Journal of Infection in Developing Countries最新文献

Introduction: Urinary tract infection (UTI) is the most common hospital-acquired infection worldwide. Nosocomial UTI develops due to swelling of the urinary catheter. This study was conducted to determine the pathogens associated with catheter-associated urinary tract infection (CAUTI), identify these microorganisms, and investigate antimicrobial resistance patterns in intensive care units-acquired CAUTIs of two hospitals during 5 years.

Methodology: Semiquantitative culture of urine samples was done in both hospitals. Identification and sensitivity of microorganisms were made using conventional methods and automated systems. Susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) standards and European Committee on Antimicrobial Susceptibility Testing (EUCAST). All 24,882 patients were admitted to the intensive care units (ICUs) at both hospitals.

Results: A total of 677 microorganisms were isolated from 580 patients. The CAUTI rate observed in patients was 580/24,882 (2.33%). The most common microorganisms isolated were E. coli (184; 27.18%), K. pneumoniae (128; 18.9%), and enterococci (104; 15.36%). Vancomycin resistance was noted in 10.6% of all enterococci. Staphylococci were not resistant to vancomycin. The most effective antibiotics for Gram-negative bacteria were colistin (90.5%), followed by amikacin (77.4%), meropenem (66.6%), and imipenem (66.4%). High rates of extended-spectrum beta lactamase (ESBL) was noted in 54.3% and 69.5% of E. coli and K. pneumoniae, respectively.

Conclusions: Universal recommendations on the use of catheters should be carefully applied to prevent the development of the infection. Patients who are infected by multidrug resistant (MDR) microorganisms should be followed carefully. Both centers should develop their own policies on this issue.

Introduction: Anal squamous cell carcinoma (ASCC) is rare in the general population but is associated with significant morbidity and mortality, particularly among people living with HIV (PLWH). Patient outcomes are influenced by human papillomavirus (HPV) status, immune function, and tumor biology.

Case report: We report a case of a 56-year-old man with long-standing HIV infection on stable antiretroviral therapy (ART), diagnosed with locally advanced ASCC (T4N1cM0). He received standard concurrent chemoradiotherapy (CRT) with mitomycin C and 5-fluorouracil (5-FU). Treatment was complicated by Grade 3 febrile leukopenia, Grade 2 radiodermatitis, and scrotal lymphedema. An institutional COVID-19 outbreak caused an unplanned treatment interruption, extending the overall CRT duration to 70 days; the patient did not contract COVID-19. Therapy was resumed without dose modification. Six months post-treatment, imaging and endoscopic evaluation revealed fibrotic changes without evidence of active disease. At twelve months, however, the patient developed rapid locoregional recurrence and pulmonary metastases, with fistula and abscess formation, necessitating palliative care. Retrospective immunohistochemical analysis of the original tumor revealed strong p16 expression (indicative of transcriptionally active high-risk HPV), aberrant p53 expression, and a markedly elevated Ki-67 index (99%), reflecting aggressive tumor biology.

Conclusions: This case illustrates the challenges of managing ASCC in PLWH and underscores the need for optimized CRT protocols for this population. Reliable molecular biomarkers, including p16, p53, and Ki-67, may guide personalized therapy and improve prognostic stratification.

Introduction: The global dissemination of colistin resistance poses a critical challenge to antimicrobial therapy amid increasing multidrug resistance. The objective of this study was to characterize the epidemiology and transmission of colistin resistance mediated by the mcr-1 gene in multidrug-resistant (MDR) Enterobacteriaceae isolated from hospitalized patients with bloodstream infections and adjacent aquatic environments.

Methodology: A three-year study was conducted to collect MDR Enterobacteriaceae isolates from two distinct sources: blood samples and environmental water samples from five distinct aquatic environments adjacent to the hospital. A systematic analysis was conducted on patient demographic data, bacterial identification, antimicrobial susceptibility profiles, mcr-1 gene screening, and conjugation assays.

Results: A total of 159 MDR Enterobacteriaceae were isolated from blood samples, demonstrating an overall colistin resistance rate of 4.4%. Three mcr-1-harbouring Escherichia coli (E. coli) strains were identified: one from an inpatient without colistin exposure, and two from aquatic environmental sources, classified into sequence types (STs) ST10, ST131, and ST155. Conjugation experiments revealed higher transfer frequencies for environmental mcr-1-positive E. coli strains within and across genera. A comparative analysis under varying nutrient conditions identified delayed transfer kinetics in aquatic isolates. Moreover, most transconjugants exhibited levels of colistin resistance that were comparable to or surpassing donor strains, with minimum inhibitory concentrations (MICs) ranging from 4 to 16 mg/L.

Conclusions: This study documents the epidemiological patterns of mcr-1-mediated colistin resistance in clinical and aquatic MDR Enterobacteriaceae. The present findings indicate the dissemination of resistance traits within aquatic environments, where persistence and amplification were observed.

Introduction: Typhoid fever is an infection of the gastrointestinal tract caused by Salmonella Typhi. Ciprofloxacin is the most widely used second-line therapy; it provides good results in therapy. Indonesia has a unique resistance pattern of fluoroquinolones. Earlier studies of the gyrA and gyrB from local S. Typhi strains showed no mutation, and amino acid replacement was identified in all reported codons. In this study, we explored the whole sequence of the gyrA and gyrB further to understand the association of the unique characteristics of our local strains with fluoroquinolone resistance.

Methodology: This was an analytical study with a cross-sectional approach. Isolates collection, identification, antibiotic sensitivity test, DNA extraction, gene amplification, purification, and sequencing were carried out. Bioedit was used for the analysis of sequencing data.

Results: Four isolates were identified as S. Typhi. Three isolates were sensitive to nalidixic acid, ciprofloxacin, levofloxacin, and moxifloxacin. One isolate was intermediate to nalidixic acid, ciprofloxacin, levofloxacin, and resistant to moxifloxacin. The gyrA and gyrB genes were aligned with S. Typhi Ty2 reference sequence (NCBI GenBank AE014613.1). Three amino acid changes (Gly133Glu, Asn538Asp, and Thr856Ala) and one amino acid change (Ala416Ser) were found in gyrA and gyrB, respectively. Protein secondary structures of these isolates showed some changes in alpha helices, beta sheets, random coils, and beta turns, which could result in alterations of the properties of proteins.

Conclusions: Some variations and protein secondary structure alterations were found in the gyrA and gyrB among local strains of S. Typhi, which might be associated with fluoroquinolone susceptibility.

Introduction: The increasing rates of AMR have been tolling the healthcare systems globally. This study aims to explore the evolution of AMR patterns against commonly encountered clinical bacterial pathogens at a major tertiary care center in Lebanon during pre-COVID (2019) and post-COVID (2023) periods.

Methodology: Consecutive non-duplicate isolates of Gram-positive (e.g., Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus spp.) and Gram-negative pathogens (e.g., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii) were analyzed using MALDI-TOF identification and CLSI-standardized disk diffusion/Etest methods.

Results: Key findings revealed persistent methicillin-resistant S. aureus (MRSA) rates (36%), increased vancomycin-resistant Enterococci (VRE; 7% to 10%), and high penicillin susceptibility among S. pneumoniae. Gram-negative isolates exhibited concerning trends: ESBL prevalence rose in E. coli (32% to 36%) but remained stable (35% to 34%) in K. pneumoniae. Carbapenem-resistant Enterobacterales (CRE) rates remained unchanged for E. coli (6% to 5%) but declined for K. pneumoniae (15% to 6%). A. baumannii susceptibility remained critically low (18-55%), while P. aeruginosa showed stable susceptibility (76-92%).

Conclusions: An overall increase in the resistance profiles among different bacterial species is noted in comparison with earlier studies from this institution. These findings align with prior multidrug-resistant strains and underscore the need for robust surveillance, antibiotic stewardship, and infection control measures.

Introduction: Dengue is a major arboviral infection. Clinical manifestations range widely from mild, non-specific febrile syndromes to serious, life-threatening conditions. Dengue cases have increased globally over the last ten years. Dengue patients show gastrointestinal and respiratory symptoms. The aim of this study was to identify the associated demographic risk factors, and evaluate the significance of respiratory symptoms for early diagnosis.

Methodology: Blood samples were collected from dengue-suspected patients reported to various health centers in South Andaman, from January 2018 to December 2022, and were processed by antigen/antibody assay. The odds of factors for being dengue positive among dengue suspects were analyzed using the Chi-square test, logistic regression models, and random forest analysis.

Results: Blood samples were collected from 14,783 (99.6%) of the 14,836 dengue suspects. Dengue infection was confirmed in 1,354 (9.2%) suspects. A significantly higher prevalence of infection was observed in the age group 16 to 30 years. Resident males of urban areas had higher dengue positives. Fever was a significant clinical manifestation of dengue infection. Rhinorrhea and other respiratory symptoms showed a significant association (p < 0.05) with dengue infection.

Conclusions: Respiratory discomfort was found to have a significant association with individuals suspected of dengue. Dengue positivity rate per 1000 population was high among these individuals. This study determined the key signs that can be considered significant to suspect dengue, including respiratory ailments. This will help the healthcare professionals to identify dengue cases at an early stage, to initiate fluid-based treatment.

Introduction: This study investigated the epidemiological characteristics, subtype distribution, and clinical correlations of cervical human papillomavirus (HPV) infection in Jingmen, China.

Methodology: A retrospective study of 5,155 women screened at Jingmen Central Hospital (2022-2024). The participants were categorized into 6 age groups: ≤ 20 years (n = 54), 21-30 years (n = 791), 31-40 years (n = 1,757), 41-50 years (n = 1,371), 51-60 years (n = 968), and ≥ 61 years (n = 214). HPV genotyping and histopathology were used to assess infection patterns and lesion correlations.

Results: The infection rates of high-risk HPV (HR-HPV), low-risk HPV (LR-HPV), and mixed infections were 18.10% (933/5,155), 3.38% (174/5,155), and 3.38% (174/5,155), respectively. HR-HPV infections exhibited a bimodal age distribution, with peak prevalence in women aged ≤ 20 years (33.33%) and ≥ 61 years (39.25%). This age-related difference was statistically significant (χ² = 81.430, p < 0.001). The dominant subtypes were HPV52 (23.5%), HPV16 (13.9%), and HPV58 (13.3%). Notably, HPV16 was significantly more prevalent in high-grade squamous intraepithelial lesions (HSIL; 44.3%) and cervical cancer (CC; 55.5%), compared with low-grade lesions (p < 0.01).

Conclusions: This study identified both adolescent/young women (≤ 20 years) and older women (≥ 61 years) as high-risk populations for HR-HPV infection. Notably, HPV16 (55.5%) exhibited significantly higher detection rates in cervical cancer cases, emphasizing the importance of prioritizing this subtype in region-specific vaccine-based prevention strategies. These findings underscore the need for tailored clinical management approaches based on viral subtype distribution and lesion severity.

Introduction: Pneumonia is an infection in the pulmonary tissue that is caused by bacteria, viruses, fungi, or parasites. Based on Indonesian Health Survey data for 2023, the prevalence of pneumonia was 10.8%. The rapid detection of pathogens accompanied by their antibiotic sensitivity pattern is crucial to obtain relevant outcomes. The gold standard test by bacterial culture needs approximately 72 hours. In order to speed this up, the PCR-based test was developed, such as syndromic testing.

