Le infezioni in medicina最新文献

Purpose: Bloodstream infections (BSIs) are one of the most frequent complications among liver transplant recipients and are associated with a markedly increased risk of death. Our study aims to define the incidence, epidemiology and clinical characteristics of BSIs after liver transplantation (LT) and to investigate risk factors related to 30-day mortality.

Methods: We considered all patients who underwent LT at the Università Politecnica delle Marche of Ancona for up to 10 years and selected those who experienced at least one episode of BSI.

Results: Out of 601 LT recipients, 96 had at least one episode of BSI. Most BSIs occurred within the first month post-transplantation. Central vascular catheter infections were the most frequent source, followed by surgical site infections, pneumonia, and urinary tract infections. Overall, we isolated 102 microorganisms: 66% were Gram-negative bacteria, 30% Gram-positive bacteria and 4% fungi. High rates of antimicrobial resistance were observed among both Gram-negative (34%) and Gram-positive bacteria (84%).Thirty-day mortality was 26%, with septic shock (HR 226.980 [CI 95% 5.083-10135.347], p=0.005), the absence of invasive procedures within 72 hours before BSI onset (HR 88.567 [CI 95% 2.484-357.754], p=0.014), white blood cell count ≥ 2,500/mmc (HR 34.948 [CI 95% 1.568-778.750], p=0.025), creatinine >1.02 mg/dl (HR 13.982 [CI 95% 1.487-131.485], p=0.021] and hypoalbuminemia (HR 24.775 [CI 95% 1.371-447.744], p=0.030) being significant risk factors.

Conclusions: This study provides detailed insights into post-transplant BSIs, highlighting the alarming rates of antimicrobial resistance, thereby suggesting a major effort to rationalize the use of antimicrobial therapy.

Background: Implementing Outpatient Parenteral Antimicrobial Therapy (OPAT) safely poses significant challenges, particularly in centers without a dedicated OPAT team, where monitoring by infectious diseases (ID) physicians can be difficult. We utilized a Lean 6-Sigma framework to evaluate our OPAT process and define opportunities for improvement.

Methods: In a retrospective cohort study, we screened 5 months of ID consult data for patients who left on OPAT from an urban hospital system. Primary outcome was incidence of adverse event (AE), a composite of either emergency department (ED) visit or all-cause 30-day readmission. Clinical characteristics and completeness of ID documentation were compared between patients with and without an AE. Complete documentation included antibiotic dose, duration, stop date, and a scheduled ID appointment. We simultaneously conducted a 6-sigma analysis involving stakeholders (physicians, case managers, nurses) in focus groups, to generate a process map, Ishikawa diagram, 5-Why's analysis, and identify heterogeneity in our OPAT process.

Results: Fifty of 441 patients (11.3%) were discharged on OPAT and incidence AE was 30%. Neither type of infection, nor demographics, clinical characteristics, or discharge location differed between groups. Only half (50%) of the patients had complete documentation. Median time from discharge to clinic was 21 days, however, AE's occurred in a median time of 12 days. Patients without an AE were more likely to have been seen in the clinic post-discharge (51% versus 20%, p=0.039). ID clinic appointments were made for 60% of patients, with a show rate of 63%. Two additional unscheduled patients initiated their own visit. The 6-Sigma analysis identified process heterogeneity at discharge location and over-reliance on human memory for complete documentation. Interestingly, focus groups revealed numerous assumptions not supported by the objective data.

Conclusions: Almost 1 in 3 patients leaving on OPAT experienced an adverse event. A 6 Sigma analysis identified heterogeneity in our process and incorrect assumptions among stakeholders. Next steps should focus on improving ID documentation and ensuring all patients leaving on OPAT have an ID clinic visit scheduled within 14 days after discharge.

Monkeypox virus (MPXV) is a DNA virus from the Orthopoxvirus genus, sharing significant genomic similarity with the variola virus that causes smallpox. The cessation of smallpox vaccinations has contributed to recent Mpox outbreaks, with reduced immunity levels, particularly in younger populations born after the vaccine was discontinued. The virus triggers innate and adaptive immune responses, with toll-like receptors (TLRs) playing a key role in recognizing viral components and activating proinflammatory cytokines. However, MPXV evades the immune system by producing proteins that inhibit immune signaling pathways. Natural killer (NK) cells and interferons are crucial for early defense, but MPXV impairs their function. Adaptive immunity involves robust antibody and T-cell responses, similar to smallpox vaccination responses. Various mRNA-based candidate vaccines have demonstrated strong immunogenicity, with preclinical studies confirming their ability to trigger potent B-cell and T-cell responses. However, the genetic changes observed in the current outbreak strains necessitate ongoing surveillance of MPXV mutations and their impact on immunogenic proteins. This review aimed to summarize current insights into antigen recognition and immune responses to MPXV, with a focus on key antigenic proteins relevant to vaccine development.

Objectives: To assess the prevalence and identify risk factors associated with smear-positive tuberculosis (acid-fast bacilli [AFB]-positive) in newly diagnosed patients in Vietnam.

Methods: A retrospective study was conducted on patients newly diagnosed with pulmonary tuberculosis (PTB) from August 2023 to August 2024. Patients were classified as smear-positive if at least one respiratory sample tested positive with AFB before starting anti-tuberculosis treatment. Smear-negative individuals had to submit a minimum of two sputum samples, all of which had to test negative before treatment initiation.

