Therapeutic Advances in Infectious Disease最新文献

Chikungunya virus (CHIKV) has emerged as a serious candidate for "Disease X"-the name for an unknown agent that could cause a global pandemic. This paper searches for the unique traits of CHIKV that match that designation. Critical mutations like E1-A226V and E2 L210Q have driven CHIKV's rapid adaptability and its transmission from Aedes mosquitoes to over 110 countries around the world. Public health impact is amped because the virus can cause debilitating diseases including chronic arthritis and severe neonatal complications. Populations remain vulnerable despite a recently approved vaccine, as there is little distribution of it and no treatments for the virus. By underscoring urbanization, climate change, and global travel as ecologic and genetic factors that enable the emergence and persistence of CHIKV, this paper emphasizes that these critical enablers of CHIKV need to be addressed both in the context of host range and transmission potential. However, phylogenetic studies and surveillance data for its capacity to sustain transmission cycles show how important it is to be included in improved global health strategies. Improved early detection, improved vector control, equitable vaccine distribution, and greater international collaboration are critical to reduce the pandemic potential of CHIKV. This paper aims to explore the genetic adaptations of CHIKV that have driven its increased transmission and expanded geographic spread. It examines how key mutations enable the virus to adapt to different mosquito vectors, contributing to its pandemic potential. The paper also assesses the epidemiological and environmental factors influencing CHIKV's emergence and persistence, alongside the public health challenges posed by limited vaccine availability and treatment options. Finally, it highlights prevention strategies and the importance of global preparedness to reduce the risk of widespread outbreaks.

Background: Group B Streptococcus (GBS) infection among pregnant women is a major risk factor for a significant proportion of early-onset disease and late-onset disease in infants worldwide; however, data on the epidemiological features of GBS in Vietnam are very limited.

Objectives: To determine the prevalence, potential risk factors, and serotype distribution of GBS isolates isolated from rectovaginal specimens of Vietnamese pregnant women.

Design: Cross-sectional study.

Methods: A cross-sectional study was conducted at three hospitals in Hanoi City, Vietnam, from October 2021 to May 2022. Combined rectovaginal swabs were collected from pregnant women at 35-37 weeks of gestation. GBS was isolated from swabs using selective enrichment in Todd-Hewitt broth and cultured on Columbia agar plates with 5% sheep blood, and Chromogenic Strepto B. All isolates were confirmed through the Gram staining, the CAMP test, and specific Polymerase Chain Reaction (PCR). GBS serotyping was performed by using the multiplex PCR assays. Risk factors for GBS carriage were analyzed using univariate and multivariate logistic regression tools.

Results: The prevalence of rectovaginal GBS carriage was 19.52% of 876 participants. Multivariate analysis identified two independent risk factors associated with GBS colonization: a high level of education and yellow vaginal discharge. Among these isolates, serotype III (n = 40, 23.39%) was the most frequently found, followed by serotypes V (n = 37, 21.64%), VI (n = 21, 12.28%), Ia (n = 18, 10.53%), Ib (n = 17, 9.95%), II (n = 8, 8.77%), and VII (n = 1, 0.58%), respectively. Capsular types IV, VIII, and IX were not detected. No statistically significant correlation was found between GBS infection and the distribution of the identified serotypes.

Conclusion: The GBS colonization rate in pregnant women was consistent with findings from other studies worldwide. Higher educational attainment and the presence of yellow vaginal discharge were independently associated with an increased risk of GBS colonization. The predominance of GBS serotypes III, V, and VI was a notable feature among the strains isolated from pregnant women in Vietnam.

Background: Bloodstream infections (BSI) caused by carbapenemase-producing Enterobacterales (CPE) represent a significant threat to patients with acute leukemia due to their high mortality. Ceftazidime-avibactam (CAZ-AVI) has emerged as a therapeutic alternative against these infections; however, its efficacy in immunocompromised patients remains unclear.

Objective: To determine the impact of ceftazidime-avibactam on mortality due to BSI caused by CPE in patients with acute leukemia.

Design: A retrospective cohort study was conducted at the Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru.

Methods: We included patients diagnosed with acute leukemia who developed BSI due to CPE during their hospital stays. Mortality was assessed for up to 30 days after BSI onset.

Results: We evaluated 41 patients with a median age of 51 years; 56.1% had acute myeloid leukemia and 43.9% had acute lymphoblastic leukemia. Mortality at 30 days occurred in 60.9% of patients. The most frequent type of chemotherapy administered was induction (51.2%). Empiric antibiotic therapy with meropenem was administered to 97.6% of the patients, and ceftazidime-avibactam was prescribed as a targeted therapy to 48.8%. In the multivariate Cox regression model, the prescription of ceftazidime-avibactam reduced the risk of death (adjusted hazard ratio, 0.29; 95% CI: 0.09-0.92; p = 0.012) compared with those who received other antibiotic therapies, such as colistin.

Conclusion: In patients with acute leukemia who developed bloodstream infections due to CPE during hospitalization, the prescription of ceftazidime-avibactam reduced 30-day mortality risk.

Here we describe a composite vignette of a patient who developed necrotic wounds and systemic infection after reported exposure to xylazine, a veterinary anesthetic found as an adulterant in the unregulated drug supply. While exposure to xylazine-containing compounds via the use of fentanyl is not a new phenomenon, xylazine's prevalence in overdose deaths has escalated, and its geographic distribution has expanded to include rural areas such as Maine. We use this composite vignette to highlight: (1) the growing number of overdoses in Maine where xylazine was found in combination with fentanyl, (2) the potential severe, infection-related complications of xylazine exposure, and (3) describe novel harm reduction strategies that utilize community- and laboratory-based drug checking technology.

