Journal of Infection in Developing Countries最新文献

Introduction: Healthcare-associated infections (HAIs) are a significant global health challenge. In Morocco, while the prevalence of HAIs has been studied in university hospitals, limited research has focused on the effectiveness of infection prevention and control (IPC) programs. This study evaluates the adherence of 8 Moroccan hospitals to IPC standards using the Infection Prevention and Control Assessment Framework (IPCAF).

Methodology: Eight Moroccan hospitals participated in this study. The IPC compliance of each hospital was assessed using the IPCAF tool, which evaluates IPC committees, staff training, infrastructure, and surveillance systems.

Results: The study showed significant variation in IPCAF scores. Hospitals such as Maternity and Reproductive Health Hospital - Orangers, Ibn Sina Hospital, and National Institute of Oncology achieved high compliance, with scores of 657.5 and 652.5, reflecting 82.19% and 81.56% compliance. These hospitals demonstrated strong IPC committees, effective training, and consistent surveillance. In contrast, Arrazi Hospital and Souissi Maternity had lower scores, with HAI scoring 352.5, indicating gaps in IPC practices. The lower-scoring hospitals struggled with infrastructure, staff involvement, and adherence to IPC guidelines.

Conclusions: The study highlights the importance of leadership commitment, regular training, and surveillance to improve IPC outcomes. It emphasizes the need for targeted interventions in underperforming hospitals to address gaps in infrastructure and staff involvement, thereby enhancing patient safety and infection control standards in Morocco.

Introduction: Antimicrobial resistance in bloodstream infections is an important clinical challenge. The impact of the coronavirus disease 2019 (COVID-19) pandemic on antimicrobial resistance remains a subject of ongoing debate. This single-center study aimed to analyze Gram-negative bacteria (GNB) isolated from blood cultures and evaluate changes in antimicrobial resistance between the pre-pandemic (March 2018-February 2020) and pandemic (March 2020-February 2022) periods.

Methodology: Blood culture data collected over 4 years were retrospectively analyzed using the BACT/ALERT 3D system. Bacterial identification was conducted with the VITEK® 2 compact system, and antimicrobial susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria.

Results: Of 1,668 positive blood cultures, 38.3% yielded GNB. There was an increase in Gram-negative isolates during the pandemic, compared to the pre-pandemic period (55.9% vs. 44.1%). Resistance changes were detected in extensive antibiogram analyses in which 18 different antibiotics were studied for the 4 most frequently isolated species, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. During the pandemic period, resistance to amoxicillin/clavulanic acid, ampicillin, ampicillin-sulbactam, ceftriaxone, and cefuroxime decreased; while resistance to amikacin, levofloxacin, and cefepime increased; except in Escherichia coli.

Conclusions: K. pneumoniae remained the most frequently isolated bacterium in both periods, while A. baumannii showed a significant increase during the pandemic. The 2.6-fold increase in A. baumannii may have been caused by the increased use of broad-spectrum antibiotics during the pandemic. These findings reflect data from a single hospital and should be validated by further multicenter studies.

Introduction: Ceftolozane-tazobactam (CLZ-TAZ) and ceftazidime-avibactam (CAZ-AVB) are recently developed β-lactam/β-lactamase inhibitor combinations active against resistant Gram-negative bacteria. This study compared the in vitro activities of ceftazidime, meropenem, piperacillin-tazobactam (PIP-TAZ), CLZ-TAZ, and CAZ-AVB in Klebsiella pneumoniae isolates from Hacettepe University hospitals and investigated the carbapenemase types detected over the past five years.

Methodology: A total of 550 K. pneumoniae isolates were collected consecutively from invasive clinical samples between 2015 and 2022 according to the SENTRY protocol. Identification was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Susceptibility testing for ceftazidime, meropenem, PIP-TAZ, CLZ-TAZ, and CAZ-AVB was carried out by broth microdilution and interpreted according to EUCAST standards. Carbapenemase genes were determined by whole-genome sequencing.

Results: Isolates were obtained from blood (n = 191), skin/soft tissue (n = 130), urine (n = 102), respiratory (n = 86), and intra-abdominal (n = 41) samples. Resistance rates were 62.3% for ceftazidime, 29.7% for meropenem, 60.4% for PIP-TAZ, 43.1% for CLZ-TAZ, and 8.7% for CAZ-AVB. The predominant carbapenemases were OXA-48, OXA-232, NDM-1, OXA-181, and KPC-2. Multiple carbapenemases coexisted in 10% of carbapenem-resistant isolates.

Conclusions: CAZ-AVB demonstrated superior activity compared to CLZ-TAZ in this high-resistance setting, While OXA-48 and NDM-1 remain the most frequent carbapenemases, emerging enzymes including OXA-181, OXA-232, KPC-3, and NDM-5 were also detected. The coexistence of multiple enzymes in single isolates highlights a growing therapeutic challenge, emphasizing the need for continued surveillance and effective antimicrobial stewardship.