Results: 379 PTB patients were included with 48.3% being AFB-positive. The proportion of hemoptysis was significantly higher in AFB-positive than in AFB-negative patients (9.8% versus 4.1%, p=0.04). AFB-negative patients had a significantly higher rate of fatigue and crackles compared to AFB-positive patients with 85.7% versus 77.0%, p=0.03 and 36.2% versus 25.7%, p=0.03, respectively. Cavitary lung lesions were significantly more common in AFB-positive patients (48.6% versus 29.1%, p<0.0001). In multivariate analysis, patients with diabetes mellitus and those with long-term corticosteroid use were respectively three times and six times more likely to be AFB-positive (OR=2.71, p=0.002 and OR=6.15, p=0.009) more likely to. Cavitation in chest-x-ray was also associated with 2.5 times of risk for smear-positive (OR=2.53, p <0.0001). All of three HIV-coinfected patients were AFB-negative.

Conclusion: Our findings emphasize the importance of screening and early diagnosis of PTB in individuals with diabetes mellitus and in those on long-term corticosteroid therapy. Strengthening TB control efforts, particularly among high-risk populations, is crucial to reducing the burden of smear-positive TB and preventing further transmission.

Strongyloides stercoralis (SS) is an intestinal parasite that can cause chronic asymptomatic infections, but in rare cases, it can progress to hyperinfection syndrome (SHS). This report describes a case of SHS associated with deep vein thrombosis and pulmonary thromboembolism, a rare manifestation in an immunocompetent patient. A 19-year-old female patient with a 15-day history of abdominal pain, progressive edema of the lower limbs, hemoptotic cough, asthenia, and weight loss. During her hospitalization, she developed sudden dyspnea, desaturation, and distributive shock, requiring invasive mechanical ventilation. Pulmonary angiotomography showed pulmonary thromboembolism, and deep vein thrombosis was diagnosed. Bronchoscopy revealed alveolar hemorrhage, while bronchoalveolar and duodenal lavage confirmed the presence of SS. Ivermectin and albendazole were started with full-dose anticoagulation for the thrombotic event. After one week of management, bronchoalveolar lavage results were negative, and the patient showed significant improvement with no long-term complications. SHS is rare in immunocompetent patients, and its association with thrombosis has been poorly documented in the literature. This case emphasizes the importance of early diagnosis and timely management to avoid life-threatening complications. It also highlights the need for surveillance in endemic regions and the appropriate use of evidence-based therapeutic strategies.

Introduction: Nocardiosis is a common cause of pneumonia in immunocompromised individuals. Limited data regarding its epidemiology, clinical presentations, and outcomes in India are available. This systematic review analysed the clinical profile and outcomes of pulmonary nocardiosis in India.

Methods: We systematically reviewed individual cases of culture-confirmed pulmonary nocardiosis from India published between January 1960 and May 2024 using the PubMed, Embase, and Web of Science databases. Studies lacking microbiological confirmation or detailed clinical data were excluded. Descriptive statistics were used to summarise demographic, clinical, and microbiological data, while chi-square and t-tests assessed differences between mortality and survival groups.

Results: The review included 109 cases from 67 studies. Male predominance (74.1%) was observed, with a mean age of 49.6 ± 16.9 years. Diabetes (26.6%), steroid use (51.4%), and chronic lung disease (37.8%) were key risk factors. Nocardia otitidiscaviarum (38.4%) was the most common species identified. Mortality was noted in 26% of the patients. Cotrimoxazole resistance and lack of cotrimoxazole use for treatment were associated with mortality.

Conclusions: Pulmonary nocardiosis presents diagnostic and therapeutic challenges in India, with high resistance rates and significant mortality. Improved diagnostic methods and region-specific treatment strategies are essential.

Latin America has reported a 9% increase in new HIV infections from 2010 to 2023. Pre-exposure prophylaxis (PrEP) is a crucial biomedical intervention for preventing HIV transmission. Currently, several antiretroviral drugs, in various forms of administration, have demonstrated high efficacy and effectiveness to protect against HIV. Among the oral drugs, we have emtricitabine/tenofovir and emtricitabine/tenofovir alafenamide, while alternative options include the dapivirine vaginal ring, injectable drugs such as Cabotegravir, and the most recently studied Lenacapavir. Despite their high efficacy and effectiveness, implementing PrEP in Latin America has been challenging throughout the region. Although some countries such as Brazil, Mexico, and Colombia have shown progress in increasing the number of users, there is a significant gap between these countries and others where PrEP access remains limited or non-existent. Barriers such as lack of awareness, inadequate funding, political instability, and outdated policies contribute to disparities in access, leaving many populations at high risk of HIV infection without this preventative measure. Innovative strategies need to be implemented to address and monitor policies that ensure access for all at-risk populations.

Antimicrobial resistance (AMR) is an emerging global threat. It increases mortality and morbidity rates and places a heavy burden on healthcare systems. Healthcare professionals can address the increasing issue of AMR by advocating responsible antibiotic use and supporting the development of new medications. Despite the economic, logistic, and scientific challenges, it is reassuring that new agents continue to be developed. This review addresses new antibiotics in the pipeline. A review of the literature was conducted including Medline, and Clinicaltrials.org, for approved and in pipeline antibiotics in phase 3 or new drug applications (NDA). We found several new antibiotics and reviewed their current development status, mode of action, spectra of activity, and indications for which they have been approved. The included studies from phase 3 clinical trials were mainly utilized for the treatment of acute bacterial skin and skin structure infections, community-acquired bacterial pneumonia, and pneumonia acquired in healthcare settings. The availability of these agents is limited for high-priority organisms. The identified antibiotics were primarily based on previously known molecules or pre-existing antimicrobial agents. There is a limited number of antibiotics against high priority organisms. New antimicrobial agents targeting the top-priority organisms identified by the World Health Organization are urgently needed. However, some antibiotics target ESBL-producing Enterobacterales, carbapenem-resistant Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa.