Journal of Infection in Developing Countries最新文献

Introduction: Wound infections, particularly diabetic foot infections (DFIs), are major clinical challenges, often exacerbated by polymicrobial colonization and rising antibiotic resistance. This study evaluates the pathogens isolated from DFIs in a Turkish hospital and their antibiotic susceptibility profiles to guide empirical treatment.

Methodology: A retrospective study was conducted in the orthopaedic wound care unit of Pamukkale University Hospital. Data from 478 wound cultures of 136 patients treated between 11/02/2021 and 02/03/2023 were analyzed. Pathogens were identified using microbiological methods and the VITEK 2 system, with antibiotic susceptibility testing performed via the Kirby-Bauer disc diffusion method, following Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Among the 478 clinical samples, 66.9% displayed monomicrobial growth, and 32.1% were polymicrobial. Gram-negative bacteria were more prevalent, found in 85.7% of samples, with Escherichia coli (21.5%) and Pseudomonas aeruginosa (14%) being the dominant isolates. Gram-positive organisms were identified in 50.6% of cases, with Staphylococcus aureus (11.7%) as the most common, of which 8.9% were methicillin-resistant (MRSA). Multidrug-resistant (MDR) strains were detected in 320 Gram-negative isolates, including E. coli (89 isolates), P. aeruginosa (40), and Proteus spp. (50). Extended-spectrum beta-lactamase (ESBL) production was observed in 27.1% of the isolates, and carbapenem resistance in 2.3%. Notably, MDR pathogens were more frequent in patients with osteomyelitis, amputations, or HbA1c levels > 8%.

Conclusions: Gram-negative bacteria, particularly E. coli and P. aeruginosa, were the predominant pathogens in DFIs in Turkey. The increasing prevalence of MDR strains necessitates careful selection of empirical antibiotics, favoring coverage of Enterobacteriaceae and P. aeruginosa over MRSA until culture results are available.

Introduction: This meta-analysis evaluates the correlation between carbapenem antibiotic use and the incidence of carbapenem-resistant Pseudomonas aeruginosa (CRPA).

Methodology: A comprehensive literature search conducted across multiple databases yielded seven clinical experimental studies involving 4,417 patients. The primary outcomes assessed were the risk factors associated with CRPA infection, drug resistance rates, and the comparison of resistance rates between meropenem (MEM) and imipenem (IPM). The Newcastle-Ottawa Scale (NOS) was used to assess study quality, and Egger's test and funnel plots were used to assess publication bias.

Results: The NOS scores for the included studies ranged between 6 and 8, indicating their generally high quality. The analysis indicated that prior carbapenem use significantly increased the risk of CRPA infection (OR = 1.866, 95% confidence interval [CI]: 1.164-2.993, p = 0.010). The drug resistance rates of P. aeruginosa to carbapenems ranged between 21.07% and 37.90%. There was no significant difference in drug resistance rates between MEM and IPM (risk ratio = 1.09, 95% CI: 0.99-1.21, p = 0.517).

Conclusions: With drug resistance rates between 21.07% and 37.90%, these findings suggest that carbapenem use is associated with an increased risk of CRPA infection, highlighting the need for the judicious use of these antibiotics in clinical practice.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that emerged shortly after the coronavirus disease 2019 (COVID-19) pandemic began have altered epidemiological and clinical findings; and these variants changed the course of this health crisis.

Methodology: Whole-genome sequencing was performed on SARS-CoV-2 strains isolated from 21 patients with COVID-19. The frequency of structural changes in the virus and their effects on clinical findings of the disease were analyzed.

Results: The spike Q493R mutation was detected more frequently in patients who had received four or more doses of a COVID-19 vaccine (p = 0.043). The clinical effect of the spike R346K and A263T mutations (reported in Türkiye for the first time) detected in a patient who had received four doses of the vaccine in the 3 months prior to being infected with COVID-19 could be related to escape from the antibody response. The spike R21T mutation may increase the virus's entry into intestinal cells; and, as a result it may be responsible for severe clinical course and gastrointestinal symptoms. The patient infected with the Omicron BA.2 subvariant with the spike L452M mutation exhibited a significant increase in inflammatory parameters; suggesting that this mutation may trigger an excessive immune response and hyperinflammation.

Conclusions: This is the first study based in Türkiye that evaluated the clinical impact of variations in the sequences of SARS-CoV-2 variants. There is a need for further investigation into the clinical impact of these results in a larger population spread over more centers, and more sequencing studies.

Introduction: This study aimed to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among health care workers in Zonguldak Gynecology and Pediatrics Hospital.

Methodology: The records of healthcare personnel working in the hospital between 2023 and 2024 were retrospectively analyzed through the hospital information management system (HIMS) and periodic examination forms. Age, gender, job, and test results for Hepatitis B surface antigen (HBsAg), Hepatitis C antibody (anti-HCV), Hepatitis B surface antibody (anti-HBs), and HIV antibodies (anti-HIV/1-2) were all recorded.

