Journal of Infection in Developing Countries最新文献

Introduction: The eradication rates of Helicobacter pylori (H. pylori) in Vietnam, with both triple therapy and non-bismuth quadruple therapy, have significantly declined due to increasing antibiotic resistance. This prospective study aimed to evaluate the eradication efficacy of high-dose dual therapy (HDDT) with esomeprazole and amoxicillin in a region with high resistance rates to clarithromycin, metronidazole, and levofloxacin.

Methodology: A total of 82 patients with active H. pylori infection, confirmed by either a rapid urease test or a ¹³C urea breath test, were enrolled at our hospital. All participants received esomeprazole (40 mg) and amoxicillin (1,000 mg), 3 times daily for 14 days. Treatment success was assessed using a ¹³C urea breath test 4-6 weeks post-treatment. Safety was evaluated based on reported adverse effects.

Results: Gastritis, gastric ulcer, and duodenal ulcer were present in 80.5%, 10.4%, and 9.1% of cases, respectively. The eradication rates according to intention-to-treat (ITT) and per-protocol (PP) analyses were 76.8% (63/82) and 81.8% (63/77), respectively. In the PP analysis, the eradication rate was 86.0% (49/57) in first-line treatment, and 70.0% (14/20) in patients with prior H. pylori treatment failure. Mild side effects, including nausea, abdominal discomfort, pruritus, diarrhea, and fatigue, were reported in 22.1% (17/77) of patients.

Conclusions: This study demonstrates that a 14-day HDDT regimen provides relatively high efficacy and a favorable safety profile for first-line H. pylori eradication. Given the widespread resistance to clarithromycin, levofloxacin, and metronidazole in Vietnam; HDDT may serve as an alternative first-line therapy for H. pylori eradication in this region.

Objective: To analyze the relationship between platelet parameters and bacterial types in patients with bacteremia.

Methodology: Data from 265 patients with positive blood bacterial cultures were collected. Clinical parameters and procalcitonin (PCT) were recorded.

Results: In 265 patients with bacteremia, gram-negative (G-) bacteria accounted for 56% of cases, and gram-positive (G +) bacteria accounted for 44% of cases. In patients with bacteremia, white blood cell counts (WBC), neutrophil counts (NEUT), the percentage of neutrophils (NEUT%), and PCT were increased, and lymphocyte counts (LYM) and the percentage of lymphocytes (LYM%) were decreased. The differences in plateletcrit values, NEUT%, LYM%, and PCT between the G- and the G + bacteria group were significantly different. The cutoff values of PCT, platelet, plateletcrit, and NEUT% were 1.31 ng/mL, 211 × 109/L, 0.205%, and 87.41%, respectively. The incidence of thrombocytopenia was 12%. There was no significant difference in WBC, NEUT%, PCT, platelet, platelet nadir, and days of thrombocytopenia between the G- and the G + bacteria among patients with thrombocytopenia.

Conclusions: Platelet, plateletcrit, NEUT%, and PCT are helpful for the early identification of G- and G + bacteria. The combination of PCT and hemogram parameters is more conducive to the early differential diagnosis of bacterial classification.

Introduction: Most of Bacillus spp. generally avirulent species in healthy patients, but if there is a fragile in the patient, especially their immune system, Bacillus spp. can be an agent for infections.

Case report: In this case, we report that Bacillus paranthracis, diagnosed by whole genome sequencing, is responsible for bacteremia in a T-ALL patient. A 26-year-old male patient was diagnosed with T-cell acute lymphoblastic leukemia. Bacillus paranthracis was isolated from two sets of blood cultures obtained from a patient with febrile neutropenia.

Results: The bacteria was identified as Bacillus cereus group in a routine microbiology laboratory by MALDI TOF MS. Then whole genome sequencing (WGS) confirmed its name as Bacillus paranthracis. The pathogenicity of the bacterium, especially in immunocompromised patients, has also been demonstrated by WGS.

Conclusions: In a microbiology laboratory, the use of Whole Genome Sequencing (WGS) is important for diagnosing diseases, especially in immunocompromised patients. It will serve the management of these patients for infection control.

Introduction: This study aimed to determine the prevalence and associated factors of coronavirus disease 2019 (COVID-19) and long COVID-19 in children in Duhok province and Zakho city in the Kurdistan region.

Methodology: The study was conducted as a cross-sectional study and included children aged 5-12 years in Duhok and Zakho, two major neighboring cities in the Bahdenan region of northern Iraq. A total of 330 participants were included and the study was conducted between October 2022 and April 2023. The children were tested for the presence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies. A questionnaire was used to collect demographic and personal data, and symptoms of each participant to determine the prevalence of long COVID-19.

Results: Out of 330 participants, 302 (91.5%) were positive for IgG, and 156 (51.7%) of them were male. Only 4 participants (1.3%) had pneumonia, and 282 (93.4%) were asymptomatic. Fourteen out of 302 (4.6%) participants had long COVID-19. There were significant associations between long COVID-19 and history of previous COVID-19 episodes (p = 0.001), presence of pneumonia (p = 0.001), and family history of COVID-19 (p = 0.005).

