Therapeutic Advances in Infectious Disease最新文献

Background: Bacterial infections frequently occur in haematological patients, especially during prolonged neutropenia after intensive chemotherapy, often leading to bloodstream infections and pneumonia.

Objective: Routine antimicrobial prophylaxis (AMP) for high-risk haematology patients is still debated while prevalence of multi-drug resistant (MDR) Gram-negative bacteria (GNB) is rising globally. We aimed to assess the current practice of AMP in this population.

Design: Cross-sectional observational survey study.

Methods: Haematologists and infectious diseases physicians Europewide were invited to an online survey including questions on routine screening for GNB, incidence of MDR-GNB colonization, antimicrobial prophylaxis practices, rates of bloodstream infections (BSI), ICU admission and mortality differentiated by infections due to GNB versus MDR-GNB.

Results: 120 haematology centres from 28 countries participated. Screening for MDR-GNB is performed in 86.7% of centres, mostly via rectal swabs (58.3%). In 39.2% of routine AMP is used, mostly with fluoroquinolones. Estimates of GNB-BSI yielded higher rates in patients not receiving anti-GNB prophylaxis than in those who do for E. coli (10% vs 7%) Klebsiella spp. (10% vs 5%), and Pseudomonas spp. (5% vs 4%). Rates for MDR-GNB infection were estimated lower in centres that administer AMP for MDR E. coli (5% vs 3%) Klebsiella spp. (5% vs 3%), and Pseudomonas spp. (2% vs 1%). In an exploratory analysis, Southern and Eastern European countries expected higher rates of MDR-GNB infections with lower ICU admission and mortality rates which may be subject to estimation bias.

Conclusion: Screening for MDR-GNB is frequently performed. AMP against GNB infections is still often implemented. Estimated BSI rates are rather low, while the rate of MDR-GNB infections rises. Tailored prophylaxis including antimicrobial stewardship becomes more important.

Background: Invasive fungal infections are responsible for a large number of infections in hospitalized patients annually and are responsible for high morbidity and mortality. Familiarity with novel agents or strategies in this area can be challenging.

Objectives: To identify the top 10 manuscripts on the treatment of invasive fungal infections from 2018 to 2023.

Design: Modified Delphi consensus-building technique.

Methods: A three-stage consensus-building approach was used comprised of (1) identifying relevant articles; (2) voting by a panel of experts to establish consensus on the importance of these articles; and (3) finalizing the list of top articles by a small group. Members of the Southeastern Research Group Endeavor network served as content experts. Publications from 2018 to 2023 were evaluated if articles met the following inclusion criteria: (1) published between 2018 and 2023, (2) contained content related to fungal infections, and (3) included an actionable intervention.

Results: A total of 6518 potential publications were assessed. After applying inclusion and exclusion criteria, 82 articles were reviewed. The top 10 publications related to invasive fungal infections, selected by a panel of experts, are summarized in this manuscript and include publications related to the treatment of invasive aspergillosis, candidiasis, and cryptococcosis.

Conclusion: This article highlights the selected publications and may serve as a key resource for teaching and training. Clinicians may also employ these reported interventions to identify new opportunities to optimize antifungal therapeutic strategies within one's institution.

Background: Understanding the time to hypertension occurrence after antiretroviral treatment (ART) initiation in people living with HIV (PLHIV) and its determinants is important for designing interventions for control.

Objective: This study sought to estimate the median time of ART use to hypertension onset and its predictors in Nigerian PLHIV.

Design: A retrospective longitudinal study.

Methods: This retrospective review of 2503 normotensive adult PLHIV (⩾18 years) from 2004 to 2020 in two HIV clinics in Nigeria. Incident hypertension was based on clinical diagnosis or two consecutive blood pressure readings ⩾140/90 mmHg, taken during the 8 months of data collection. Survival event was defined as incident hypertension during follow-up or interview day for observed patients unless they were right censored. The Kaplan-Meier survival curve was used to estimate the survival probabilities of hypertension. The Cox proportional hazard model was fitted to identify predictors of hypertension at p < 0.05.

Results: A total of 2503 PLHIV was followed up. The majority were females (74.6%) and on Dolutegravir-based therapy (93.0%). About 22 (0.9%) were diabetic. Median age at ART initiation was 35 (interquartile range: 29-41) years. The median period of follow-up was 12.0 ± 3.9 years. The cumulative incidence of hypertension was 32.5% (381/2540), with an incidence rate of 40.1/1000 person-years. The median time to incident hypertension was 17.0 years (95% CI: 12.5-21.5 years). Shorter hypertension-free survival times were seen in males, those aged 60+, with diabetes, unsuppressed viral load, history of tuberculosis, other opportunistic infections, or co-trimoxazole use. Significant risk factors included male sex (adjusted odds ratio (AOR) = 1.3, 95% CI = 1.1-1.6), middle age (AOR = 2.3, 95% CI = 1.7-3.2), old age (AOR = 5.6, 95% CI = 3.9-8.4), and unsuppressed viral load (AOR = 1.9, 95% CI = 1.3-2.7).

Conclusion: Hypertension is commoner among PLHIV with unsuppressed viral load, males, and persons older than 40 years. Effective ART with viral suppression remains essential. Incorporating regular hypertension screening and treatment into HIV care is necessary for optimum health outcomes.

Background: Deep mycoses are serious fungal diseases commonly associated with the immunocompromised but can also present in the immunocompetent following severe exposure to fungal pathogens. Included in this group are subcutaneous and systemic fungal infections.

Objectives: Reviews highlighting skin involvement in patients with deep mycosis in the Nigerian setting are sparse in the literature. This systematic review summarized the clinical presentation, risk factors, and diagnosis of deep mycosis presenting with cutaneous manifestations in Nigerians.

Design: This was a systematic review conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines.

Data sources and methods: PubMed, Google Scholar, and the African Journal Online database were searched from inception to February 2024 to identify published articles from Nigeria on deep mycoses with cutaneous manifestations. We included single case reports and case series on cutaneous involvement in deep fungal infections in Nigeria. Review articles, guidelines, meta-analyses, animal studies, and fungal studies not relating to the Nigerian setting were excluded.

Results: We identified 16 well-documented articles on deep cutaneous mycoses published in Nigeria over the past six decades which amounted to 137 cases; 102 (74.5%) cases were reported before the year 2000, while the remainder were published within the past two decades. The 137 cases were majorly histoplasmosis (n = 87, 63.5%) and eumycetoma (n = 19, 13.9%) and predominant risk factors, farming (n = 13, 9.5%) and diabetes mellitus (n = 3, 2.2%), The diagnosis of cases was predominantly via histopathology (n =131, 95.6%) with a few cases diagnosed by fungal culture (n = 15, 10.9%), and antigen assay (n = 1, 0.7%) respectively. Twenty-one (15.3%) were clinically diagnosed as cancers including a case of carcinoma of the skin, and one each (0.7%) as skin tuberculosis or neurofibromatosis but all histologically confirmed as deep cutaneous mycoses.

Conclusion: The decline of reports on deep cutaneous mycoses in recent times suggests neglect or a low index of suspicion from attending clinicians. This is further buttressed in the misdiagnosis of cases as other clinical entities. Ensuring a histological diagnosis of skin lesions, especially in at-risk patients will mitigate these gaps.

Background: The risk of infection following cesarean delivery is 5-20 times higher than that following normal delivery, contributing to 10% of pregnancy-related mortality. In 2019, Mbarara Regional Referral Hospital (MRRH) performed cesarean section for 40% of deliveries, surpassing the WHO's recommended 15%-20%. The availability and provision of effective prophylactic antibiotics are crucial in preventing surgical site infections (SSIs).

Objectives: To determine the prevalence and predictors of SSIs among mothers after cesarean section, length of hospital stay, and antibiotic use at MRRH.

Design: This was an observational retrospective study conducted in the maternity ward of the MRRH.

Methods: Data on the diagnosis of SSI, length of hospital stay, and antibiotic use were extracted and entered into EpiData software version 3.1 and analyzed using STATA version 15. We conducted logistic regression analysis to identify factors independently associated with SSIs. We also compared the length of hospital stay.

Results: The prevalence of post-cesarean SSIs was 7.9% (95% CI: 6.3%-9.9%). Mothers aged 25 years and younger were less likely to develop SSIs (adjusted odds ratio (aOR): 0.53, 95% CI: 0.30-0.93; p = 0.027). Those with more than six pregnancies were more likely to develop SSIs (aOR: 3.4; 95% CI: 1.35-8.58; p = 0.009). The median length of stay was 8 days for mothers who developed an SSI (interquartile range (IQR): 5, 16) and 3 (IQR: 3, 4) days for those who did not (p < 0.001). Prophylactic antibiotics were prescribed to 83.4% of the women (95% CI: 80.7-85.8). Ampicillin (88.2%) was the most prescribed prophylactic antibiotic, and metronidazole was the most prescribed postoperatively (97.8%) and at discharge (77.6%).

Conclusion: The current prevalence of post-cesarean SSIs is higher in Uganda than in developed countries. Older age and having had more than six pregnancies are independent predictors of SSIs, and post-cesarean SSI significantly prolonged hospital stay.

Background: Ethiopia is a country with a high endemicity of the hepatitis B virus, and the primary mode of transmission for this virus is mother-to-child transmission. However, the country lacks a comprehensive plan for viral hepatitis surveillance, prevention, and control.

Objectives: To assess the knowledge, attitudes, and practices toward preventing and controlling hepatitis B virus infection among pregnant women attending antenatal care at a University Hospital in Central Ethiopia.

Design: A hospital-based cross-sectional study was conducted among pregnant women from October to November 2023 at a University Hospital in Central Ethiopia.

Methods: A total of 412 pregnant women were selected and included in the study using a systematic random sampling technique. An interviewer-administered questionnaire was used to collect the data. The collected data were imported into Epi-data version 3.1 and then exported to the Statistical Package for Social Sciences version 25 for analysis. In the bivariate analysis, variables with a p-value less than 0.25 were included in the multivariate analysis. A logistic regression model was used. A p-value <0.05 indicated statistical significance.

Results: The overall response rate was 94.1%. Of the total 412 respondents, 37.6% exhibited good practices. Notably, pregnant women within the age categories of 29-39 years (adjusted odds ratio (AOR): 0.31; 95% confidence interval (CI): 0.15, 0.64) and ⩾40 years (AOR: 0.17; 95% CI: 0.06, 0.50), residing in rural areas (AOR: 0.35; 95% CI: 0.17, 0.70), with smaller family sizes (AOR: 0.13; 95% CI: 0.07, 0.25), lacking information about hepatitis B virus infection (AOR: 5.15; 95% CI: 2.91, 9.13), having a positive attitude (AOR: 0.03; 95% CI: 0.02, 0.06), and possessing good knowledge (AOR: 0.38; 95% CI: 0.20, 0.71) were significantly associated with poor practice.

Conclusion: This study revealed that pregnant women had a low level of knowledge, attitudes, and practices related to hepatitis B virus infection prevention and control. A greater understanding is necessary to effectively prevent and control the spread of infection through prioritized health education programs targeting pregnant women. These programs must focus on raising awareness through campaigns that promote knowledge and immunization for their children.

Background: Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19.

Objective: The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19.

Design: Single-center, retrospective cohort study.

Methods: The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (n = 56) and non-CA-UTI (n = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI.

Results: CA-UTIs developed in 28% of patients (n = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, p < 0.001) and more elevated mortality rates (75.0% vs 54.5%, p = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, p = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, p < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly Klebsiella pneumoniae (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%.

Conclusion: The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.