Results: A total of 364 healthcare personnel, including 25 doctors, 135 nurses, 14 technicians, 39 cleaning staff, and 151 other personnel, were included in the study. The staff comprised 266 (73%) female and 98 (27%) male workers, and the mean age was 37.69 ± 9.95 years. The HBsAg positivity rate was found to be 0.8%, and the anti-HBs positivity rate was noted to be 82.9%. Significant differences were determined for age, gender, and anti-HBs among occupational groups (p < 0.001). The prevalence of anti-HBs was markedly elevated in the group of doctors (p < 0.001). The anti-HBs value was statistically significantly different between occupational groups (p < 0.001). No staff members tested positive for anti-HCV or anti-HIV.

Conclusions: Differences in infection rates and immunological responses were seen among various occupational groups, emphasizing the necessity for targeted medical attention within this population. Healthcare personnel should have screening for HBV, HCV, and HIV, and individuals susceptible to HBV should receive vaccination.

Introduction: Nosocomial pneumonia includes hospital-acquired pneumonia without association with mechanical ventilation (HAP) and ventilator-associated pneumonia (VAP). The prevalence and microbial etiology of HAP/VAP in Shandong Province were evaluated to provide a reference for hospital infection control.

Methodology: Data was obtained from patients with HAP/VAP admitted to hospitals within the network of Shandong Provincial Hospital infection management and monitoring from 2019 to 2023.

Results: The prevalence of HAP/VAP showed an overall downward trend across the 5-year period, with range of 0.68-0.43% and 0.067-0.04%, respectively. A total of 83,533 HAP and 7,205 VAP cases were diagnosed (male-to-female ratio of 1.89:1 and 2.13:1; and median age of 67.7 and 64.2 years), among which 47,862 and 9,806 strains were isolated from patients with HAP/VAP, respectively. The primary pathogens in HAP/VAP were similar, and included Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The antimicrobial susceptibility was low, with lesser susceptibility in VAP. The major multidrug resistant microorganisms (MDROs) were identical in HAP/VAP; and MDR-A. baumannii had the highest detection rate, followed by MDR-Staphylococcus. aureus and MDR-P. aeruginosa. The Mantel-Haenszel χ2 test suggested that there was a linear relationship between the detection rate of MDR-P. aeruginosa and MDR-S. aureus and time (p < 0.001 for MDR-P. aeruginosa in HAP/VAP and MDR-S. aureus in HAP; p = 0.023 for MDR-S. aureus in VAP).

Conclusions: The infection rates of HAP and VAP displayed a declining trend. The major pathogens were similar in HAP and VAP, but with low antimicrobial susceptibility and high detection rate of MDROs.

Introduction: Measles is highly contagious and transmitted via droplets, leading to complications such as encephalitis, pneumonia, diarrhea, and death. Although global vaccination efforts have reduced cases, gaps in vaccination coverage and vaccine hesitancy continue to cause outbreaks. This study aims to evaluate measles cases reported in Kayseri, Türkiye, from 2019 to 2023.

Methodology: The study analysed measles cases reported to the Kayseri Provincial Health Directorate's İZCİ system from 1 January 2019 to 31 December 2023. Demographic characteristics, vaccination status, symptoms, complications, and case classifications were recorded. Annual incidence rates were calculated using data from the Turkish Statistical Institute.

Results: A total of 137 measles cases were reported, of which 126 were included in the analysis. Among confirmed cases, 48.2% were children aged 0-4 years. The most common symptoms were rash (89.7%) and fever (81.0%). Among confirmed cases, 17.9% developed complications, including pneumonia (12.5%) and diarrhea (1.8%). The incidence of measles peaked in 2019 and 2023.

Conclusions: The resurgence of measles is driven by factors such as inadequate vaccination coverage, with 35.7% of the population remaining unvaccinated. Strengthening immunization programs and primary healthcare services is essential for the elimination of measles.

Introduction: In developing countries like Vietnam, childhood diarrhea remains frequent and is often treated empirically without an etiological diagnosis.

Methodology: Patients aged under five years, hospitalized at a gastroenterology department with acute diarrhea, were recruited at one hospital. Enteric pathogens were tested by real-time PCR.

