Pub Date : 2024-09-05eCollection Date: 2024-09-01DOI: 10.1093/ofid/ofae509
[This corrects the article DOI: 10.1093/ofid/ofae462.].
[此处更正了文章 DOI：10.1093/ofid/ofae462]。
{"title":"Correction to: Postacute Sequelae of COVID (PASC or Long COVID): An Evidenced-Based Approach.","authors":"","doi":"10.1093/ofid/ofae509","DOIUrl":"https://doi.org/10.1093/ofid/ofae509","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ofid/ofae462.].</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11376068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Feline Bos, Romain Gueneau, Thomas Crepin, Claire Tinévez, Benjamin Taton, Lionel Couzi, Karine Moreau, Betoul Schvartz, Peggy Perrin, Philippe Gatault, Anne Scemla, Valérie Chatelet-Pouliquen, Charlène Levi, Nassim Kamar, Fanny Lanternier, Didier Neau, Pierre Merville, Philippe Lehours, Mathilde Puges, Hannah Kaminski
Background Campylobacteriosis in kidney transplant recipients (KTR) is the most common identified bacterial cause of diarrhoea. Risk factors in KTR are unknown. Methods A 10-year multicentric, retrospective 1:1 case control study was performed in France between 2010 and 2020. The main aim was to identify factors associated with Campylobacter-related infection in KTR. The KTR with a functional graft and campylobacteriosis (positive stool culture and/or blood culture and/or positive nucleic amplification test) and their control matched on transplantation date within the same center were included. Results We identified 326 patients with campylobacteriosis. The estimated incidence-rate of campylobacteriosis was 2.3/1000 patients-years. The infection occurred at a median of 2.4 years post-transplantation. The independent risk factors for campylobacteriosis were (i) use of corticosteroids as maintenance regimen (75.8 vs 66%; p < 0.001), (ii) acute rejection (8.9 vs 4%; p = 0.048), (iii) low lymphocyte count (0.96 vs 1.4 G/L; p < 0.001) and (iv) low basal eGFR (44.2 mL/min/1.73m2 vs 57.5 mL/min/1.73m2; p<0.001). Fluoroquinolone was initiated in 64 (21.4%) patients, with 51.1% of antimicrobial resistance, whereas almost all strains were erythromycin sensitive. Conclusion Campylobacteriosis has a higher incidence in the two first years of transplantation. The factors independently associated with campylobacteriosis are corticosteroids as maintenance immunosuppressive regimen, low lymphocyte counts, low eGFR and a history of acute rejection. Due to high antimicrobial resistance with fluoroquinolone, the first line of treatment should be azythromycin.
背景 肾移植受者（KTR）中的弯曲杆菌病是最常见的细菌性腹泻病因。KTR的风险因素尚不清楚。方法 2010 年至 2020 年期间在法国进行了一项为期 10 年的多中心、1:1 病例对照回顾性研究。主要目的是确定 KTR 中弯曲杆菌相关感染的相关因素。研究对象包括在同一中心接受功能性移植且患有弯曲杆菌病（粪便培养和/或血液培养呈阳性和/或核酸扩增试验呈阳性）的 KTR 及其与移植日期匹配的对照组。结果 我们发现了 326 名弯曲杆菌病患者。弯曲杆菌病的估计发病率为 2.3/1000。感染发生的时间中位数为移植后 2.4 年。弯曲杆菌病的独立风险因素是：(i) 使用皮质类固醇作为维持治疗方案（75.8 vs 66%；p < 0.001）；(ii) 急性排斥反应（8.9 vs 4%; p = 0.048），(iii) 低淋巴细胞计数（0.96 vs 1.4 G/L；p<0.001）和(iv) 低基础 eGFR（44.2 mL/min/1.73m2 vs 57.5 mL/min/1.73m2；p<0.001）。64例（21.4%）患者开始使用氟喹诺酮类药物，51.1%的患者对其产生抗菌药耐药性，而几乎所有菌株都对红霉素敏感。结论 弯曲状杆菌病在移植后的头两年发病率较高。与弯曲杆菌病独立相关的因素包括皮质类固醇作为维持性免疫抑制方案、低淋巴细胞计数、低 eGFR 和急性排斥史。由于氟喹诺酮类抗生素的耐药性较高，一线治疗应使用阿奇霉素。
{"title":"Epidemiology of Campylobacter spp. infection in kidney transplant recipients: a retrospective multicentric case-control study in France","authors":"Feline Bos, Romain Gueneau, Thomas Crepin, Claire Tinévez, Benjamin Taton, Lionel Couzi, Karine Moreau, Betoul Schvartz, Peggy Perrin, Philippe Gatault, Anne Scemla, Valérie Chatelet-Pouliquen, Charlène Levi, Nassim Kamar, Fanny Lanternier, Didier Neau, Pierre Merville, Philippe Lehours, Mathilde Puges, Hannah Kaminski","doi":"10.1093/ofid/ofae498","DOIUrl":"https://doi.org/10.1093/ofid/ofae498","url":null,"abstract":"Background Campylobacteriosis in kidney transplant recipients (KTR) is the most common identified bacterial cause of diarrhoea. Risk factors in KTR are unknown. Methods A 10-year multicentric, retrospective 1:1 case control study was performed in France between 2010 and 2020. The main aim was to identify factors associated with Campylobacter-related infection in KTR. The KTR with a functional graft and campylobacteriosis (positive stool culture and/or blood culture and/or positive nucleic