DOI: 10.1016/j.jiac.2025.102878
Liqing Zhu , Mengmeng Li , Zhongjian Wang
Background
Diabetes mellitus significantly complicates multidrug-resistant tuberculosis (MDR-TB) treatment outcomes. This study investigated the predictive value of integrating bedaquiline pharmacokinetics, inflammatory markers, and glycemic parameters for treatment response in diabetic MDR-TB patients.
Methods
We conducted a retrospective cohort study of 186 patients with MDR-TB and diabetes mellitus receiving bedaquiline-containing regimens from January 2019 to December 2023. Bedaquiline trough concentrations, inflammatory markers (CRP, IL-6, TNF-α), and glycemic indices (HbA1c, fasting glucose) were measured at baseline and during follow-up. The primary outcome was sputum culture conversion or clinical improvement at 6 months. Multivariate logistic regression identified predictors of treatment response, and a predictive model was developed using 70 % training and 30 % validation cohorts.
Results
Overall treatment response rate was 72.0 %. Responders demonstrated significantly higher bedaquiline trough concentrations and better glycemic control. The integrated predictive model incorporating bedaquiline concentration, baseline CRP, HbA1c, and HbA1c change achieved superior discrimination compared to individual biomarkers. Subgroup analysis revealed a critical interaction between glycemic control and drug exposure, with poor glycemic control patients showing 0 % response in the lowest bedaquiline quartile but 100 % response in higher quartiles.
Conclusions
Multi-biomarker integration effectively predicts bedaquiline treatment response in diabetic MDR-TB patients. The synergistic relationship between adequate drug exposure and glycemic control underscores the necessity for integrated therapeutic drug monitoring and diabetes management strategies in this high-risk population.
{"title":"Multi-biomarker integration in predicting bedaquiline treatment response among diabetic MDR-TB patients","authors":"Liqing Zhu , Mengmeng Li , Zhongjian Wang","doi":"10.1016/j.jiac.2025.102878","DOIUrl":"10.1016/j.jiac.2025.102878","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes mellitus significantly complicates multidrug-resistant tuberculosis (MDR-TB) treatment outcomes. This study investigated the predictive value of integrating bedaquiline pharmacokinetics, inflammatory markers, and glycemic parameters for treatment response in diabetic MDR-TB patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 186 patients with MDR-TB and diabetes mellitus receiving bedaquiline-containing regimens from January 2019 to December 2023. Bedaquiline trough concentrations, inflammatory markers (CRP, IL-6, TNF-α), and glycemic indices (HbA1c, fasting glucose) were measured at baseline and during follow-up. The primary outcome was sputum culture conversion or clinical improvement at 6 months. Multivariate logistic regression identified predictors of treatment response, and a predictive model was developed using 70 % training and 30 % validation cohorts.</div></div><div><h3>Results</h3><div>Overall treatment response rate was 72.0 %. Responders demonstrated significantly higher bedaquiline trough concentrations and better glycemic control. The integrated predictive model incorporating bedaquiline concentration, baseline CRP, HbA1c, and HbA1c change achieved superior discrimination compared to individual biomarkers. Subgroup analysis revealed a critical interaction between glycemic control and drug exposure, with poor glycemic control patients showing 0 % response in the lowest bedaquiline quartile but 100 % response in higher quartiles.</div></div><div><h3>Conclusions</h3><div>Multi-biomarker integration effectively predicts bedaquiline treatment response in diabetic MDR-TB patients. The synergistic relationship between adequate drug exposure and glycemic control underscores the necessity for integrated therapeutic drug monitoring and diabetes management strategies in this high-risk population.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102878"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634431","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}
A man in his 50's with a history of acute lymphoblastic leukemia underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) over 20 years earlier and later developed bilateral giant pulmonary bullae, presumed secondary to pulmonary chronic graft-versus-host disease (cGVHD), requiring bilateral lung transplantation. Six months after lung transplantation, he developed rapid-onset severe normocytic anemia with reticulocytopenia. Cytomegalovirus (CMV) reactivation was initially suspected, and antiviral therapy was commenced, but the anemia persisted. Subsequent Polymerase chain reaction (PCR) testing revealed parvovirus B19 viremia, and bone marrow examination demonstrated erythroid hypoplasia with giant proerythroblasts, confirming parvovirus B19–associated pure red cell aplasia (PRCA). Treatment with intravenous immunoglobulin (IVIG) led to rapid hematologic improvement and complete recovery without recurrence.
This case underscores the importance of considering parvovirus B19 infection as a potential cause of anemia in immunocompromised individuals, especially following solid organ transplantation, where overlapping viral infections and immunosuppressive agents complicate diagnosis. Early recognition and prompt IVIG therapy can result in excellent outcomes and prevent unnecessary interventions.