Results: 451 children with diarrhea were included, 65.2% were male. 56.3% were aged under 12 months. Upon inclusion, 49.7% (224/451) had nausea and vomiting, and 17.5% had bloody diarrhea. 27.1% of children had a fever, and 37.7% and 4.2% had moderate and severe dehydration, respectively. Almost all patients (437/451, 96.9%) received empirical antimicrobial treatment. 76.5% of children were positive for at least one pathogen, with 37.9% positive for two to four pathogens. Adenovirus, norovirus, and enterovirus were the most frequent viruses detected, with a proportion of 35.7%, 25.7%, and 20.6%, respectively, while Campylobacter jejuni was the most frequent bacterium detected (14.2%), followed by Salmonella spp. and Escherichia coli pathotypes. Male gender, patients positive for at least one virus, and rotavirus were associated with an increased risk of severe disease (OR = 1.55, p = 0.04, OR = 2.23, p < 0.001, and OR = 1.86, p = 0.03, respectively).

Conclusions: These findings underscore the complex interplay of viral and bacterial pathogens in pediatric diarrheal illness and highlight the need for targeted interventions focusing on appropriate diagnostic strategies, antimicrobial stewardship, and gender-specific considerations to mitigate the burden of childhood diarrhea in resource-limited settings like Vietnam.

Introduction: Interactions between host and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are incompletely understood. Studies have highlighted the roles of L-dopa decarboxylase (DDC), interferon-inducible truncated isoform of angiotensin-converting enzyme 2 (dACE2), and immunomodulatory hypoxia-regulated gene erythropoietin (EPO) in viral infections. This study investigated the expression levels of DDC, dACE2, and EPO in 136 coronavirus disease 2019 (COVID-19) patients and 88 controls.

Methodology: Real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to quantify mRNA levels of DDC, dACE2, and EPO; and the SARS-CoV-2 viral load in nasopharyngeal swabs.

Results: Significantly elevated levels of dACE2 (p = 0.003), DDC (p = 0.004), and EPO (p = 0.006) were observed in patients compared to controls. No correlation with the viral load (DDC: r = 0.12, p = 0.136; EPO: r = 0.02, p = 0.802; dACE2: r = 0.05, p = 0.491), and no associations with age or gender (all p > 0.05) were noted. There were positive correlations between DDC and dACE2 mRNA levels in infected (r = 0.31, p = 0.0002) and uninfected individuals (r = 0.25, p = 0.015); and between DDC and EPO in infected (r = 0.22, p = 0.008) and uninfected individuals (r = 0.27, p = 0.010). There was a positive correlation between dACE2 and EPO mRNA levels in both groups (infected: r = 0.22, p = 0.007; uninfected: r = 0.38, p = 0.0002).

Conclusions: DDC, dACE2, and EPO may contribute to COVID-19 pathogenesis through mechanisms independent of viral load, age, or gender.

Introduction: The COVID-19 pandemic influenced the behaviour of numerous diseases, overloading health systems and weakening public health infrastructure and access.

Methodology: This study aimed to analyse the repercussions of the COVID-19 pandemic on tuberculosis diagnosis indicators. A systematic review was conducted, examining studies published between 2020 and 2024 in Portuguese, English, or Spanish across five databases and Google Scholar. The search, performed in March 2024, led to the identification of 6,378 studies, of which 23 were included after an independent review of titles, abstracts, and full texts. Data were extracted and narratively synthesized following a methodological quality assessment.

Results: The review revealed significant declines in TB incidence, detection, notification, and diagnosis during the pandemic, alongside reduced etiological confirmation of cases.

Conclusions: The findings highlight a need to reorganize and enhance health service responses to address the disruptions caused by the pandemic. Strengthening these services is crucial to recover missed TB cases and improve indicators, supporting the goal of eliminating TB by 2030.

Introduction: Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic with clinical manifestations ranging from asymptomatic infection to life-threatening illness. While physician assessment of disease severity is largely objective, patient perception of illness is often influenced by psychosocial and demographic factors. This study aimed to explore determinants of illness perception among patients hospitalized with COVID-19.

Methodology: A cohort of 262 patients with confirmed SARS-CoV-2 infection was evaluated. Baseline characteristics included age, gender, smoking history, body mass index, and sociodemographic information (relationship status, education, employment, and physical activity). Disease severity was assessed using chest computed tomography (CT) scans. Illness perception was measured with the Brief Illness Perception Questionnaire (BIPQ).

Results: The median patient age was 56.3 years, and 65.6% were male. More than half (56.5%) had completed higher education, 90% were married or in a relationship, 57.6% were unemployed, and 85.9% reported no regular physical activity. Male patients demonstrated higher absolute CT scores (p = 0.018) but lower BIPQ scores. Severe pneumonia, as defined by CT findings, correlated with longer hospitalization, although no significant differences in total BIPQ scores were observed across CT severity groups. Illness perception was not influenced by education (p = 0.43), employment (p = 0.096), or physical activity (p = 0.94). However, relationship status significantly affected total BIPQ scores (p = 0.034).

Conclusions: The study found BIPQ useful for rapid illness perception assessment, recommended for routine practice. Socio-economic factors influenced responses, while CT severity did not. Linking CT scores with BIPQ may identify patients at risk of psychological distress.