Introduction: Although the unprecedented outbreak of coronavirus disease 2019 (COVID-19) and its deep-rooted consequences are visible in many areas, their impact on vector-borne diseases (VBDs) is only poorly understood. Therefore, the temporal trends of major VBDs such as malaria, dengue, chikungunya, Japanese encephalitis, and kala-azar in India were analyzed before and after the COVID-19 pandemic.

Methodology: Data of annually reported VBD cases, such as malaria, dengue, chikungunya, Japanese encephalitis, and kala-azar, in India from 2014 to 2024 were collected and plotted on a bar graph using Microsoft Excel. Trend lines were drawn separately for all VBDs before and after 2020 and the R2 value was calculated. The Pearson correlation coefficient (r value) for each trend was calculated using Microsoft Excel to determine the strength of the trend before and after 2020 for each VBD.

Results: The trend line of each VBD; including malaria, dengue, chikungunya, Japanese encephalitis, and kala-azar; showed a different pattern before and after 2020. The r value of the trend indicated that the COVID-19 pandemic has transformed the declining trend of malaria into a strongly increasing trend. The other trends affected by the pandemic were Japanese encephalitis, dengue, chikungunya, and kala-azar.

Conclusions: This study demonstrates a clear influence of the COVID-19 pandemic over the trend of VBDs ranging from mild changes to a total reversal of the trend.

Introduction: This study aimed to evaluate the Type VI secretion system (T6SS) and microbiological features in hypervirulent Klebsiella pneumoniae (hvKP) causing urinary tract infections (UTIs) in hospitalized adults.

Methodology: This retrospective, observational analysis encompassed 167 inpatients with UTIs caused by KP. The study investigated disease prevalence, antimicrobial susceptibility, gene carriage rates, and competition indices. Strains were classified as classic KP (cKP), T6SS-positive hvKP, or T6SS-negative hvKP, and compared for clinical traits, antimicrobial susceptibilities, and virulence gene carriage. Furthermore, the bacterial competition index of T6SS-positive hvKP strains was assessed through in vitro cultivation.

Results: Of 167 patients, 82 had hvKP and 85 had cKP. hvKP had higher rates of thrombosis, immunotherapy, hypoproteinemia, and longer hospital stays (p < 0.05). The 30-day mortality was 29.26% for hvKP vs. 12.94% for cKP (p = 0.045). hvKP showed highest resistance to cefuroxime (81.70%) and cKP to ampicillin/sulbactam (56.47%), with low resistance to tigecycline. The resistance to carbapenems (carbapenem-resistant KP, CR-KP) was significantly higher in hvKP compared to cKP (30.48% vs 16.47%, p = 0.032). Aerobactin and iroB differed between hvKP and cKP. T6SS-positive hvKP had higher rates of thrombosis and immunotherapy (p < 0.05). The 30-day mortality was 9.52% for T6SS-positive vs. 36.06% for T6SS-negative (p = 0.043). T6SS-positive hvKP strains exhibited lower resistance to carbapenems compared to T6SS-negative strains (9.52% vs 37.70%, p = 0.015). T6SS-positive strains had higher aerobactin and iroB positivity.

Conclusions: T6SS-positive hvKP exhibits lower antimicrobial resistance but stronger virulence, playing a major role in bacterial competition.

Introduction: This study investigates the current status and regional disparities of resistance to novel antibiotics in East Asia, exploring links to socioeconomic factors and identifying high-risk resistance determinants.

Methodology: Metagenomic sequencing was performed on 1024 human fecal samples (25 local, 999 public) from 12 regions across China and Japan. Antibiotic resistance genes (ARGs) were identified by aligning sequences against a comprehensive antibiotic resistance database, focusing on 8 novel antibiotic classes. The relationship between regional per capita GDP and resistance rates for clinically relevant novel antibiotics was statistically analyzed.

Results: Significant regional variation in resistance rates was observed for clinically used novel antibiotics (aminocoumarins, glycylcyclines, oxacephems, oxazolidinones, pleuromutilins). A significant inverse correlation was found between per capita GDP and resistance rates for aminocoumarins, glycylcyclines, and oxacephems, particularly pronounced within inland regions. Oxacephem resistance was alarmingly high (> 55% in all regions, > 90% in some). Oxazolidinone resistance remained low (< 28%). Pleuromutilin resistance showed a strong negative GDP correlation only inland. Analysis revealed 24 high-frequency ARGs (5 exceeding 45% coverage: CfxA, IsaB, MexB, abeS, IsaE). Minimal shared resistance determinants existed among novel antibiotic classes, except between oxazolidinones and pleuromutilins.

Conclusions: Resistance to novel antibiotics in East Asia exhibits significant regional heterogeneity, strongly influenced by local economic development levels. Resistance rates for specific agents (e.g., oxacephems) critically limit their clinical utility, necessitating mandatory susceptibility testing. High-frequency ARGs linked to traditional antibiotic misuse pose cross-resistance risks. Surveillance and stewardship strategies must be regionally tailored, prioritizing vulnerable areas and tracking critical resistance loci for novel agents.