Methodology: The present study was a retrospective study conducted from May 2021 to July 2024, using total sampling, on BAL and sputum specimens, with as inclusion criteria of patients aged ≥ 18 years diagnosed with pneumonia on the basis of bacterial culture and the pneumonia panel test.

Results: A total of 147 specimens were collected, with a 66.7% predominance of males and a mean age of 67.24 ± 18.23 years. There was 72.11% correspondence between the two tests, with the proportion of pathogens being 67.35% from the pneumonia panel test and 55.1% from culture. The distribution of pathogens in both tests was dominated by K. pneumoniae, whereas the most frequent antibiotic resistance genes were CTX-M and IMP. The antibiotics that may still be of choice for the therapy of Gram-negative bacteria are tigecycline and amikacin, while for P. aeruginosa, the antibiotic of choice is piperacillin-tazobactam.

Conclusions: The pneumonia panel test provides higher positivity rates, faster results, and detects resistance genes, but lacks coverage for fungi and S. maltophilia.

Introduction: Resistance to pathogens against kinds of traditional medicines is a public health problem, which calls for the continuous search for new compounds that are effective in eliminating diseases caused by these pathogens. Marine Animals come on top of animals that contain natural treasures of active substances that have not yet been discovered.

Methodology: In this study, two organic extracts (methanol and ethyl acetate) were prepared from the soft tissue of a marine organism (Brachidontes variabilis). Then, the antioxidant activity and phenol content were determined in these two extracts. Finally, their biological activities were studied toward drug-resistant microbes isolated from Syrian hospitals.

Results: The results showed that the IC50, the concentration required to reduce DPPH radicals by 50%, for methanol and ethyl acetate extracts were 179.286 and 73.676 mg/mL, respectively. The total phenolic contents of the methanol and ethyl acetate extracts were found to be 1.84 mg/g and 1.7 mg/g of the Gallic acid equivalent, respectively. The two extracts had an inhibitory effect on the growth of the following resistant bacterial species isolates: Staphylococcus aureus, Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa, at a concentration of 5 mg/mL, with inhibitory zones ranging from 5 mm to 20 mm. The ethyl acetate extract has an inhibitory effect on the growth of the fungal pathogen Aspergillus fumigatus, which is resistant to fungal antibiotics.

Conclusions: The results of this study are promising in finding new compounds with antimicrobial effects against resistant pathogens.

Introduction: Fasciola species are trematodes primarily infecting the liver and bile ducts of animals and humans, and causing serious lesions. They have significant medical and economic impacts, leading to chronic illness and reduced productivity in livestock. This study aimed to assess the genetic diversity of liver flukes isolated from domestic ruminants in Sulaimani province in Iraq.

Methodology: A total of 100 fecal samples were collected from animals living in local farms, including sheep (n = 44), goats (n = 36), and cattle (n = 20). Additionally, 42 liver flukes were obtained from 21 slaughtered animals (10 sheep, 6 cattle, and 5 goats) at the Sulaimani abattoir; 2 flukes per host were collected. DNA was extracted from sedimentation-positive fecal samples and from fluke tissue. Molecular characterization was performed by polymerase chain reaction (PCR) of the internal transcribed spacer 1 (ITS1), and subsequent restriction fragment length polymorphism (RFLP) using RsaI and Tsp509I endonucleases. Genetic diversity was assessed through sequence comparison and phylogenetic analysis.

Results: RFLP analysis revealed 3 distinct patterns among liver flukes. DNA sequencing and phylogenetic analysis revealed 3 main clusters, primarily consisting of Fasciola hepatica, Fasciola gigantica, and Fasciola intermediate.

Conclusions: The study demonstrates that PCR-RFLP of ITS1 with RsaI is effective for distinguishing F. hepatica from F. intermediate, while Tsp509I is useful for differentiating F. hepatica from F. gigantica. Additionally, PCR-RFLP of the ITS1 is a simple, fast, and reliable method for species identification of liver flukes present in fecal samples of animals, and directly from fluke tissue.