Journal of Infection in Developing Countries最新文献

Introduction: Invasive candidiasis is an important cause of nosocomial infection and recent studies have shown an increase in the number of cases during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to evaluate the epidemiology and incidence of invasive candidiasis before and during the COVID-19 pandemic at a reference tertiary hospital in Brazil.

Methodology: A retrospective observational study was performed with 148 patients infected with Candida spp.

Results: The incidence of invasive candidiasis was 3.43 cases per 1000 admissions in the pre-pandemic period and 4.54 cases per 1000 admissions in the pandemic period, with a particularly high incidence in the intensive care unit. Compared to the pre-pandemic period, patients presented more frequently with immunosuppression (p = 0.01), sepsis (p = 0.03), and need for mechanical ventilation (p = 0.01) during the pandemic. The prevailing type of Candida spp. infection was candidemia, mostly by C. albicans. Invasive candidiasis was associated with high mortality; 52% of the infected patients died from this disease in the pre-pandemic period, while 62% died in the pandemic period. COVID-19, mechanical ventilation, and sepsis were significantly associated with mortality (p = 0.008, p < 0.001, and p < 0.001 respectively).

Conclusions: A high incidence of Candida infection was observed at a tertiary general hospital in Brazil between 2018 and 2022. An increase in incidence of Candida infection during the COVID-19 pandemic was associated with a greater number of critical patients. Sepsis, mechanical ventilation, and COVID-19 were related to higher mortality in patients with invasive candidiasis.

Introduction: Convalescent plasma (CP) therapy is a form of passive immunization which has been used as a treatment for coronavirus disease 2019 (COVID-19). This study aims to evaluate the efficacy and safety of CP therapy in patients with severe COVID-19.

Methodology: In this retrospective cohort study, 50 patients with severe COVID-19 treated with CP at Shahid Beheshti Hospital, Kashan, in 2019 were evaluated. Eligible plasma donors were COVID-19 survivors with high IgG levels and no comorbidities. Clinical and laboratory parameters, including vital signs, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) levels, were measured before and after CP therapy at specified intervals including 24 h and 48 h post-therapy.

Results: The average age of the patients was 55.96 years, and 46% had comorbidities. No adverse effects from CP therapy were reported. Significant associations were observed between baseline ESR levels and factors such as age, comorbidities, hypertension history, and intubation status. However, there was no significant correlation between the outcomes of WBC, ESR, and CRP levels and the IgG levels in recipients.

Conclusions: CP therapy appears to be a safe and potentially effective treatment for severe COVID-19, especially in patients with certain baseline characteristics. These findings add valuable insights into the management of severe COVID-19 cases, although further research is needed to fully understand the implications and optimize treatment protocols.

Introduction: Significant challenges to implementing international health regulations (IHR) at points of entry (PoEs) have been highlighted by the coronavirus disease 2019 (COVID-19) pandemic. Better assessment of the capacities of the PoEs may promote focused interventions. This study aimed to assess the capacities and practices at PoEs.

Methodology: A self-filled questionnaire based on the World Health Organization (WHO) Joint External Evaluation Tool was distributed to frontline workers at four major PoEs. A total of 368 questionnaires were distributed and 308 were completed. Online interviews were conducted with key informants (n = 16). The capacity of PoE was scored by referencing the WHO checklist for core capacity requirement, and categorized into limited, partial, or full capacity. Pearson's Chi square test was used to compare differences among PoEs. Qualitative data was thematically analyzed.

Results: The majority of the 308 participants in the survey were from Ngwenya (59.4%). Approximately 68% were government employees, and 81% had more than 2 years of experience. Participants reported shortage of resources, such as medical facility (30.5%), staff (37.7%), gloves (47.7%), masks (48.4%), and isolation room; and inconsistencies in practices such as record keeping, reporting cases, and quarantine measures. The overall capacity for IHR implementation was limited, with the airport PoE showing partial capacity and the three ground PoEs having limited capacity.

Conclusions: The capacity to implement the IHR at Eswatini PoEs was limited. The results suggest the need to allocate resources to PoEs and to enhance training on practices regarding case handling, reporting, and record keeping.

Introduction: The frequency of scabies and its relationship with the coronavirus disease 2019 (COVID-19) pandemic is a current scientific curiosity in Turkey and worldwide. The data presented in this article will help raise awareness of dermatologists in situations such as pandemic-induced quarantines where scabies can spread rapidly.

Methodology: This was a retrospective study to compare patients who presented with scabies and were evaluated during the COVID-19 pandemic, with those who presented before and after the pandemic, in terms of the diagnosis ratios. In addition, the recurrence rates were compared in terms of age, nationality, and the environment in which they lived.

Results: The frequency of scabies was statistically significantly higher in the post-COVID period in all quarters of the year, with a higher rate of patients in the first and last quarters, which is typical of scabies patients. However, a significant difference in recurrence rates was not detected.

Conclusions: Several factors might be responsible for the increased frequency of scabies during the lockdown periods in Turkey. First, entire families, including relatives, had to live together in a crowded space. Second, there was a relative increase in doctor visits, in spite of the stay-at-home policy, owing to the overwhelming itchiness of scabies.

Introduction: Coronavirus disease 2019 (COVID-19) is associated with long-term symptoms, but the spectrum of these symptoms remains unclear. We aimed to identify the prevalence and factors associated with persistent symptoms in patients at the post-COVID-19 outpatient clinic.

Methodology: This cross-sectional, observational study included hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients followed-up at a post-COVID-19 clinic between September 2021 and January 2022. Persistent symptoms, defined as lasting > 4 weeks after infection, were analyzed alongside symptom timing (28-90, 91-120, and > 120 days) and associated factors using multivariate analysis.

Results: Among 277 patients, mean (SD) age was 56 (16.6) years, and 58.5% were male. Of these, 80.9% reported at least one persistent symptom. Common symptoms included dyspnea (48.2%), insomnia (42.4%), and myalgia (42.1%). In multivariate analysis, being female [odds ratio (OR) 3.41; 95% confidence interval (CI) 1.5-7.76], and oxygen therapy (OR 3.39; 95% CI 1.3-8.81) were independently associated factors with persistent symptoms. High-sensitivity C-reactive protein (HsCRP) (> 75 mg/dL) was an independent risk factor for dyspnea (adjusted OR 2.29; 95% CI 1.28-4.12), and fatigue (adjusted OR 2.24; 95% CI 1.25-4). Oxygen therapy was an independent risk factor for neurologic symptoms, i.e. insomnia (adjusted OR 2.05; 95% CI 1.15-3.65), and brain fog (adjusted OR 2.02; 95% CI 1.14-3.58).

Conclusions: There was a high prevalence of persistent COVID-19 symptoms. The most common symptom was dyspnea. Female gender and oxygen supplementation were independent associated factors. Continuous follow-up of these patients is still required.

Introduction: The objective of this study was to assess the effectiveness of ivermectin and colchicine as treatment options for coronavirus disease 2019 (COVID-19).

Methodology: A three-arm randomized controlled clinical trial was conducted in the Triage Clinic of the family medicine department at Ain Shams University Hospitals on participants who had been diagnosed with moderate COVID-19. Patients aged < 18 years or > 65 years, with any co-morbidities, pregnant or lactating females, and those with mild or severe COVID-19 confirmed cases were excluded. Sealed envelopes were used for randomization of intervention or control. Patients are followed until there was improvement of symptoms and no development of new symptoms for over one month.

Results: A total of 120 patients (40.16 ± 10.74 years) with COVID-19 were enrolled; 40 patients in each arm. Out of them, 44 (36.6%) were male and 76 (63.4%) were female. Fever and cough were the predominant symptoms in each group. There was no statistically significant difference in the mean duration of fever between the ivermectin, colchicine, and control groups (7.3 ± 1.68, 6.6 ± 1.58, and 7.075 ± 1.58 days, respectively). The majority of patients (67.5%, 70%, and 72.5%) were completely cured within 10 days of infection, with no differences between the three groups (p > 0.05). A statistically significant improvement of inflammatory markers occurred in each of the three groups over time with no statistically significant difference between them.

Conclusions: Ivermectin and colchicine have no beneficial effect over standard care in the treatment of COVID-19.

Introduction: The global healthcare system faced unparalleled challenges during the coronavirus disease 2019 (COVID-19) pandemic, potentially reshaping antibiotic usage trends. This study aimed to evaluate the knowledge, perceptions, and observations of community pharmacists concerning antibiotic utilization during and after the pandemic; and offer crucial insights into its impact on antibiotic usage patterns and infection dynamics.

Methodology: This cross-sectional study involved 162 community pharmacists in Northern Cyprus. Data were gathered via a structured survey, including pharmacist demographics, antibiotic knowledge, perceptions of antibiotic resistance, and observations on antibiotic misuse during and after the COVID-19 pandemic. The data were analyzed by biostatistical methods.

Results: Over 90% of pharmacists demonstrated high awareness of antibiotic overuse and resistance. The average antibiotic use knowledge score was 5.09/7. The majority expressed interest in further education (85.2%) and participation in campaigns (96.9%) to promote appropriate antibiotic use. Notably, 87.7% of participants observed an increase in respiratory infections post pandemic, and 45.7% reported administering more antibiotics, reflecting heightened demand. Furthermore, 63.6% noted increased demand for unprescribed antibiotics, while 45.7% expressed concerns about potential neglect of the antibiotic resistance issue as a consequence of the pandemic.

Conclusions: The study highlights critical changes in antibiotic dispensing patterns among community pharmacists during and after the COVID-19 pandemic. The results here underscore the pivotal role of pharmacists in antibiotic stewardship, advocating for ongoing education, and stricter prescription regulations to optimize antibiotic use and combat resistance.

Introduction: Antimicrobial resistance (AMR) is a major public health challenge globally. This study aimed to analyze the antibacterial consumption (ATBc), and the incidence of multidrug-resistant organisms (MDRO), focusing on pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE group), in a Brazilian tertiary care hospital.

Methodology: The ATBc was measured by defined daily doses (DDD) calculated per 1000 patient days. The incidence of MDRO was collected from the hospital infection control committee specialized reports. Changes in ATBc and MDRO incidence over time were explained by the compound annual growth rate (CAGR) represented by the average yearly change as a proportion (%) of consumption in the starting year. This was a time series study using data collected retrospectively from January 2015 to December 2021.

Results: There was an increase in consumption of daptomycin and linezolid during the study period (39.4% and 27.7%, respectively), followed by polymyxins (9.8%). The MDRO of the ESKAPE group with the highest variation in the period were Staphylococcus spp (29.2%), Enterococcus spp (27.8%), and Acinetobacter spp (18.4%). Other MDROs, outside the ESKAPE group, such as Providencia sp (51.2%) and Clostridioides dificille (37.7%) had significant variation.

Conclusions: The coronavirus disease 2019 (COVID-19) pandemic may have reinforced the deterioration of the scenario of accelerating AMR increase. This warrants investigations of further surveillance data to assess the impact of the pandemic on AMR epidemiological trends.

Introduction: This study aimed to analyze the levels of MMP-9 and TIMP-1 as biomarkers for identifying lung anatomical and functional abnormalities in coronavirus disease 2019 (COVID-19).

Methodology: Adult COVID-19 patients hospitalized between October and December 2021 were included in the study. MMP-9 and TIMP-1 levels were measured from the blood. Chest X-ray was categorized using the Brixia index. A blood gas analysis was performed in the emergency room.

Results: MMP-9 was higher in severe COVID-19 patients (1,430.09 ± 1,492.22) than in non-severe cases (819.90 ± 750.13) with p < 0.05, but not different between mortality groups. TIMP-1 was lower in non-severe cases (4.88 ± 3.49) than in severe cases (8.61 ± 9.09) with p > 0.05. The increase in MMP-9 was correlated to TIMP-1 with a linear regression value R2 = 0.945. Lung abnormalities were categorized as normal (6.9%), mild (23.6%), moderate (29.2%), and severe (40.3%). Brixia score was significantly correlated with FiO2 (r = 0.547), PaO2/FiO2 (r = - 0.317), and SpO2/FiO2 (r = - 0.476). MMP-9 and TIMP-1 were significantly correlated with the Brixia score (r = 0.315 and r = - 0.234, respectively), and PaO2/FiO2 (r = - 0.291 and r = 0.283, respectively). MMP-9 was significantly correlated with severity (r = 0.313).

Conclusion: MMP-9 and TIMP-1 were related to lung imaging, functional abnormalities, and severity; but were not associated with mortality.

Introduction: Acute kidney injury involves inflammation and intrinsic renal damage, and is a common complication of severe coronavirus disease 2019 (COVID-19). Baseline chronic kidney disease (CKD) confers an increased mortality risk. We determined the renal long-term outcomes of COVID-19 in patients with baseline CKD, and the risk factors prompting renal replacement therapy (RRT) initiation and mortality.

Methodology: We included 77 patients (median age was 67.1 ± 13.7 years) with a history of renal failure at baseline and recovery from COVID-19 at our institution, in a retrospective analysis from December 2020 to May 2021. Demographic, clinical, and laboratory data were compared between patients requiring RRT and those who did not. A correlogram analysis determined the risk factors for RRT. Survival analysis using the Kaplan-Meier method and Cox regression statistics assessed in-hospital mortality.

Results: 70.1% of the patients had CKD. RRT initiation was higher in patients with known CKD (46.4%) than in those with no known CKD (28.5%). Those with diabetic nephropathy had a higher predisposition for RRT initiation compared to other CKD etiologies. Diabetics (42.3%) and hypertensive nephropathy (33%) were the most common etiologies in the general population. Blood urea nitrogen (BUN), creatinine, phosphorus, lactate dehydrogenase, and proteinuria were significantly higher; and platelets and calcium levels were lower; in patients requiring RRT. Decreased lymphocyte count negatively correlated with BUN levels.

Conclusions: Known CKD patients had a higher initiation rate of RRT, and laboratory features suggestive of kidney damage. However, RRT patients did not have an increased risk of mortality.