Journal of Infection in Developing Countries最新文献

Introduction: This study investigated the macro-quantitative correlation between Klebsiella pneumoniae resistance rates and concurrent antimicrobial use in the intensive care unit (ICU), to guide treatment for chronic refractory infections caused by this pathogen, by optimizing outcomes for critically ill patients while curbing bacterial resistance spread or transmission.

Methodology: A retrospective analysis was conducted on the resistance rate of K. pneumoniae and the concurrent use of antimicrobial agents in the ICU. A multiple linear regression model was employed to analyze whether there was an independent linear correlation between the two, and to identify the relevant factors.

Results: 936 K. pneumoniae isolates were identified in the ICU between 2020 and 2024, representing 20.45% (936/4,577) of all bacterial isolates recovered from the ICU. The resistance rates to most antimicrobial agents, except for tigecycline and trimethoprim-sulfamethoxazole, exceeded 65%, indicating a severe resistance situation. Multiple linear regression analysis revealed that the resistance rates of K. pneumoniae to imipenem, piperacillin-tazobactam, and ceftazidime were independently linear correlated only with piperacillin-tazobactam defined daily doses (DDDs), with regression coefficients (β) of 0.221, 0.224, and 0.166, respectively. The resistance rates to ceftriaxone, cefoperazone-sulbactam, and ertapenem were positively correlated with piperacillin-tazobactam DDDs. Resistance to cefepime was positively correlated with ceftazidime DDDs. Resistance to tigecycline was positively correlated with meropenem DDDs. Resistance to levofloxacin was negatively correlated with cefoperazone-sulbactam DDDs.

Conclusions: The resistance rate of K. pneumoniae in the ICU is closely related to antimicrobial use. Hospitals should strengthen the regulation of antimicrobial use to delay the emergence of drug-resistant species.

Introduction: The World Health Organization (WHO) plans to control the epidemics of malaria and neglected tropical diseases (NTDs) by 2030. The aim of this study was to evaluate the realizability of achieving the WHO targets by assessing the past, present, and future global disease burden of malaria and NTDs.

Methodology: Joinpoint regression, Spearman's correlation, and the autoregressive integrated moving average model (ARIMA) were used to estimate the trends of malaria and NTDs from 1990 to 2030 based on the Global Burden of Disease (GBD) Study 2019.

Results: Western Sub-Saharan Africa had the highest cases of malaria and NTDs in 2019, with one-half of the global cases. The age-standardized incidence rate (ASIR) in high socio-demographic index (SDI) and World Bank high-income regions showed upward trends from 1990 to 2019. The highest burden of NTDs was dengue in 2019, and the ASIR of dengue showed an obvious upward trend from 1990 to 2019. Children (< 5 years) had the most serious disease burden of malaria and NTDs from 1990 to 2019. The predicted results showed that the age-standardized mortality rate of malaria and NTDs worldwide had a slow upward trend from 2020 to 2030.

Conclusions: This analysis emphasizes that the control of malaria and NTDs in western sub-Saharan Africa should be continuously strengthened and the resurgence of malaria and NTDs in high SDI and World Bank high-income regions needs to be highlighted. Dengue and children (< 5 years) are the primary diseases and populations of concern, respectively, for future prevention efforts.

Introduction: The epidemiology of ESBL infection varies widely from one region to another and rapidly evolves across hospital and community boundaries. Therefore, obtaining an updated local picture of the epidemiology of ESBL-producing microorganisms and analyzing trends in their dissemination is essential. The main aim of this study was to assess the prevalence and the antibiotic resistance profiles of ESBL-producing Enterobacteriaceae (ESBL-E) at Ibn Tofail Hospital in Marrakesh.

Methodology: To our knowledge, the present study is the first to conduct a descriptive analysis from January 1, 2010, to December 31, 2022, including all ESBL-E strains isolated in the microbiology laboratory. Antimicrobial susceptibility testing was determined using the standardized Kirby-Bauer disk diffusion method on Mueller-Hinton agar. The double-disc synergy test confirmed the presence of ESBL.