Conclusions: There was a high prevalence of COVID-19 among children in Duhok province and Zakho city, and 4.6% of them experienced long COVID-19. Factors such as prior COVID-19, pneumonia, and family history of COVID-19 were associated with long COVID-19. Continued monitoring, education, vaccination, preventive measures, and supportive care are recommended to effectively address the impact of COVID-19 on the pediatric population.

Introduction: Quinolones are frequently associated with adverse effects such as tendinopathies and joint damage. However, the safety of quinolone use in pediatric patients remains inadequately established, with limited recommended applications. This study aimed to investigate the escalating consumption of quinolones among Brazilian children aged 0-10 years.

Methodology: An interrupted time series analysis was conducted to examine fluctuations in quinolone consumption within the pediatric population. Data were sourced from the Brazilian National Controlled Products Management System (SNGPC). Analysis of variance and joinpoint regression were employed to assess yearly variations in commercial unit sales of quinolones.

Results: Brazil witnessed the consumption of approximately 93 million commercial units of quinolones by the entire population, with 1 million units prescribed for children (0-10years). The surge in quinolone utilization among children during this period exceeded 50% (p < 0.05), a statistically significant increase compared to the 24% growth observed in the entire population. Regression analysis indicated an annual linear growth of around 9% (year on year) in Brazil for quinolone use among children.

Conclusions: Our study revealed a concerning rise in quinolone prescriptions for Brazilian children aged 0-10 years, underscoring the imperative for cautious use due to limited safety data and acknowledged risks, such as musculoskeletal damage. Healthcare providers should prioritize safer alternatives when possible, focusing on children`s well-being and combating antimicrobial resistance. Advocacy for prudent prescribing practices and increased awareness is crucial, along with further research to comprehensively understand long-term effects and establish evidence-based guidelines for quinolone use in pediatric populations.

Introduction: This study evaluated the prognostic value of serum cytokines tumor necrosis factor-alpha (TNF-α), procalcitonin (PCT), interleukin-8 (IL-8), and heparin binding protein (HBP); combined with acute physiology and chronic health evaluation II (APACHE II) score in sepsis patients.

Methodology: Patients were divided into sepsis and septic shock groups based on sepsis-3 criteria, with non-sepsis individuals as controls. Serum TNF-α, PCT, IL-8, and HBP levels; and APACHE II scores were recorded upon intensive care unit (ICU) admission. The diagnostic value was evaluated using receiver operating characteristic (ROC) curves and areas under the curves (AUCs).

Results: Correlation analysis revealed that serum TNF-α (r = 0.701), PCT (r = 0.623), IL-8 (r = 0.617), and HBP (r = 0.721) were positively correlated with the APACHE II score (p < 0.05). Serum TNF-α, PCT, IL-8, HBP levels, and APACHE II scores were significantly higher in non-survivors than survivors (p < 0.05). The AUC for combined indicators in predicting mortality was 0.913 (confidence interval, CI: 0.861-0.912), significantly higher than individual indicators. HBP showed AUC of 0.798 (CI: 0.707-0.879) and APACHE II 0.769 (CI: 0.782-0.892). The combined prediction demonstrated 96.21% sensitivity and 79.34% specificity.

Conclusions: Serum TNF-α, PCT, IL-8, and HBP levels influenced sepsis patient prognosis, and their combined detection with APACHE II score provided a high predictive value for patient outcomes.

Introduction: Nowadays, treating serious infections caused by multi-drug resistant Gram-negative bacteria is best left to the antiquated medication "colistin.". There have been reports of colistin-resistant (Col-R) and heteroresistant (hR) MDR and XDR-GNB strains worldwide. Therefore, we aimed to ascertain the rate of colistin resistance, certain potential resistance mechanisms, and heteroresistance in colistin-susceptible (Col-S) clinical isolates.

Methodology: Identification and Antibiotic susceptibility test (AST) for all isolates were determined by Vitek-2 automated system. The Col-S strains were evaluated for heteroresistance using the population analysis profiling (PAP) method, while the Col-R strains were tested for mcr-1 gene activity by combined disk test (CDT) and colistin minimum inhibitory concentration reduction (CMR) test. The efflux pump mechanism was identified using cyanide 3-chlorophenylhydrazone (CCCP).

Results: Out of 60 isolates enrolled in the study, AST revealed that 60% were MDR-GNB and 40% were XDR-GNB. Ten isolates were colistin resistant (16.6%). The mcr-1 gene was detected in five (5/10) Col-R isolates by PCR. CDT test detected mcr-1 gene activity in four (4/5) of mcr-1 gene positive isolates, while CMR test detected all. Efflux pump inhibition by CCCP showed a reduction of MICs by ≥ 8-folds in four Coli-R isolates. The frequency of carbapenem resistance (CR) within Col-hR strains was 75%, while ESBL was 25%.

