Journal of Infection in Developing Countries最新文献

Introduction: Bloodstream infection (BSI) is a major contributor to morbidity and mortality in hemodialysis patients. Our objective was to identify pathogens causing BSI, its incidence, and associated risk factors.

Methodology: Retrospective positive blood culture data were analyzed from five hemodialysis centers (January 2019 until December 2023) across Saudi Arabia.

Results: There were 437 bacteremia episodes in 432 patients, with 405 central line and 367 peripheral samples. The BSI rate was 0.67 per 100 patient months. 375 (85.8%) patients had a Central Venous Catheter (CVC), 27 (6.17%) had an arteriovenous fistula (AVF), 5 (1.14%) had an arteriovenous graft (AVG), and 30 (6.9%) had dual access. The central line-associated bloodstream infection (CLABSI) rate was 1.41 per 100 patient months. Gram-positive organisms in the central line blood culture were 169 (44%), and Gram-negative were 200 (51.81%); 16 (4%) cases were polymicrobial, and there was one case of fungi. In peripheral blood cultures, 158 (48.9%) were Gram-positive and 150 (46.4%) were Gram-negative. The most common pathogens were Staphylococcus aureus, MRSA, and Staphylococcus epidermidis in Gram-positive organisms, and Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa in Gram-negative organisms. Three cases of fungal infection occurred during the study period. Two-thirds of patients (68%) required hospital treatment, and in 54% of the cases, there was loss of vascular access. Mortality due to sepsis within 4 weeks occurred in five patients.

Conclusions: The risk of BSI in hemodialysis patients is high. Gram-negative pathogens contribute to half of the events. In Saudi Arabia, Gram-negative pathogen incidence is significant, and measures are required to curtail it.

Introduction: Antimicrobial resistance is recognized as one of the major health challenges. Thus, urgent therapeutic solutions are needed. This study aims to test the activity of plant extracts against multi-resistant bacteria, as well as the synergistic effect of these extracts with some antibiotics.

Methodology: The evaluation of the antibacterial effect of eight medicinal extract plants (G. alypum, R. graveolens, U. dioica, P. lentiscus, A. vulgaris, L. angustifolia, T. vulgaris, and J. phoenicea) against 10 bacterial strains (K. pneumoniae, E. coli, C. freundii, S. haemolyticus, S. epidermidis, S. saprophyticus) has been performed using both wells and disks diffusion methods (DDM/WDM). The evaluation of the synergistic effect of some of the natural extracts with some antibiotics has been performed using the disk diffusion method (DDM).

Results: A significant difference resulting from the effect of various plant extracts on different bacterial species has been observed. Interestingly, an important inhibition zone related to the effect of the essential oil of T. vulgaris and L. angustifolia was observed in all bacterial strains. The combination of plants/antibiotics does not always give a more effective effect than the antibiotic /or the plant extract alone. The lavender oil seems to be able to enhance the activity of ertapenem on C. freundii, while the combination of A. vulgaris/ertapenem induced the reduction of the inhibition zone on the same species.

Conclusions: These results are of great importance; regarding the valorization of natural resources for the creation of solutions to urgent health problems while taking advantage of existing pharmaceutical resources.

Introduction: Cutaneous leishmaniasis (CL) is a significant public health concern in Türkiye, especially in the Southeastern Anatolia and Mediterranean regions. This study evaluated the epidemiological characteristics of CL cases diagnosed at Mersin University Hospital, including the impact of migration and the COVID-19 pandemic.

Methodology: The diagnosis of CL was confirmed by microscopic examination of lesion smears. In this study, data from 144 patients diagnosed with CL between January 2011 and December 2022 were evaluated retrospectively. Demographic characteristics of the patients, temporal distribution (by month and year), and lesion features (location, number, and duration) were included.

Results: CL was confirmed in 32.9% of patients (144/438). Of the 144 patients, 82 (56.9%) were Turkish citizens and 62 (43.1%) were Syrian refugees. The mean age was 20.7 ± 19.8 (1-78) years. CL was detected more frequently in females (52.1%, 75/144) and in the 0-20-year age group (64.6%, 93/144). The head-neck region was the most affected (53.9%), and the mean lesion duration was 6.8 ± 11.6 months. Most cases were detected in February and March. The number of cases increased with Syrian refugee migration but decreased during the COVID-19 pandemic.

Conclusions: Although the frequency of CL in the region has decreased in recent years, it remains a significant public health concern.

Introduction: Klebsiella pneumoniae is a common causative agent of hospital-acquired (HA) bloodstream infections (BSI) in intensive care units (ICU). This study aimed to investigate mortality rates and the factors affecting mortality in BSI due to K. pneumoniae acquired in the ICU.

Methodology: This retrospective study included adult patients hospitalized in the ICU between January 2021 and December 2022 who developed HA BSI due to K. pneumoniae. The association between clinical characteristics, invasive and medical treatment practices before bacteremia, and 15-day and 30-day mortality was investigated.