Introduction: Edwardsiella tarda is a Gram-negative facultative anaerobe commonly isolated from fish and reptiles. This bacterium infrequently causes disease in humans, but the mortality rate is very high when associated with sepsis.

Case presentation: This case report describes an 80-year-old female patient with Edwardsiella tarda infection who rapidly deteriorated, ultimately succumbing to infection within 9 hours after presenting to the emergency department. This patient was diagnosed with sepsis, hemolytic, emphysematous liver abscess.

Conclusions: This report underscores the potential fatality and rapid progression of Edwardsiella tarda infection, highlighting the importance of early recognition and intervention.

Introduction: Tuberculosis (TB) is a major public health challenge worldwide. Despite the aspiration of the World Health Organization's 'End TB Strategy', Indonesia continues to struggle with adequate identification and diagnosis of TB cases, resulting in prolonged delays in accessing treatment. This study examined the factors influencing patients' delay and routes to accessing a reliable TB diagnosis.

Methodology: A cross-sectional survey design was employed, involving 179 TB patients receiving appropriate treatment from 10 primary healthcare services in Semarang, Indonesia. Data were collected through a questionnaire, analyzed using Chi square analysis, and binary logistic regression was used to predict the correlation and odds ratio variables related to the delayed diagnosis.

Results: Most participants were diagnosed by primary healthcare services (89%). Females experienced more delay compared to males (53% vs 47%). The median diagnostic delay was 19 days between the first onset of symptoms and receiving a reliable diagnosis. Education (p value: 0.040; adjusted odds ratio (AOR): 0.348; 95% confidence interval (CI): 0.127-0.951), and belief that TB is a hereditary disease (p value < 0.001; AOR: 1.671; 95% CI: 1.253-2.229) were identified as key factors associated with diagnostic delay.

Conclusions: Comprehensive community interventions targeting the factors identified in this study are needed to improve education with culturally sensitive strategies and greater engagement with both formal and informal care providers.

Introduction: Human brucellosis is a significant zoonotic disease with a substantial public health impact, particularly among individuals in high-risk occupations such as veterinarians, farmers, and laboratory workers. Despite its global prevalence, data on the occupational risk of brucellosis, particularly in specific regions like the Kurdistan region, remains limited. This study aimed to investigate the prevalence of Brucella infections among different occupational groups in Erbil, Kurdistan.

Methodology: A cross-sectional study was conducted from July to December 2023, involving 350 human blood samples collected from participants with various occupations in Erbil. Brucella infection was assessed using the Rose Bengal Test (RBT) and bacterial culture method. The results were analyzed with a focus on the association between occupation, gender, residence, and age; with the prevalence of Brucella infection.

Results: The overall prevalence of Brucella infection was 10.9% by RBT and 8.9% by bacterial culture. Veterinarians and veterinary assistants had the highest infection rates (16.0% RBT, 14.0% culture). Gender and residence had no significant impact on infection rates, although rural residents exhibited slightly higher prevalence. The age group 31-40 years showed the highest positivity rates, but differences across age groups were not statistically significant.

Conclusions: The prevalence of brucellosis in Erbil has remained stable over the past decade. High-risk occupations, particularly veterinarians and laboratory workers, require targeted preventive measures, including the use of personal protective equipment. This study emphasizes the need for enhanced occupational health strategies to reduce the risk of brucellosis in vulnerable groups.

Introduction: The SARS-CoV-2 virus and its variants affect not only the respiratory system but also the heart. The impact of SARS-CoV-2 on the heart during the Omicron pandemic is not yet fully elucidated.

Methodology: We conducted a retrospective cohort study of 1,026 hospitalized patients with the Omicron variant at Southwest Hospital (December 2022 to March 2023). Adverse events were defined as a composite of all-cause mortality, intensive care unit admission, mechanical ventilation use, and discharge against medical advice. The risk factors were analyzed by Logistic regression and the Cox regression model.

Results: Median age was 69 years (IQR 56-79), myocardial injury occurred in 54.7% (n = 561); adverse events occurred in 25.5% (n = 262). The risk factors of myocardial injury included older age (OR 1.04 [1.03, 1.05], p < 0.001), body temperature at admission (OR 1.64 [1.19, 2.29], p = 0.003), critical COVID-19 (OR 4.96 [2.34, 11.54], p < 0.001), severe valvular heart disease (OR 2.46 [1.06, 6.12], p = 0.042), renal insufficiency (OR 4.04 [2.75, 6.01], p < 0.001), anemia (OR 3.10 [2.12, 4.58], p < 0.001), type II respiratory failure (OR 5.54 [1.79, 24.39], p = 0.008) and higher white blood cell (OR 1.09 [1.05, 1.14], p < 0.001). After adjustment, myocardial injury (HR 1.79 [1.28, 2.48], p = 0.001) was significantly associated with adverse events in patients with Omicron variant infection.

Conclusions: Myocardial injury, the most common extrapulmonary complication of COVID-19 caused by the SARS-CoV-2 Omicron variant, requires timely attention to prevent adverse events in hospitalized patients.