Journal of Infection in Developing Countries最新文献

Introduction: Acinetobacter baumannii is endemic in hospital environments, and since the coronavirus disease 2019 (COVID-19) pandemic, multidrug-resistant A. baumannii has become more potent. This potential evolution is driven by the undetectable numbers of gene resistances it has acquired. We evaluated the antibiotic-resistance genes in isolates from patients in Erbil hospitals.

Methodology: This is the first study to demonstrate the antimicrobial resistance epidemic in Erbil, Iraq. A total of 570 patients, including 100 COVID-19 patients were tested. Isolate identification, characterization, antibiotics susceptibility test, polymerase chain reaction (PCR) amplification of the antibiotic resistance genes in both bacterial chromosome and plasmid, 16S-23S rRNA gene intergenic spacer (ITS) sequencing using the Sanger DNA sequencing, and phylogenetic analysis were used in this study.

Results: Only 13% of A. baumannii isolates were from COVID-19 patients. All isolates were multi-drug resistant due because of 24 resistance genes located in both the bacterial chromosome or the plasmid. blaTEM gene was detected in the isolates; however, aadB was not detected in the isolated bacteria. New carbapenemase genes were identified by Sanger sequencing and resistance genes were acquired by plasmids.

Conclusions: The study identified metabolic differences in the isolates; although all the strains used the coumarate pathway to survive. Several resistance genes were present in the isolates' plasmids and chromosome. There were no strong biofilm producers. The role of the plasmid in A. baumannii resistance development was described based on the results.

Introduction: The unexpected outbreak of human Mpox infection beginning in some European countries that were non-endemic for Mpox stunned the world during the Coronavirus Disease 2019 (COVID-19) pandemic in May 2022. The re-emerging Mpox outbreak, which has a greater capacity for human-to-human transmission, was mainly due to traveling. In this paper, we describe the first case of the disease was observed in an Iranian woman infected by her husband who had a history of traveling to Canada.

Case report: The 34-year-old woman had flu-like syndrome with some skin rashes on her hand, finger, and arm. No antivirals were prescribed in this case, and supportive care was used to help her recover. RT-PCR and Sanger sequencing were used to analyze the sample from the oropharyngeal swab and the rash, and the results confirmed the Mpox infection.

Conclusions: The risk of infectious disease outbreaks after COVID-19, such as Mpox, is of great importance, and health systems should be vigilant for timely identification and preparedness.

Introduction: The current gold standard for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis by real-time reverse transcriptase polymerase chain reaction (RT-PCR) is limited by the number of genes that can be detected. In this study, we developed a low-cost and high-throughput next-generation sequencing technology that can overcome the limitations of real time RT-PCR.

Methodology: A targeted sequencing panel (TSP) consisting of approximately 500 amplicons was designed. This panel could simultaneously detect a broad range of gene loci of SARS-CoV-2, and genes for the most common infectious viruses that affect the respiratory tract, in a single run and could include up to 96 samples. Four hundred and forty-eight samples and 31 control samples were analyzed independently with both TSP and RT-PCR, and the results were compared for accuracy and other indicators.

Results: TSP identified 50 SARS-CoV-2 positive samples with a 99.33% match to RT-PCR results. It is not surprising that TSP also identified multiple infections from the 96 samples, whereas RT-PCR could not. Thus, TSP was able to accurately diagnose the samples which could not be identified based on single RT-PCR test.

Conclusions: Our data demonstrated that TSP is a fast and accurate testing method for identifying multiple pathogen infections of the respiratory tract.

Introduction: COVID-19 is a significant cause of morbidity and mortality. It is crucial to identify biomarkers that can aid in predicting patients' prognosis and mortality. This study evaluated the relationship between galectin-3 (Gal-3), interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) levels and the prognosis and mortality of COVID-19 patients.

Methodology: The study included 69 COVID-19 patients (32 outpatients, 37 inpatients) and 19 healthy controls. Gal-3, IL-1, IL-6, and TNF-α levels in serum samples were measured using an ELISA test.

Results: In a comparison between the patient and healthy control groups, it was observed that the patient group had significantly higher levels of Gal-3, IL-6, and TNF-α. Comparison between the outpatient and inpatient groups revealed that the hospitalized patient group had significantly higher levels of IL-6 and TNF-α, while the Gal-3 levels were lower in this group. In the analysis of subgroups to assess disease severity, critical COVID-19 patients exhibited elevated levels of Gal-3 and IL-6 compared to those with severe COVID-19. Moreover, Gal-3 and IL-6 were identified as having predictive value for mortality in hospitalized patients, while both IL-6 and TNF-α demonstrated diagnostic accuracy across all patient groups.