Results: A total of 232 patients (median age 68.0 years) were included. All-cause mortality rates on days 15 and 30 were 56.0% and 72.8%, respectively. The proportion of patients infected with carbapenem-resistant K. pneumoniae was 77.6%. Logistic regression analysis revealed significant associations between systemic corticosteroid use (OR: 2.38; p = 0.014), high qPitt score (OR: 1.32; p = 0.046), and presence of immunosuppression (OR: 2.70; p = 0.020); and 15-day mortality. Significant associations were found between systemic corticosteroid use (OR: 3.69; p = 0.002), high qPitt score (OR: 1.44; p = 0.043) and presence of immunosuppression (OR: 6.61; p = 0.004); and 30-day mortality.

Conclusions: Corticosteroid treatment before the development of bacteremia in ICU patients may contribute to mortality in BSI due to K. pneumoniae. Therefore, corticosteroids should be used with caution despite their benefit in the treatment of acute respiratory distress syndrome. High qPitt scores and the presence of immunosuppression may be used as predictors of mortality in HA BSI due to K. pneumoniae.

Introduction: Influenza is a respiratory infectious disease that seriously affects public health. Currently, there is lack of study on spatial-temporal and seasonal analysis of data for nearly five years. This study aimed to investigate the epidemiological characteristics of influenza in Qingdao City, China, from 2019 to 2023, to contribute towards public health and disease control interventions.

Methodology: The annual influenza incidence rate of the city was visualized in streets and towns. Spatial autocorrelation analysis and spatial-temporal analysis were performed to measure the cluster effect on spatial distribution and temporal trends. Seasonal trend analysis was used to describe the seasonal distribution of influenza. Etiology analysis of the influenza virus displayed an altered trend of positive rates and subtypes.

Results: Positive spatial autocorrelation was detected on urban and coastal streets, except in 2021. A possible spatial-temporal cluster was discovered in November 2023 that was located in urban and coastal streets. There was a major peak in winter and small fluctuations formed the seasonal epidemic trend of influenza incidence in Qingdao. Etiology analysis revealed that the positive rate of influenza virus usually peaks from January to March. Influenza A virus (H1N1 and H3N2) and influenza B virus (Victoria lineage) alternatively or jointly spread in the five years, and influenza A virus was the dominant type.

Conclusions: This study identified the epidemic characteristics of influenza in Qingdao City in the five years. Further research on environmental factors and etiological characteristics is recommended to help explore the epidemic patterns of outbreaks and aggregation of influenza.

Introduction: Dengue remains a public health concern in Paraguay. Paraguay´s 2023-2024 epidemic was examined, emphasizing on the Itapua department in the southern region bordering Argentina.

Methodology: This retrospective, cross-sectional observational study analyzed confirmed dengue cases from 17 September 2023, to 4 May 2024. Demographic and clinical data of the participants were gathered from Paraguay's national surveillance system.

Results: Among the 307,058 suspected dengue cases reported, 77,675 were confirmed through laboratory testing. The Itapua department contributed 8,310 (2.7%) and 1,910 (2.5%) of the suspected and confirmed cases; pediatric cases comprised 33% nationwide and 35% in Itapua. Intensive care needs were higher in Itapua (n = 18, 11.2%) than in other Paraguayan regions (n = 152, 2.0%). Mortality rates were also elevated in Itapua (n = 11, 0.6%) compared to the national average (n = 95, 0.13%). DENV-1 and DENV-2 were responsible for this epidemic. Encarnacion, the capital of Itapua State and a neighboring city to Posadas, Argentina, was the most severely affected (1,262 reported cases).

Conclusions: The elevated rates of pediatric cases, intensive care admissions, and mortality in Itapua highlight the need for multicomponent health strategies, including enhanced vector control through community-led Aedes aegypti elimination programs and insecticide residual spraying in high-incidence zones, vaccination campaigns targeting high-risk pediatric populations with World Health Organization (WHO)-approved dengue vaccines (e.g., TAK-003), and cross-border collaboration with Argentina (e.g., Posadas-Encarnacion) to synchronize outbreak surveillance, share real-time epidemiological data, and coordinate vaccine deployment in binational hotspots.

Introduction: The effectiveness of remdesivir (RDV) and interferon beta-1a (IFNβ-1a) was assessed and compared in patients hospitalized with coronavirus disease of 2019 (COVID-19).

Methodology: A total of 162 hospitalized COVID-19 patients were divided into two groups: the RDV group and the IFNβ-1a group. Through laboratory tests and a physical examination, the patient's clinical condition was evaluated.