Results: Among 3672 Enterobacteriaceae strains isolated, 20% were ESBL producers. Klebsiella pneumoniae accounted for 45.9% of ESBL-E, followed by Escherichia coli (25.3%) and Enterobacter cloacae (12.8%). The surgical and intensive care units were most affected. Urine samples were the most common source (42.4%). ESBL-E strains exhibited high resistance to tobramycin (80.3%), gentamicin (72.9%), and ciprofloxacin (73.7%), but maintained sensitivity to imipenem (15.6% resistance) and amikacin (21.9%). Significant differences were detected between non-ESBL and ESBL regarding all tested antibiotics. Male patients were significantly more affected by ESBL-E than females.

Conclusions: The increasing incidence of ESBL-E has become a significant concern. Monitoring their epidemiological and resistance profiles is crucial for guiding antibiotic therapy and preventing the development of further resistant strains.

Introduction: Giardia lamblia and Trichomonas vaginalis are flagellated protozoan parasites that often cause asymptomatic infections but may lead to gastrointestinal or genitourinary symptoms. Improved treatment options are needed due to emerging resistance. However, selecting an appropriate method for assessing the in vitro susceptibility of G. lamblia and T. vaginalis in the presence of potential therapeutic compounds remains challenging due to the variability in these methods. This study aimed to provide an overview of commonly employed methods for determining trophozoite viability in the presence of potential therapeutic compounds and to propose a standardized viability assay for susceptibility testing for G. lamblia and T. vaginalis.

Methodology: A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement, using databases including MEDLINE, ScienceDirect, and Web of Science, with the following search equation: "in vitro" AND "method" AND ("susceptibility" OR "viability" OR "sensitivity") AND ("giardia" OR "trichomonas").

Results: The search identified 32 experimental studies with diverse viability assays. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, adherence inhibition assay, and [3H]-thymidine incorporation assay were prominent for G. lamblia. The trypan blue assay, motility assessment, and resazurin assay were frequently used for T. vaginalis. These findings underscore the diversity in viability assessment methods, highlighting the importance of standardizing viability assays to ensure accurate and reproducible results in drug susceptibility studies.

Conclusions: The fluorometric resazurin assay has emerged as a suitable choice for standardization in both parasites, offering cost-effectiveness, reliability, and ease of use.

Introduction: Sepsis is a life-threatening condition caused by an excessive immune response to infection, leading to severe tissue and organ damage. In resource-limited settings, early, low-cost, and readily available laboratory parameters may guide outcome prediction. This study aimed to evaluate the role of hematological indices and laboratory parameters in predicting mortality among intensive care unit (ICU) patients with sepsis.

Methodology: This retrospective study included adult sepsis patients admitted to the ICU between January 2018 and December 2023. Blood samples obtained within the first 6 hours of ICU admission were processed using standardized analyzers. Demographic data, laboratory results at admission, length of hospital stay, and mortality status were retrieved from the hospital database. Associations between hematological indices, laboratory parameters, and mortality were analyzed.

Results: A total of 180 patients were included; 40 died during hospitalization. No significant association was found between neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), or platelet-to-lymphocyte ratio (PLR) and mortality (NLR: p = 0.834, LMR: p = 0.895, PLR: p = 0.192). In contrast, pH levels showed a strong negative correlation with mortality (p < 0.001), while lactate levels were significantly positively correlated (p = 0.006). Carboxyhemoglobin and methemoglobin levels were not significantly related to mortality.

Conclusions: Low pH and high lactate levels were the strongest predictors of mortality in sepsis patients, highlighting the prognostic value of simple blood gas parameters, especially where advanced diagnostics are limited. Hematological indices showed no significant association with mortality. pH and lactate should be prioritized in clinical decision-making for sepsis patients.

Introduction: Neonatal sepsis is a life-threatening bloodstream infection that occurs within the first 4 weeks of life and represents a significant cause of illness and death, especially in developing countries. Regular assessment of the local causative agents and their resistance patterns is important for effective management. This study aimed to determine the microbiological profile of neonatal sepsis and its antibiotic resistance patterns.

Methodology: Our study was conducted on 237 neonates suspected of sepsis. Blood samples were collected and inoculated into BACT/ALERT blood culture bottles. Bacteria causing positive blood cultures were identified conventionally and confirmed to the species level using MALDI-TOF MS. Antibiotic susceptibility patterns were identified using the disk diffusion method in combination with the VITEK® 2 compact system. Data analysis was performed using version 28 of SPSS software.

Results: The overall rate of neonatal sepsis was 33.8% (80/237). Of these, 54 (67.5%) and 26 (32.5%) were caused by Gram-negative and Gram-positive bacteria, respectively. Klebsiella pneumoniae 38 (47.5%) was the dominant causative pathogen, followed by coagulase-negative Staphylococci (CoNS) 24 (30%). Multidrug resistance (MDR) and extensively drug resistance (XDR) were detected in 82.5% and 10% respectively. An alarmingly high incidence of carbapenem-resistance (90.7%) was detected among Gram-negative bacteria. Methicillin resistance was detected in S. aureus and CoNS in 100% and 54.2%, respectively. Tigecycline was the most effective antibiotic for both Gram-positive and Gram-negative bacteria.

Conclusions: Our study showed that neonatal sepsis is mostly caused by MDR pathogens, predominantly Klebsiella pneumoniae, urging revised empirical treatments and stricter infection control measures.

Introduction: The incidence and mortality of polymicrobial bloodstream infections (pBSIs) are increasing, yet their clinical characteristics and outcomes remain poorly understood.

Methodology: A retrospective analysis was conducted on 425 patients with confirmed bloodstream infections at the First Affiliated Hospital of Chongqing Medical University between January 2022 and September 2023. Clinical data, laboratory indicators, and in-hospital mortality rates were collected and analyzed.

Results: Lower respiratory tract infections were identified as the most common source of pBSIs (34.4%). The most frequent pathogen combination involved Gram-negative bacilli (GNB) and Gram-positive cocci (GPC), accounting for 32.8% of cases. Among the 257 pathogens isolated, 122 were Gram-positive bacteria (47.4%) and 130 were Gram-negative bacteria (50.6%). The most commonly isolated organisms included Escherichia coli (15.6%), Klebsiella pneumoniae (10.1%), and Enterococcus faecalis (7.0%), with a notable detection rate of coagulase-negative staphylococci (CoNS; 17.9%). Gastrointestinal tumors, invasive mechanical ventilation, intra-abdominal infections, and hospital-acquired infections were identified as independent risk factors for pBSIs. Compared to monomicrobial bloodstream infections (mBSIs), pBSIs were associated with a higher mortality rate (24% vs. 17.3%, p = 0.075) and a greater incidence of septic shock (36.8% vs. 24%, p = 0.006). Diabetes, invasive mechanical ventilation, and respiratory failure were independent predictors of mortality in pBSIs patients.

Conclusions: Hospitalized patients with pBSIs are at a significantly higher risk of adverse outcomes, including mortality. Early identification and targeted management of risk factors are crucial to improving prognosis and reducing mortality in patients with pBSIs.

Introduction: Antimicrobial resistance poses a critical global health concern, particularly in developing countries like Syria, and is responsible for the increased rates of infection and mortality associated with community-acquired pneumonia (CAP).

Methodology: This cross-sectional study determined the prevalence of bacteria that cause CAP and the rate of antibiotic resistance in a sample of patients who attended the Chest Department of Ibn Al-Nafis Hospital in Damascus, Syria from September 2022 to March 2023.

Results: Almost three-quarters of the 100 CAP cases were caused by 3 agents: Streptococcus pneumonia (41%), Staphylococcus aureus (16%), and Klebsiella sp. (14%). The study showed high resistance of bacteria to the usually recommended antibiotics, which presents a significant challenge in treating these infections. Specifically, in this sample, Gram-negative bacteria had a higher antibiotic resistance rate than Gram-positive bacteria. Gram-negative bacteria showed the highest resistance against nitrofurantoin, cefazolin, and cefoxitin (100%, 91.7%, and 91.3%, respectively). Gram-positive bacteria exhibited the highest resistance against erythromycin, cefoxitin, and oxacillin (91.37%, 91.22%, and 87.71%, respectively). Resistance to the commonly recommended amoxicillin, and amoxicillin + clavulanic acid, was higher than 80%, while the tested Gram-positive bacteria showed high sensitivity to other recommended options such as cefotaxime (71%) and ceftriaxone (81%).