Conclusions: The study results indicate that the levels of IL-6 TNF-α play a crucial role in determining the hospitalization and mortality of COVID-19 patients. Additionally, it was observed that Gal-3 and IL-6 levels can be utilized to assess the severity of the disease and predict mortality in patients who require hospitalization.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a global health concern and has persisted through the emergence of variants that have caused subsequent waves of COVID-19 due to the high dispersion and contagiousness of the virus. The aim of this work was to analyze the epidemiology of the cases of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants during the third and fourth wave of the COVID-19 pandemic at the Hospital Juárez de México (HJM).

Methodology: A prospective study of the cases of SARS-CoV-2 reinfection, variants detected, symptoms, and associated comorbidities was carried out on 1,347 patients who attended the HJM from September 2021 to July 2022.

Results: 760 (56.4%) and 587 (43.6%) patients were negative and positive for SARS-CoV-2, respectively. The Omicron variant was the most frequent and the most common symptoms were: cough (80%), headache (61.32%), fever (51.6%), and dyspnea (40%). A higher proportion of females were vaccinated, ranging from one dose to the complete schedule. The factors that were associated with a greater risk of death from complications of SARS-CoV-2 reinfection were male gender, diabetes mellitus, and arterial hypertension.

Conclusions: Females were the most susceptible to an Omicron reinfection event, even though they were vaccinated. However, the risk of death was higher when the patient was male; being male was a potential risk factor for death from COVID-19 and comorbidities.

Introduction: Patients with underlying diseases do not respond adequately to vaccines. Thus, continued research on the effects of vaccination in patients with comorbidities is crucial to evaluate the necessity of vaccination in this population. This study assessed the protective effects of inactivated vaccines on the severity and prognosis of COVID-19 in patients with comorbidities.

Methodology: A real-world retrospective cohort study was conducted from April 7, 2022, to June 6, 2022, at the Fudan University Pudong Medical Center. The collected data included demographic characteristics, symptoms, clinical severity, and outcomes of the COVID-19 patients.

Results: A total of 3,996 indigenous confirmed cases and asymptomatic infections with the Omicron variant were enrolled. Of these, 1322 (33.1%) patients had chronic comorbidities. Compared to others, COVID-19 patients with comorbidities were older, had lower vaccination rates, longer days of nucleic acid conversion and hospitalization, and a higher incidence of severe-critical illness and composite endpoint. Multivariable analyses suggested that in the comorbidity group, two-dose- (odds ratio [OR] 0.38, 95% CI 0.24-0.60; OR 0.20, 95% CI 0.08-0.51) and three-dose vaccinated patients (OR 0.26, 95% CI 0.14-0.47; OR 0.21, 95% CI 0.08-0.58) had a lower risk of aggravation and the composite endpoint; similar results were observed in the non-comorbidity group.

Conclusion: Two or more doses of inactivated vaccines could prevent deterioration and poor prognosis in Omicron-infected patients, regardless of the presence of an underlying disease. Our findings support maximizing coverage with inactivated vaccines in highly vaccinated populations, such as those in China.

Introduction: Klebsiella pneumoniae is an encapsulated Gram-negative bacterium that is responsible for numerous infections in healthcare facilities worldwide and is frequently isolated. The World Health Organization has listed K. pneumoniaeas as a critical antibiotic resistant bacterial pathogen for which new antibiotics are urgently needed. This study aimed to use molecular tools to identify and examine antibiotic resistance in clinical strains of K. pneumoniae.

Methodology: A total of 15 unduplicated K. pneumoniae strains isolated from patient samples with multidrug-resistant (MDR) profiles were subjected to polymerase chain reaction (PCR) to amplify the most common carbapenem resistance genes. (GTG)5 PCR and phylogenetic analysis were performed to identify the genetic relationship between the strains.

Results: All strains yielded a (GTG)5-PCR profile, and this allowed us to group these strains into 8 groups according to the size and number of characteristic bands. Phylogenetic analysis was done using the free software UPGMA and a single bacterial clone with a correlation coefficient of over 97% was identified. New Delhi metallo-beta-lactamase NDM-like (blaNDM) carbapenem resistance genes were detected in three strains of K. pneumoniae, which represented a resistance rate of 20%. However, carbapenemases type A [Klebsiella pneumoniae carbapenemase (KPC) and imipenem-hydrolysing beta-lactamase (IMI), type D [oxacillinase-48 (OXA-48)], and other metallo-β-lactamase [Verona integron-encoded metallo-beta-lactamase (VIM), and enzyme active on imipenem (IMP)] were not detected.

Conclusions: We identified and grouped the blaNDM resistance genes of Klebsiella pneumonia strains.

Introduction: The type of admission to the Intensive Care Unit (ICU) influences the prognosis of patients with severe pneumonia and, in the case of patients with COVID-19 pneumonia, this is still unexplored. The objective of this study was to determine the differences between early and late ICU admission.

Methodology: A retrospective cohort study of patients with COVID-19 pneumonia at two high-complexity hospitals in Colombia. Early ICU admission (EICUA) was defined as direct admission from the emergency department or within the first 24 hours of admission. Late ICU admission (LICUA) was defined as admission from the hospitalization service after 24 hours of arrival. A robust Cox regression was performed for the variable recovery time, to determine the impact of the ICU admission type in the hazard rate.

Results: 68.2% were EICUA patients and 31.8% were LICUA patients. Recovery and duration of hospital stay were significantly lower in EICUA than in LICUA (9 vs 15 days, p = 0.0001, and 10 vs 15.5 days, p < 0.0001, respectively). However, the duration of ICU stay (7 vs 9 days, p = 0.131) and the invasive mechanical ventilation requirement (48.9% vs 54.9%, p = 0.374) were not statistically significant. The 30-day follow-up showed no difference between the EICUA and LICUA (alive 97% vs 94.6%, p = 0.705).

Conclusions: Mortality between EICUA and LICUA patients with COVID-19 pneumonia showed no statistically significant differences. However, the recovery time, the probability intensity of instant recovery, and the duration of hospital stay were better in EICUA than in LICUA. Neither EICUA nor LICUA affects the final status (death) of patients.

Introduction: Healthcare-associated infections (HAIs) are common in intensive care unit (ICU) patients and may cause devastating consequences. However, the prevalence of HAI and its effects on in-hospital mortality among critically ill COVID-19 patients is ambiguous. We determined the prevalence of HAI and the rate of mortality in critically ill COVID-19 patients and compared it with pre-pandemic ICU patients.

Methodology: This retrospective study was conducted with adult ICU patients admitted to Gazi Yaşargil Training and Research Hospital (Diyarbakir,Turkey) in April-November 2019 (defined as the pre-pandemic period) and in April-November 2020 (defined as the pandemic period). All patients in the pandemic period had COVID-19, while none in the pre-pandemic period did. Patients diagnosed with HAIs during the in-hospital follow-up period were recorded.

Results: Of 4596 enrollees, 3386 (73.7%) were pandemic-period patients and 1210 (26.3%) were pre-pandemic-period patients. HAI prevalence was significantly higher at 5.9% (n = 71) in the pandemic-period patients and 2.7% (n = 91) in the pre-pandemic-period patients (p < 0.001). Comorbidities including hypertension (63.4% vs 14.2%, p < 0.001), diabetes mellitus (39.4% vs 8.8%, p < 0.001), and coronary artery disease (30.9% vs 10.9%, p = 0.002) were significantly more frequent in pandemic-period HAI-positive patients. The most common HAI was catheter-related bloodstream infection in both groups, with similar frequency (p = 0.652). In-hospital mortality rate was 85.9% versus 65.9% in pandemic- versus pre-pandemic-period HAI-positive patients (p < 0,05).

Conclusions: The prevalence of HAI and the in-hospital mortality rate was significantly higher among pandemic-period patients.

Introduction: Coronaviruses, a family of enveloped RNA viruses, have been implicated in various clinical disorders including coronavirus disease 2019 (COVID-19). Host genetic factors, including the OAS1 and MxA gene variants may have a role in determining susceptibility to viral infections. Understanding the genetic factors involved in unraveling COVID-19`s diverse clinical outcomes is critical for disease management. This study investigated the impact of OAS1 rs2660 and MxA rs2071430 genotypes on COVID-19 susceptibility and severity among Pakistani patients.

Methodology: This was a comparative cross-sectional study. Fifty patients diagnosed with COVID-19 and 50 controls were recruited and genotyped for the selected gene variants.

Results: The OAS1 gene rs2660 exhibited an association with COVID-19 susceptibility in various genetic models. The risk decreased with AG genotype (OR = 0.23, 95% CI = 0.09-0.58; p = 0.0011) compared to GG in codominant models. In dominant (OR = 0.35, 95% CI = 0.15-0.81; p = 0.013) and overdominant (OR = 0.21, 95% CI = 0.08-0.53; p = 0.0005) models, the single nucleotide variant (SNV) decreased COVID-19 susceptibility risk. There was no association of OAS1 rs2660 genotypes with COVID-19 severity. We did not find a significant association between MxA rs2071430 variant and COVID-19 susceptibility.

Conclusions: OAS1 rs2660 AG genotype showed decreased risk of COVID-19 susceptibility among Pakistani patients. This study provides insight into the role of the OAS1 and MxA variants in COVID-19. This finding could aid researchers in understanding genetic susceptibility and severity in COVID-19 by identifying at-risk individuals and determining the optimal treatment.