Results: RDV and IFNβ-1a treatments significantly decreased fever, cough, shortness of breath, and weakness in COVID-19 patients (All p < 0.001). RDV treatment significantly decreased shortness of breath, erythrocyte sedimentation rate (ESR), and creatinine, relative to IFNβ-1a treatment (p < 0.03, p = 0.001, and p < 0.004, respectively). RDV treatment significantly decreased Lactate Dehydrogenase (LDH) in COVID-19 patients (p = 0.006). The mean time of hospitalization was 8.9 days in the RDV group and 8.2 days in the IFNβ-1a group. There was no statistical difference between the two groups. The IFNβ-1a group had a considerably lower rate of intensive care unit (ICU) admission than the RDV group (p = 0.006).

Conclusions: No difference in clinical outcomes was found between RDV and IFNβ-1a treatments. RDV was more effective than IFNβ-1a in moderating the inflammatory response in COVID-19 patients by reducing LDH and ESR. The IFNβ-1a group had a considerably lower rate of ICU admission than the RDV group.

Introduction: Oral hygiene in patients with fixed orthodontic appliances is not satisfactory in most cases. Namely, rough and irregular edges on fixed orthodontic appliances can facilitate attachment of microorganisms, which causes periodontal diseases and caries. The purpose of this in vitro study was to evaluate the reduction of microbes between the wires of fixed orthodontic appliances after the action of the Neo Pill electrolysis device.

Methodology: The study was carried out in the laboratory of the Faculty of Stomatology in Pančevo, where serial dilutions were prepared in buffered peptone water, and together with the most appropriate dilution rate for the desired colony-forming units in a given volume (80-120 colony-forming units per plate) for bacterial strains (Streptococcus mutans ATCC 25175, Lactobacillus acidophilus ATCC 4356, Actinomyces odontolyticus ATCC 17929) as well as for Candida albicans (ATCC 10231). The microbial assessment was done for the detection of colony-forming units from the samples before and after using the Neo Pill electrolysis device. All data were statistically analyzed with the Wilcoxon Two-Sample Test.

Results: Results of analyses revealed that the number of microbes in all Neo Pill groups was significantly lower compared to the Control group (p < 0.05).

Conclusions: The Neo Pill electrolysis device is efficient in the removal of oral bacteria and fungi and could be an addition to the oral hygiene for patients with fixed orthodontic appliances.

Introduction: Patients with perianal necrotizing fasciitis (PNF) frequently require admission to the intensive care unit (ICU). The study aimed to develop a novel scoring system to predict ICU admission in PNF patients.

Methodology: This cohort study retrospectively recruited patients in the Nanjing Hospital of Chinese Medicine. The outcome was the admission to the ICU. Random forest was used to select variables for the development of a new scoring system, whose performance was assessed using the area under the curve (AUC) with a 95% confidence interval (CI). Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were applied to assess the performance improvement of Sequential Organ Failure Assessment (SOFA) score and Fournier's Gangrene Severity Index (FGSI) compared to the new scoring system.

Results: Totally 106 eligible individuals with PNF were enrolled. SOFA, age, course of disease, and extent of disease were selected to develop the new scoring system, which was named "modified SOFA" (mSOFA). The AUC of the mSOFA was 0.974 (95% CI: 0.931-1.000). SOFA (NRI: -0.72, p = 0.010; IDI = -0.05, p = 0.002) and FGSI (NRI: -1.50, p < 0.001; IDI = -0.55, p < 0.001) demonstrated a decreased predictive performance for the ICU admission compared to mSOFA.

Conclusions: The mSOFA scoring system had a better predictive performance for the ICU admission than SOFA and FGSI, indicating that mSOFA may be a reliable tool for the prediction of ICU admission in PNF patients.

Introduction: Serum cryptococcal antigen (CrAg) screening is crucial for early diagnosis of cryptococcal meningitis. This study presents the results of CrAg screening among people living with HIV (PLWH) followed in our clinic over the past six years.

Methodology: Patients with a CD4+ T cell count below 200 cells/µL who were tested for CrAg were included in the study. Data regarding age, gender, comorbidities, CD4+ T cell count, HIV RNA level, blood culture results, and cerebrospinal fluid (CSF) findings-including CrAg, microscopy, culture, and PCR-were retrospectively collected. Descriptive statistical methods were used for the analysis.

Results: Serum CrAg testing was performed on 99 patients, nine of whom tested positive. Among the patients with positive antigenemia, four were diagnosed with cryptococcal meningitis. In two cases, serum CrAg positivity was interpreted as false-positive due to the absence of clinical or laboratory findings consistent with cryptococcal infection. One patient died shortly after the CrAg test and could not be further evaluated. Two patients were lost to follow-up; however, one of them presented with symptoms two months later and was diagnosed with cryptococcal meningitis. Additionally, there was one patient with confirmed cryptococcal meningitis despite an initial negative serum CrAg result.

Conclusions: CrAg positivity may be detected during the asymptomatic phase of cryptococcal infection. Although current guidelines recommend serum CrAg screening for individuals with CD4+ T cell counts below 100 cells/µL, the detection of positive results in those with CD4+ T cell counts above this threshold should also be carefully evaluated, considering the possibility of false-positive or false-negative results.