Background: Echinocandins are recommended as an initial treatment for invasive candidiasis. Although safety and efficacy profiles of both anidulafungin and caspofungin are well established, direct head-to-head comparisons have not been reported before.

Objective: Compare efficacy and safety of anidulafungin versus caspofungin among patients with invasive candidiasis.

Design: Retrospective observational study.

Methods: Adult patients with invasive candidiasis who were treated with either anidulafungin or caspofungin for ⩾5 days were retrospectively reviewed over a period of 6 years. The primary endpoint was global response, defined as clinical and microbiological success at the end of treatment duration.

Results: A total of 223 patients who received either anidulafungin (n = 176) or caspofungin (n = 47) were initially included. Propensity score matching (based on age, malignancy, level of care, presence of candidemia, and other factors) was performed to improve comparability of the two groups. As a result, 32 patients in the caspofungin arm and 79 patients in the anidulafungin arm were included in the final analysis. Around three-quarters of the cohort had candidemia, and the most common isolated Candida species were C. albicans and C. glabrata. Response rates were comparable between both groups, with the primary outcome of global response showing no significant difference (56.3% for the caspofungin group vs 63.3% for anidulafungin, p = 0.490). Similarly, no differences between the two groups were observed in terms of 90-day all-cause mortality (p = 0.672) or any other secondary endpoints.

Conclusion: Our data suggest that anidulafungin and caspofungin have comparable global response among patients with invasive candidiasis. Additionally, both studied echinocandins showed no significant difference in 90-day all-cause mortality. However, due to the limited sample size, larger studies are needed to confirm these results.

[This corrects the article DOI: 10.1177/20499361241242240.].

Mycoplasma hominis is a rare cause of infective endocarditis, typically reported in immunocompetent patients following valve replacement. We report the first case of post-renal transplant prosthetic valve infective endocarditis and concurrent endophthalmitis caused by M. hominis. A 47-year-old woman with prior aortic valve replacement and renal transplantation presented with fever & atrial fibrillation. She was diagnosed with culture-negative endocarditis complicated by cerebral septic emboli and visual symptoms. Plasma cell-free DNA metagenomic next-generation sequencing identified M. hominis, which was confirmed by culture of aortic abscess tissue. Management included valve replacement surgery and antibiotic therapy with doxycycline and levofloxacin. This case highlights the diagnostic challenges of M. hominis infections, the utility of advanced molecular diagnostics, and the importance of considering M. hominis in immunocompromised patients with culture-negative endocarditis. Donor and recipient screening for M. hominis in recipients with prosthetic heart valves may help prevent infection.

Background: Panton-Valentine Leukocidin (PVL) is one of the major virulence factors known to be associated with invasive, life-threatening Staphylococcus aureus (S. aureus) soft tissue infections. Several studies have shown that methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are carriers of the lukSF-PV; however, data describing their prevalence and distribution in the Nigerian setting are sparse in the literature, and thus informed the need for the current study.

Objective: We aimed to detect mecA and analysed the risk factors associated with lukSF-PV-producing S. aureus wound infections.

Design: This was a single-centre hospital-based descriptive cross-sectional study conducted between March 2019 and September 2019 at the University of Calabar Teaching Hospital, Calabar, Nigeria.

Methods: Aspirates from participants with soft tissue infections were cultured, and all isolates of S. aureus were tested for the presence of lukSF-PV using endpoint polymerase chain reaction. The mecA was also detected, and antibiotic susceptibility testing was performed.

Results: Eighty S. aureus isolates were identified from 360 participants. Of the eighty, 47 (58.8%) were MRSA and 10 (12.5%) were lukSF-PV-producing S. aureus strains. Of the ten, six were MSSA and four were MRSA, but the difference was not statistically significant. A significant association was observed between lukSF-PV-producing S. aureus-infected wounds and recurrent skin infections (p = 0.024), as well as working in a day care nursery home (p = 0.0008). The majority of S. aureus isolates were susceptible to tigecycline (76%) and vancomycin (76%), followed by susceptibility to linezolid (72.5%), quinupristin/dalfopristin (67.2%), levofloxacin (38.6%) and erythromycin (11.7%).

Conclusion: The prevalence of PVL-positive S. aureus strains causing soft tissue infections in our setting is seemingly high. There is a need for active surveillance of this gene in patients presenting with S. aureus soft tissue infections in our setting, ensure antibiotic susceptibility testing, evaluate the impact of these strains on clinical outcomes and prevent the spread of lukSF-PV-positive S. aureus strains.

Uncomplicated urinary tract infections (uUTIs/acute cystitis) carry a substantial physical and psychological burden that negatively impacts patient quality-of-life, particularly for those who experience recurrent infection. A disconnect can exist between patients and healthcare professionals (HCPs), leading to poor patient-HCP communication, suboptimal treatment, and feelings of frustration and anxiety for many patients. The views of four patient authors with recurrent UTI or chronic uUTI and two HCP authors managing patients with this disease are presented in this Patient Perspectives article. While HCPs recognize both the physical and mental impacts of recurrent uUTIs, most HCPs focus on relieving a patient's physical symptoms, often resulting in the psychological impact being overlooked. Inadequate testing, lengthy diagnostic procedures, and treatment failure caused by antimicrobial resistance (AMR) further exacerbate the problems associated with uUTIs, limiting the effectiveness of treatment options for patients. Enhancing education for patients and HCPs on AMR and the reasons why treatment failure might occur could improve the discourse between HCPs and patients, leading to improvements in the overall patient experience.