amplification test) and their control matched on transplantation date within the same center were included. Results We identified 326 patients with campylobacteriosis. The estimated incidence-rate of campylobacteriosis was 2.3/1000 patients-years. The infection occurred at a median of 2.4 years post-transplantation. The independent risk factors for campylobacteriosis were (i) use of corticosteroids as maintenance regimen (75.8 vs 66%; p &lt; 0.001), (ii) acute rejection (8.9 vs 4%; p = 0.048), (iii) low lymphocyte count (0.96 vs 1.4 G/L; p &lt; 0.001) and (iv) low basal eGFR (44.2 mL/min/1.73m2 vs 57.5 mL/min/1.73m2; p&lt;0.001). Fluoroquinolone was initiated in 64 (21.4%) patients, with 51.1% of antimicrobial resistance, whereas almost all strains were erythromycin sensitive. Conclusion Campylobacteriosis has a higher incidence in the two first years of transplantation. The factors independently associated with campylobacteriosis are corticosteroids as maintenance immunosuppressive regimen, low lymphocyte counts, low eGFR and a history of acute rejection. Due to high antimicrobial resistance with fluoroquinolone, the first line of treatment should be azythromycin.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189251","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}
Gemma Webb, Mei Yen Michelle Leong, Emma Bishop, Marjoree Sehu
Human Herpesvirus 6 (HHV-6) is associated with its presentation in the paediatric population as roseola infantum. Rarely, it is the causative agent of encephalitis, with most cases reported amongst the immunocompromised population due to reactivation. This review article analyses the available literature records of cases labelled as HHV-6 encephalitis in immunocompetent adults, aiming to understand the diagnostic methods behind each case and explore the complexities of such a diagnosis. We note significant variability in the methods used to come to a diagnosis of HHV-6 encephalitis, as well as inconsistent approaches to treatment of this condition. Given the rarity of HHV-6 encephalitis in immunocompetent adults, there are no clearly structured diagnostic guidelines for this condition in this patient population. We highlight several diagnostic methods that provide more convincing evidence of true HHV-6 encephalitis and may provide a basis for further development of guidelines for the diagnosis and treatment of this condition.
{"title":"Diagnostic Dilemmas: A Review of Reported Cases of Human Herpesvirus-6 Encephalitis in Immunocompetent Adults","authors":"Gemma Webb, Mei Yen Michelle Leong, Emma Bishop, Marjoree Sehu","doi":"10.1093/ofid/ofae501","DOIUrl":"https://doi.org/10.1093/ofid/ofae501","url":null,"abstract":"Human Herpesvirus 6 (HHV-6) is associated with its presentation in the paediatric population as roseola infantum. Rarely, it is the causative agent of encephalitis, with most cases reported amongst the immunocompromised population due to reactivation. This review article analyses the available literature records of cases labelled as HHV-6 encephalitis in immunocompetent adults, aiming to understand the diagnostic methods behind each case and explore the complexities of such a diagnosis. We note significant variability in the methods used to come to a diagnosis of HHV-6 encephalitis, as well as inconsistent approaches to treatment of this condition. Given the rarity of HHV-6 encephalitis in immunocompetent adults, there are no clearly structured diagnostic guidelines for this condition in this patient population. We highlight several diagnostic methods that provide more convincing evidence of true HHV-6 encephalitis and may provide a basis for further development of guidelines for the diagnosis and treatment of this condition.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189280","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}
Casey Smiley, Jessica Rizzuto, Nicola White, Christina Fiske, Jennifer Thompson, Minhua Zhang, Ben Ereshefsky, Milner Staub
Background Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center. Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression. Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change. Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences.