{"title":"Parvovirus B19 infection induces pure red cell aplasia after lung transplantation","authors":"Yusuke Okamoto , Kenichi Ishiyama , Akira Matsumoto , Yusuke Tsuda , Miki Nagao , Masahiro Hirata , Masakazu Fujimoto , Hironori Haga , Yojiro Yutaka , Akifumi Takaori-Kondo","doi":"10.1016/j.jiac.2025.102901","DOIUrl":"10.1016/j.jiac.2025.102901","url":null,"abstract":"<div><div>A man in his 50's with a history of acute lymphoblastic leukemia underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) over 20 years earlier and later developed bilateral giant pulmonary bullae, presumed secondary to pulmonary chronic graft-versus-host disease (cGVHD), requiring bilateral lung transplantation. Six months after lung transplantation, he developed rapid-onset severe normocytic anemia with reticulocytopenia. Cytomegalovirus (CMV) reactivation was initially suspected, and antiviral therapy was commenced, but the anemia persisted. Subsequent Polymerase chain reaction (PCR) testing revealed parvovirus B19 viremia, and bone marrow examination demonstrated erythroid hypoplasia with giant proerythroblasts, confirming parvovirus B19–associated pure red cell aplasia (PRCA). Treatment with intravenous immunoglobulin (IVIG) led to rapid hematologic improvement and complete recovery without recurrence.</div><div>This case underscores the importance of considering parvovirus B19 infection as a potential cause of anemia in immunocompromised individuals, especially following solid organ transplantation, where overlapping viral infections and immunosuppressive agents complicate diagnosis. Early recognition and prompt IVIG therapy can result in excellent outcomes and prevent unnecessary interventions.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102901"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786657","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}
We investigated the long-term impact of an antimicrobial stewardship program (ASP) led by a dedicated intensive care unit (ICU) pharmacist belonging to an antimicrobial stewardship team (AST) on trends in antimicrobial use and patient outcomes.
Methods
This was a single-center, retrospective study of patients admitted in an open ICU. Days of therapy (DOT) and number of patients receiving antimicrobial drug (NAD) of carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams, and all-cause mortality at 28 days were compared between the pre-ASP period (April 2012 to March 2016) and post-ASP period (April 2016 to March 2024). We divided patients into the sepsis, non-sepsis, and non-infection groups and compared outcomes. De-escalation rates and number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams were investigated in sepsis and non-sepsis cases.
Results
DOT decreased significantly for carbapenems, anti-pseudomonal and non-anti-pseudomonal β-lactams post-ASP. In sepsis cases, the number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams significantly decreased post-ASP; the ICU pharmacist intervened in all cases for sepsis and non-sepsis post-ASP. DOT of carbapenems and anti-pseudomonal β-lactams decreased significantly in non-sepsis and non-infection cases post-ASP. NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams post-ASP. In non-infection cases, NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams post-ASP. No significant difference occurred in all-cause mortality rate between groups.
Conclusion
ASP led by a pharmacist belonging to an AST in the open ICU contributed to long-term appropriate antimicrobial use of carbapenems and anti-pseudomonal β-lactams, and DOT for non-pseudomonal β-lactams.
{"title":"The effect of pharmacist-led antimicrobial stewardship on antimicrobial use in an intensive care unit: a single-center, retrospective, observational study","authors":"Yoshihiro Nishita , Natsuko Ishida , Masatoshi Taga , Ryoji Takata , Yoshitsugu Iinuma , Togen Masauji , Junko Ishizaki","doi":"10.1016/j.jiac.2025.102898","DOIUrl":"10.1016/j.jiac.2025.102898","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the long-term impact of an antimicrobial stewardship program (ASP) led by a dedicated intensive care unit (ICU) pharmacist belonging to an antimicrobial stewardship team (AST) on trends in antimicrobial use and patient outcomes.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective study of patients admitted in an open ICU. Days of therapy (DOT) and number of patients receiving antimicrobial drug (NAD) of carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams, and all-cause mortality at 28 days were compared between the pre-ASP period (April 2012 to March 2016) and post-ASP period (April 2016 to March 2024). We divided patients into the sepsis, non-sepsis, and non-infection groups and compared outcomes. De-escalation rates and number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams were investigated in sepsis and non-sepsis cases.</div></div><div><h3>Results</h3><div>DOT decreased significantly for carbapenems, anti-pseudomonal and non-anti-pseudomonal β-lactams post-ASP. In sepsis cases, the number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams significantly decreased post-ASP; the ICU pharmacist intervened in all cases for sepsis and non-sepsis post-ASP. DOT of carbapenems and anti-pseudomonal β-lactams decreased significantly in non-sepsis and non-infection cases post-ASP. NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams post-ASP. In non-infection cases, NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams post-ASP. No significant difference occurred in all-cause mortality rate between groups.</div></div><div><h3>Conclusion</h3><div>ASP led by a pharmacist belonging to an AST in the open ICU contributed to long-term appropriate antimicrobial use of carbapenems and anti-pseudomonal β-lactams, and DOT for non-pseudomonal β-lactams.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102898"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786750","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}
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