Conclusions: The alarmingly high occurrence of colistin resistance and heteroresistance in hospital care settings is of major concern and necessitates a reassessment of recommended AST methods since it can result in colistin therapy failure.

Introduction: The treatment of acute myeloid leukemia (AML) is accompanied by infectious complications, particularly during induction. The surge of multi-drug resistant (MDR) bacteria represents an additional problem for the health care of patients with AML.

Methodology: A retrospective analysis of infectious complications was performed in 84 patients with AML undergoing induction therapy hospitalized between October 2020 and April 2023 at the Clinic of Hematology, University Clinical Centre of Serbia.

Results: From 84 patients and 95 bacterial isolates, Enterococcus spp. was the most frequent Gram-positive bacterium (26%), showing a 56% resistance rate to vancomycin, and a 77.3% resistance rate to carbapenems, with a 4.3% resistance rate to linezolid and no resistance to tigecycline detected. The most common Gram-negative bacterium, Klebsiella spp. (28%), was resistant to cephalosporins, carbapenems, fluoroquinolones (88%, 84.6%, and 88.5% respectively), with a sizeable resistance rate to ceftazidime/avibactam and colistin (20% and 36.4% respectively). XDR Klebsiella spp. dominated the isolated strains, being detected in 57.7% of cultures, whereas Enterococcus spp. was identified as MDR or XDR in 40% and 28% respectively. The factors associated with developing MDR infections were ECOG PS > 2 (p = 0.024), sepsis (p = 0.0016), and the presence of two or more infectious syndromes (p = 0.016). Patients with a confirmed MDR bacterial infection had a mortality rate of 36.7%.

Conclusions: Our work demonstrates that the frequency of infections in this population is high, especially with MDR and XDR strains of Klebsiella spp. and Enterococcus spp., which are accompanied by high rates of early death.

Introduction: The antimicrobial effect of hibiscus acid (HA) alone and in combination with nalidixic acid (NA) on multi-antibiotic-resistant Shiga-like toxin-producing Escherichia coli (STEC) and Salmonella Typhimurium (ST) was evaluated in CD-1 mice.

Methodology: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for NA and HA were determined against both STEC and ST. Fifteen sets of 6 mice each were utilized: 6 groups were exposed orally to 5 log10 colony forming units of a pool of 3 ST strains, another 6 were exposed to a pool of STEC; and 3 acted as controls. Six hours post-inoculation, specific mice groups received either oral solutions containing HA (2 and 7 mg/mL), or NA (20 and 250 µg/mL), or HA/NA (2 mg/mL HA and 20 µg/mL NA), or isotonic saline. All mice were euthanized on day 5 post infection, and tissues were collected to analyze the numbers of bacteria.

Results: The study determined the MIC and MBC of 7 mg/mL HA; 150 and 250 µg/mL of NA; and two concentrations of HA/NA (1 mg/mL/5 µg/mL and 2 mg/mL/20 µg/mL). Mice that were infected and treated with HA at 7 mg/mL or with HA/NA (2 mg/mL/20 µg/mL) did not have STEC or ST in their fecal samples or in the tissues. However, the pathogens were present in the stool and tissues of infected and untreated mice, and those infected and exclusively treated with NA250, NA20, or HA2 mg/mL.

Conclusions: HA is an alternative for the treatment against antibiotic-resistant pathogenic bacteria.

Introduction: Children are at a higher risk of antibiotic overprescribing, while limited surveillance is evident in primary care settings. This study aims to examine patterns of infections and associated antibiotic use in children attending Primary Health Centers (PHCs), including an explanatory analysis of antibiotics for non-pneumonia acute respiratory infections (ARIs), pneumonia, and diarrhea.

Methodology: An observational study used records of all children  5 years of age prescribed antibiotics from January 2019 to December 2020 in selected PHCs in Surabaya and Banjarmasin, Indonesia. Data on children's characteristics, diagnoses, and antibiotics prescribed, were collected from patient records. The explanatory analysis was based on national guidelines. A descriptive analysis was used to summarize the data.

Results: A total of 1053 and 1463 children's records with antibiotics were located at Surabaya and Banjarmasin PHCs, respectively. ARIs were the most common indications for antibiotic prescribing in both settings, either non-pneumonia ARIs (60.6% versus 33.8%, respectively) or pneumonia (20.2% versus 25.2%, respectively). High conformity with guidelines were evident for antibiotics used for pneumonia (i.e., amoxicillin/cotrimoxazole/erythromycin - 89.3%) or specified upper ARIs (e.g., amoxicillin for pharyngitis - 73.9%), and for diarrhea (i.e., cotrimoxazole - 73.1%). However, some information, such as diagnoses, were not recorded or were unspecific, hence limiting assessment.

Conclusions: This study provided insights into prescribing antibiotics among children in Indonesia. Lack of specific guidelines for children and inadequate documentation for antibiotic prescribing warrants improvement. Larger prospective studies should assess appropriate prescribing at the national level to optimize the use of antibiotics.