{"title":"Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center","authors":"Casey Smiley, Jessica Rizzuto, Nicola White, Christina Fiske, Jennifer Thompson, Minhua Zhang, Ben Ereshefsky, Milner Staub","doi":"10.1093/ofid/ofae475","DOIUrl":"https://doi.org/10.1093/ofid/ofae475","url":null,"abstract":"Background Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center. Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression. Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change. Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189230","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}
Ravi K Tripathi, Blaine Kenaa, Kimberly C Claeys, J Kristie Johnson, Meghana Patel, Jayne Atkinson, Mary E Maldarelli, Michelle Newman, Surbhi Leekha
Background Overtreatment of ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) is driven by positive respiratory tract cultures in the absence of a clinical picture of pneumonia. We evaluated the potential for diagnostic stewardship at the respiratory culture reporting step. Methods In this mixed-methods study, we conducted a baseline evaluation of lower respiratory tract (LRT) culture appropriateness and antibiotic prescribing, followed by a non-randomized intervention in two adult ICUs. The intervention was a comment in the report to indicate potential colonization instead of organism identification when LRT cultures were inappropriate, i.e., not meeting criteria for pneumonia as adjudicated by a physician using a standard algorithm. Results At baseline, among 66 inappropriate LRT cultures, antibiotic treatment for VAP was more frequent with identification of potential pathogen(s) in the index culture compared to no growth/normal flora (16/35 (46%) vs 7/31 (23%), P=0.049). In the intervention period, 28 inappropriate cultures with growth of potential pathogen(s) underwent report modification. The proportion of episodes for which antibiotic therapy for VAP was completed was significantly lower in the intervention compared to baseline group (5/28 (18%) vs 16/35 (46%), P = 0.02). Conclusions Diagnostic stewardship for VAP could be facilitated by modification of LRT culture reporting guided by clinical features of pneumonia.
{"title":"Improving Antibiotic Use for Ventilator-Associated Pneumonia Through Diagnostic Stewardship: A Proof-of-Concept Mixed-Methods Study","authors":"Ravi K Tripathi, Blaine Kenaa, Kimberly C Claeys, J Kristie Johnson, Meghana Patel, Jayne Atkinson, Mary E Maldarelli, Michelle Newman, Surbhi Leekha","doi":"10.1093/ofid/ofae500","DOIUrl":"https://doi.org/10.1093/ofid/ofae500","url":null,"abstract":"Background Overtreatment of ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) is driven by positive respiratory tract cultures in the absence of a clinical picture of pneumonia. We evaluated the potential for diagnostic stewardship at the respiratory culture reporting step. Methods In this mixed-methods study, we conducted a baseline evaluation of lower respiratory tract (LRT) culture appropriateness and antibiotic prescribing, followed by a non-randomized intervention in two adult ICUs. The intervention was a comment in the report to indicate potential colonization instead of organism identification when LRT cultures were inappropriate, i.e., not meeting criteria for pneumonia as adjudicated by a physician using a standard algorithm. Results At baseline, among 66 inappropriate LRT cultures, antibiotic treatment for VAP was more frequent with identification of potential pathogen(s) in the index culture compared to no growth/normal flora (16/35 (46%) vs 7/31 (23%), P=0.049). In the intervention period, 28 inappropriate cultures with growth of potential pathogen(s) underwent report modification. The proportion of episodes for which antibiotic therapy for VAP was completed was significantly lower in the intervention compared to baseline group (5/28 (18%) vs 16/35 (46%), P = 0.02). Conclusions Diagnostic stewardship for VAP could be facilitated by modification of LRT culture reporting guided by clinical features of pneumonia.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189231","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}
Jenna M Wick, Yuching Ni, Nicole Halmer, Robert J Wong, Amit S Chitnis, Devan Jaganath, Amy L Krueger, Jacek Skarbinski
Background Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection both disproportionately affect non-U.S.—born persons. Early identification and treatment are critical to reduce transmission, morbidity and mortality, but little is known about screening in the United States. Methods We conducted a cross-sectional study in a large, integrated California health system in September 2022 assessing TBI and HBV screening among persons aged ≥18 years born in countries with high TB (TB disease incidence rates ≥20/100,000 population) and/or HBV (hepatitis B surface antigen seroprevalence >2%) burden. Results Of 510,361 non-U.S.—born persons born in countries with high TB burden, 322,027 (63.1%) were born in countries with high HBV burden and 188,334 (36.9%) were born in countries with only high TB burden. Among persons born in countries with high TB and HBV burden, 29.6% were screened for TBI, 64.5% were screened for HBV, and 23.4% were screened for both TBI and HBV; 9.9% had TBI and 3.1% had HBV infection. Among persons born in countries with high TB burden only, 27.9% were screened for TBI and 7.5% had TBI. Conclusions Among non-U.S.—born persons from countries with high TB and HBV burden, we found low screening rates and elevated prevalence of TBI and chronic HBV infection. Co-testing for TBI and HBV infection in non-U.S.—born persons from countries with high TB and HBV burden might improve outcomes by identifying persons who warrant TBI treatment, HBV treatment, or HBV vaccination. Increased screening is the first step in reducing health inequities and overall disease burden.