Conclusions: These findings underscore the importance of being able to adapt the general World Health Organization recommendations according to local evidence. It is crucial to emphasize the need for continuous local monitoring, functioning and well-equipped laboratories, and well-trained specialists in infectious diseases in hospitals to be able to make these decisions.

Introduction: The aim of this study was to investigate the epidemiology, clinical characteristics, antifungal susceptibility, and prognosis of fungemia among pediatric patients.

Methodology: A retrospective cohort analysis was conducted on 195 fungemia cases at Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital over a 7-year period (2016-2023). Comprehensive clinical data were extracted from the electronic medical record system.

Results: Microbiological analysis of 195 fungemia cases revealed 22 distinct fungal species. Candida parapsilosis was the predominant pathogen (28.2%, 55/195), followed by Candida albicans (26.7%, 52) and Candida tropicalis (10.8%, 21). The cohort demonstrated distinctive epidemiological features: median patient age of 30 days, neonatal predominance (40.5%), and male preponderance (60%). Alarmingly high antifungal resistance profiles were observed, particularly in C. albicans (66% fluconazole and 62% voriconazole resistance) and C. dubliniensis (82% itraconazole resistance). Non-albicans infections correlated with elevated intensive care unit (ICU) admission rates and neutropenia incidence, while C. albicans cases showed stronger associations with prematurity and low birth weight. The clinical course was marked by prolonged hospitalization (median 37 days), with 56.4% requiring intensive care and 20% developing persistent candidemia. 81.5% achieved clinical resolution, though 15.4% required non-medical transfers and 3.0% succumbed to refractory infections despite maximal therapy.

Conclusions: Neonates represented the highest-risk population for pediatric fungemia, with a median hospitalization duration of 37 days. Over half of the affected children (56.4%) required ICU admission. The high rate of antifungal resistance and poor prognosis underscore the urgent need for enhanced surveillance protocols and optimized antifungal stewardship in pediatric settings.

Introduction: Salmonella enterica, particularly the monophasic variant of Salmonella typhimurium, is a significant foodborne pathogen with an increasing prevalence and alarming multidrug resistance profile. This study analyzed the prevalence, antimicrobial resistance, and genomic characteristics of Salmonella typhimurium monophasic variants in Hanzhong, China.

Methodology: Genomic analysis was conducted on 94 Salmonella enterica strains derived from diarrheal patients in Hanzhong, China, from 2021 to 2023. Serotyping was performed using microbial mass spectrometry and whole-genome sequencing. Drug susceptibility testing was conducted. Drug resistance genes were screened. Genomic characterization included core genome multi-locus sequence typing (cgMLST) and core genome single-nucleotide polymorphism (cgSNP) analysis.

Results: Out of 94 strains, 34 were confirmed as monophasic Salmonella typhimurium. Notably, 85.29% of cases were in children under five years. Multi-drug resistance was alarmingly high at 88.24%, particularly against streptomycin (85.29%), tetracycline (70.59%), ampicillin (61.76%), and sulfamethoxazole (61.76%). Additionally, only one strain was fully susceptible to all tested antibiotics. Genomic analysis identified 30 distinct drug-resistance genes across the strains. All 34 strains belonged to the ST34 type. The cgMLST generated six clusters. The largest cluster contained 14 strains, predominantly from the Hantai District. The cgSNP analysis identified eight distinct evolutionary branches, each containing isolates from different periods and regions.

Conclusions: This study highlights the alarming prevalence and high resistance rates of monophasic Salmonella typhimurium in Hanzhong, particularly among vulnerable populations such as young children. The findings underline the urgent need for public health interventions, including enhanced monitoring and antibiotic stewardship, to mitigate the risks associated with this pathogen.