{"title":"Tuberculosis and chronic hepatitis B virus infection screening among non-U.S.—born persons in an integrated health system in California","authors":"Jenna M Wick, Yuching Ni, Nicole Halmer, Robert J Wong, Amit S Chitnis, Devan Jaganath, Amy L Krueger, Jacek Skarbinski","doi":"10.1093/ofid/ofae484","DOIUrl":"https://doi.org/10.1093/ofid/ofae484","url":null,"abstract":"Background Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection both disproportionately affect non-U.S.—born persons. Early identification and treatment are critical to reduce transmission, morbidity and mortality, but little is known about screening in the United States. Methods We conducted a cross-sectional study in a large, integrated California health system in September 2022 assessing TBI and HBV screening among persons aged ≥18 years born in countries with high TB (TB disease incidence rates ≥20/100,000 population) and/or HBV (hepatitis B surface antigen seroprevalence &gt;2%) burden. Results Of 510,361 non-U.S.—born persons born in countries with high TB burden, 322,027 (63.1%) were born in countries with high HBV burden and 188,334 (36.9%) were born in countries with only high TB burden. Among persons born in countries with high TB and HBV burden, 29.6% were screened for TBI, 64.5% were screened for HBV, and 23.4% were screened for both TBI and HBV; 9.9% had TBI and 3.1% had HBV infection. Among persons born in countries with high TB burden only, 27.9% were screened for TBI and 7.5% had TBI. Conclusions Among non-U.S.—born persons from countries with high TB and HBV burden, we found low screening rates and elevated prevalence of TBI and chronic HBV infection. Co-testing for TBI and HBV infection in non-U.S.—born persons from countries with high TB and HBV burden might improve outcomes by identifying persons who warrant TBI treatment, HBV treatment, or HBV vaccination. Increased screening is the first step in reducing health inequities and overall disease burden.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189266","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}
Xiaolu Li, Fangfei Xiao, Xufei Wang, Lin Ye, Yongmei Xiao, Dan Li, Ting Zhang, Yizhong Wang
Background Recurrent Clostridioides difficile (C. difficile) infection (rCDI) is a critical clinical issue due to the increase in incidence and difficulty in treatment. We aimed to identify gut microbial and metabolic features associated with disease recurrence in a group of pediatric CDI patients. Methods A total of 84 children with primary CDI were prospectively enrolled in the study. Fecal samples collected at the initial diagnosis were subjected to 16S rRNA gene sequencing and targeted metabolomics analysis to profile the bacterial composition and metabolome. Results Twenty-six (26/84, 31.0%) pediatric CDI patients experienced recurrence. The alpha diversity of the fecal microbiota was significantly lower in the recurrent group than in the nonrecurrent group, and the beta diversity was different from that of the nonrecurrent group. Taxonomic profiles revealed that the relative abundances of multiple bacterial taxa significantly differed between the recurrent and nonrecurrent groups. Linear discriminant analysis (LDA) effect size (LEfSe) analysis identified several bacterial genera that discriminated between recurrent and nonrecurrent groups, including Parabacteroides, Coprococcus, Disalister and Clostridium. Recurrent bacteria presented lower abundances of several short-chain fatty acid (SCFA)-producing bacteria (Faecalibacterium, Butyricicoccus, Clostridium, Roseburia, and Ruminococcus), which were correlated with reduced fecal SCFA levels. In addition, several bile acids (BAs), including lithochalic acid (LCA), 12-ketoLCA, trihydroxycholestanoic acid (3-DHCA), and deoxycholic acid (DCA), were decreased in recurrent patients. Conclusions Our study suggests that the differing gut microbiota profiles in pediatric CDI patients may contribute to disease recurrence by modulating SCFA concentrations and BA profiles. The gut microbiota and metabolite signatures may be used to predict disease recurrence in children with CDI.
{"title":"Gut microbial and metabolic features associated with Clostridioides difficile infection recurrence in children","authors":"Xiaolu Li, Fangfei Xiao, Xufei Wang, Lin Ye, Yongmei Xiao, Dan Li, Ting Zhang, Yizhong Wang","doi":"10.1093/ofid/ofae506","DOIUrl":"https://doi.org/10.1093/ofid/ofae506","url":null,"abstract":"Background Recurrent Clostridioides difficile (C. difficile) infection (rCDI) is a critical clinical issue due to the increase in incidence and difficulty in treatment. We aimed to identify gut microbial and metabolic features associated with disease recurrence in a group of pediatric CDI patients. Methods A total of 84 children with primary CDI were prospectively enrolled in the study. Fecal samples collected at the initial diagnosis were subjected to 16S rRNA gene sequencing and targeted metabolomics analysis to profile the bacterial composition and metabolome. Results Twenty-six (26/84, 31.0%) pediatric CDI patients experienced recurrence. The alpha diversity of the fecal microbiota was significantly lower in the recurrent group than in the nonrecurrent group, and the beta diversity was different from that of the nonrecurrent group. Taxonomic profiles revealed that the relative abundances of multiple bacterial taxa significantly differed between the recurrent and nonrecurrent groups. Linear discriminant analysis (LDA) effect size (LEfSe) analysis identified several bacterial genera that discriminated between recurrent and nonrecurrent groups, including Parabacteroides, Coprococcus, Disalister and Clostridium. Recurrent bacteria presented lower abundances of several short-chain fatty acid (SCFA)-producing bacteria (Faecalibacterium, Butyricicoccus, Clostridium, Roseburia, and Ruminococcus), which were correlated with reduced fecal SCFA levels. In addition, several bile acids (BAs), including lithochalic acid (LCA), 12-ketoLCA, trihydroxycholestanoic acid (3-DHCA), and deoxycholic acid (DCA), were decreased in recurrent patients. Conclusions Our study suggests that the differing gut microbiota profiles in pediatric CDI patients may contribute to disease recurrence by modulating SCFA concentrations and BA profiles. The gut microbiota and metabolite signatures may be used to predict disease recurrence in children with CDI.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189252","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}
Arnold W Lambisia, Martin Mutunga, Esther N Katama, Charles N Agoti, Charlotte J Houldcroft
Background Although seven human adenovirus (HAdV) species are known to exist, only F (types 40 and 41) and G, are identified as diarrhoeal disease agents. The role of other HAdV species in diarrhoeal disease remains unclear and data of their prevalence is limited. We describe HAdV species and types in hospitalised children with diarrhoea in coastal Kenya. Methods 329 stool samples collected between June 2022 and August 2023 from children aged <13-years were screened for HAdV using quantitative polymerase chain reaction (qPCR). Positive HAdV cases were genotyped by adenovirus primers from the RespiCoV panel by amplification, next generation sequencing followed by phylogenetic analysis. Results 65 samples (20%) tested HadV positive from which five HAdV species were identified. Other than HAdV F, other species included A, B, C and D; these were detected as either mono-detections or coinfections. Six HAdV F identified by NGS had been missed by our q PCR typing method. This appeared to be as a result of a 133-nucleotide deletion in the long fiber protein which abrogated a primer and probe binding site. Based on VESIKARI scores grading of diarrheal disease severity, 93% of the HAdV cases presented with severe disease. One child with an HAdV F infection died. Conclusion Our study shows the enormous diversity and clinical characteristics of HAdV species in children with diarrhea in coastal Kenya. These data offer an opportunity to improve current diagnostic assays, increase knowledge of HAdV in Africa for control of outbreaks in the future.
{"title":"Multi-species co-circulation of adenoviruses identified by next generation sequencing during an acute gastroenteritis outbreak in coastal Kenya in 2023","authors":"Arnold W Lambisia, Martin Mutunga, Esther N Katama, Charles N Agoti, Charlotte J Houldcroft","doi":"10.1093/ofid/ofae505","DOIUrl":"https://doi.org/10.1093/ofid/ofae505","url":null,"abstract":"Background Although seven human adenovirus (HAdV) species are known to exist, only F (types 40 and 41) and G, are identified as diarrhoeal disease agents. The role of other HAdV species in diarrhoeal disease remains unclear and data of their prevalence is limited. We describe HAdV species and types in hospitalised children with diarrhoea in coastal Kenya. Methods 329 stool samples collected between June 2022 and August 2023 from children aged &lt;13-years were screened for HAdV using quantitative polymerase chain reaction (qPCR). Positive HAdV cases were genotyped by adenovirus primers from the RespiCoV panel by amplification, next generation sequencing followed by phylogenetic analysis. Results 65 samples (20%) tested HadV positive from which five HAdV species were identified. Other than HAdV F, other species included A, B, C and D; these were detected as either mono-detections or coinfections. Six HAdV F identified by NGS had been missed by our q PCR typing method. This appeared to be as a result of a 133-nucleotide deletion in the long fiber protein which abrogated a primer and probe binding site. Based on VESIKARI scores grading of diarrheal disease severity, 93% of the HAdV cases presented with severe disease. One child with an HAdV F infection died. Conclusion Our study shows the enormous diversity and clinical characteristics of HAdV species in children with diarrhea in coastal Kenya. These data offer an opportunity to improve current diagnostic assays, increase knowledge of HAdV in Africa for control of outbreaks in the future.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189269","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}
Background In immunocompromised individuals, trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis pneumonia (PCP) prophylaxis has adverse events, and the optimal dosage is unclear. The objective of this study was to assess efficacy and safety of intermittent versus daily TMP/SMX for PCP prophylaxis. Methods This systematic review included randomised controlled trials (RCTs) indexed in the CENTRAL, PubMed, Ichushi, or Embase databases, published from database inception to September 2023. The inclusion criteria were adults taking intermittent or daily TMP/SMX for PCP prophylaxis. Risk of bias was assessed using the Cochrane risk-of-bias tool. The primary outcomes were PCP incidence, PCP-related mortality, and adverse events requiring temporary or permanent TMP/SMX discontinuation. This study was registered with PROSPERO (CRD42022359102). Results Four RCTs (N = 2808 patients) were included. PCP incidence did not differ significantly between the intermittent and daily regimen groups (relative risk [RR], 1.17; 95% confidence interval [CI], 0.89–1.53; certainty, very low). There was no PCP-related mortality in the three RCTs reporting its outcome. Compared with the daily regimen group, the intermittent regimen group experienced significantly fewer adverse events requiring temporary or permanent TMP/SMX discontinuation (RR, 0.51; 95% CI, 0.42–0.61; certainty, low) Conclusions This systematic review and meta-analysis suggests that intermittent TMP/SMX regimens for PCP prophylaxis may be more tolerable than daily regimens and may have similar efficacy. Further RCTs are needed to apply this to current practice.
{"title":"Intermittent versus Daily Trimethoprim/Sulfamethoxazole Regimens for Pneumocystis Pneumonia Prophylaxis: A Systematic Review and Meta-analysis","authors":"Tetsuhiro Masaki, Kazuhiro Ishikawa, Takahisa Fujino, Ryosuke Koyamada, Fujimi Kawai, Erika Ota, Shinichiro Mori","doi":"10.1093/ofid/ofae499","DOIUrl":"https://doi.org/10.1093/ofid/ofae499","url":null,"abstract":"Background In immunocompromised individuals, trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis pneumonia (PCP) prophylaxis has adverse events, and the optimal dosage is unclear. The objective of this study was to assess efficacy and safety of intermittent versus daily TMP/SMX for PCP prophylaxis. Methods This systematic review included randomised controlled trials (RCTs) indexed in the CENTRAL, PubMed, Ichushi, or Embase databases, published from database inception to September 2023. The inclusion criteria were adults taking intermittent or daily TMP/SMX for PCP prophylaxis. Risk of bias was assessed using the Cochrane risk-of-bias tool. The primary outcomes were PCP incidence, PCP-related mortality, and adverse events requiring temporary or permanent TMP/SMX discontinuation. This study was registered with PROSPERO (CRD42022359102). Results Four RCTs (N = 2808 patients) were included. PCP incidence did not differ significantly between the intermittent and daily regimen groups (relative risk [RR], 1.17; 95% confidence interval [CI], 0.89–1.53; certainty, very low). There was no PCP-related mortality in the three RCTs reporting its outcome. Compared with the daily regimen group, the intermittent regimen group experienced significantly fewer adverse events requiring temporary or permanent TMP/SMX discontinuation (RR, 0.51; 95% CI, 0.42–0.61; certainty, low) Conclusions This systematic review and meta-analysis suggests that intermittent TMP/SMX regimens for PCP prophylaxis may be more tolerable than daily regimens and may have similar efficacy. Further RCTs are needed to apply this to current practice.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189254","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 : 2024-08-31eCollection Date: 2024-09-01DOI: 10.1093/ofid/ofae464
Kai-Lin Liu, Wan-Lun Hsu, Wei Bu, Kelly J Yu, Cheng-Ping Wang, Yin-Chu Chien, Tseng-Cheng Chen, Chien-Jen Chen, Allan Hildesheim, Jaap M Middeldorp, Tim Waterboer, Jeffrey I Cohen, Anna E Coghill, Zhiwei Liu
Elevated levels of Epstein-Barr virus (EBV) gp350 and gH/gL antibodies have been associated with a lower risk of developing nasopharyngeal carcinoma (NPC), although the evidence remains inconclusive and unexplained. We conducted a longitudinal study within a high-risk Taiwanese cohort, analyzing total immunoglobulin against EBV-gp350 and -gH/gL in blood and EBV DNA shedding in saliva. Contrary to our hypothesis-that elevated levels of antibodies previously shown to be associated with a lower NPC risk should result in a decrease in EBV shedding in saliva-higher anti-gp350 antibodies at baseline were significantly associated with detectable EBV DNA in saliva at follow-up (odds ratio [OR], 1.99 [95% confidence interval {CI}, 1.03-3.97]; P = .04). Higher anti-EBV-gH/gL antibodies at baseline were not significantly associated with risk of detectable EBV DNA at follow-up (OR, 0.69 [95% CI, .35-1.32]; P = .26). These findings underscore the complexity of virus-host interactions and emphasize the need for further investigations into their role in EBV-associated diseases.
{"title":"Association Between Antibodies That Bind Epstein-Barr Virus (EBV) gp350 and gH/gL and Shedding of EBV in Saliva From Nasopharyngeal Carcinoma Multiplex Family Members in Taiwan.","authors":"Kai-Lin Liu, Wan-Lun Hsu, Wei Bu, Kelly J Yu, Cheng-Ping Wang, Yin-Chu Chien, Tseng-Cheng Chen, Chien-Jen Chen, Allan Hildesheim, Jaap M Middeldorp, Tim Waterboer, Jeffrey I Cohen, Anna E Coghill, Zhiwei Liu","doi":"10.1093/ofid/ofae464","DOIUrl":"10.1093/ofid/ofae464","url":null,"abstract":"<p><p>Elevated levels of Epstein-Barr virus (EBV) gp350 and gH/gL antibodies have been associated with a lower risk of developing nasopharyngeal carcinoma (NPC), although the evidence remains inconclusive and unexplained. We conducted a longitudinal study within a high-risk Taiwanese cohort, analyzing total immunoglobulin against EBV-gp350 and -gH/gL in blood and EBV DNA shedding in saliva. Contrary to our hypothesis-that elevated levels of antibodies previously shown to be associated with a lower NPC risk should result in a decrease in EBV shedding in saliva-higher anti-gp350 antibodies at baseline were significantly associated with detectable EBV DNA in saliva at follow-up (odds ratio [OR], 1.99 [95% confidence interval {CI}, 1.03-3.97]; <i>P</i> = .04). Higher anti-EBV-gH/gL antibodies at baseline were not significantly associated with risk of detectable EBV DNA at follow-up (OR, 0.69 [95% CI, .35-1.32]; <i>P</i> = .26). These findings underscore the complexity of virus-host interactions and emphasize the need for further investigations into their role in EBV-associated diseases.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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