Canadian Journal of Infectious Diseases & Medical Microbiology最新文献

Objective: To investigate if red blood cell distribution width (RDW) is a risk factor for hospital mortality in patients admitted to a public university hospital in Belo Horizonte, Minas Gerais, Brazil. Methods: This observational prospective study included patients over 16 years who had been hospitalized for COVID-19 between May and October 2020. A descriptive and time-to-death analysis was performed using the Cox proportional hazards model. Results: Of the 161 patients included, 39 (24.2%) died during hospitalization. A total of 2227 blood counts were performed, an average of 13.8 tests per patient (standard deviation, SD 2.9). Upon admission, the RDW was normal (11.5% to 14.6%) in 115 patients (71.4%), elevated in 45 (28%), and low in 1 (0.6%). The mean RDW value at admission was 14.5 (SD 2.4), which falls within the normal reference range. Of the patients with normal RDW at admission, 82 (71.3%) maintained normal levels throughout their stay, while 33 (28.7%) showed increased RDW levels over time. Among those with elevated RDW at admission, 40 (88.9%) remained elevated, while 5 (11.1%) returned to normal levels. There was no significant difference in the mean RDW value at admission between survivors and nonsurvivors (14.4 [SD 2.4] for survivors vs. 14.9 [SD 2.4] for nonsurvivors; p=0.2081). The risk for mortality in the group with high RDW upon admission was higher than in the group with normal RDW, but without statistical significance (31.1% vs. 21.7%; RR = 1.43; p=0.413). When performing a multivariate analysis, the following continue to be risk factors for lower survival: age > 70 years, HR 4.8 (95% CI: 2.3; 10.3), p < 0.001; white race, HR 3.2 (95% CI: 1.2; 8.61), p=0.018; and need for invasive MV, HR 3.8 (1.7; 8.7), p=0.001. The presence of a chest X-ray suggestive of COVID-19, HR 3.5 (95% CI: 1.0; 11.5), p=0.044, also appears to be a risk factor in this analysis. Conclusion: Alterations on RDW values on admission were not associated with higher mortality, and further increases in RDW during hospitalization were not linked to a higher risk of mortality across all age groups. Our findings suggest that while RDW may indicate disease severity, it may not serve as a reliable independent predictor of mortality when other factors are accounted for in this cohort.

Background: Limited public knowledge of antimicrobial agents contributes to their misuse and antimicrobial resistance (AMR). Objective: This study aimed to assess the intentions of healthcare students and professionals in promoting public awareness and understanding of AMR. Methods: A 31-item survey based on the theory of planned behavior (TPB) and the health belief model was developed, incorporating intention, attitudes, subjective norms, perceived behavioral control, and perceived benefits. The survey aligned with global and national AMR action plans and was distributed among healthcare professionals and students in Al-Jouf, Saudi Arabia, via Google Forms. Responses were analyzed using frequencies, percentages, correlations between constructs, and ordinal logistic regression to assess significant associations between intention and other variables. Results: A total of 572 participants completed the survey, comprising 59.4% males and 40.6% females. Over one-third were younger individuals, and about one-third were undergraduate students or had less than 5 years of experience. Most respondents (74%) expressed an intention to educate the public on AMR, with a median intention score of 24 (out of 30). Intention showed strong positive correlations with past behavior (r = 0.703), subjective norms (r = 0.695), perceived behavioral control (r = 0.690), and perceived benefits (r = 0.683), while attitudes had a weak correlation (r = 0.122). Attitudes also had low correlations with other constructs (r = 0.137-0.278). Among predictors, subjective norms significantly influenced intention (p < 0.001), while other factors showed no significant predictive relationship. Conclusion: Healthcare students and professionals exhibited a strong inclination toward educating the public on responsible antimicrobial use and AMR. The findings underscore the complex interplay of factors influencing this intention, with subjective norms playing a key role, highlighting the impact of social pressure. Identifying these contributing factors can inform targeted strategies for healthcare professionals and students, enabling broader educational outreach and strengthening AMR control efforts.

Rickettsiosis infections pose a significant public health concern in Sarawak, Malaysia. Despite their importance, these infections remain poorly recognised, under-researched and inadequately documented within the context of the Sarawak region. This comprehensive evaluation seeks to address this knowledge gap by providing an in-depth analysis of Rickettsioses in Sarawak, focussing on four main aspects: the vectors and reservoirs of Rickettsioses, transmission dynamics and risk factors, existing challenges and public health implications and control strategies and future directions for raising awareness. Between 2013 and 2023, eleven Rickettsiosis cases were reported across seven districts in Sarawak. Three Rickettsial groups, namely, spotted fever group, typhus group and scrub typhus, have been identified in the region and linked to their respective arthropod vectors and vertebrate reservoirs. Although the overall number of confirmed Rickettsial infections in Sarawak remains relatively low, the detection of cases in both urban centres and smaller towns within rural areas raises concern regarding potential spread and under-recognition of these infections. This review underscores the urgent need to enhance regional awareness, strengthen disease surveillance and encourage focused research to bridge existing knowledge gaps. Developing evidence-based strategies for early detection, vector control and public health education will be crucial for preventing future outbreaks and safeguarding the health and well-being of communities throughout Sarawak.

Background: Improper maintenance of water used for hemodialysis poses a serious risk for patients by allowing the growth of biological contaminants like Candida species in the water system. These contaminants can be transmitted to patients through hemodialysis, exposing them to an increased risk of candidiasis. The objective of this study was to determine the antifungal susceptibility profile of Candida species isolated from water treatment units and urine from patients undergoing hemodialysis at GHY and UTHY in Yaounde, Cameroon. Methods: This cross-sectional descriptive study was conducted from February 2024 to May 2024. Urine samples were collected from 132 consenting hemodialysis patients using a questionnaire, cultured on Sabouraud plus chloramphenicol agar. Water samples were collected every two days from different sites in the hemodialysis circuits; input, pretreatment, reverse osmosis (RO), RO output of both hospitals, filtered through membranes deposited on SC, and incubated at 35°C-37°C. Positive samples were cultured on CHROMagarTM to identify Candida species, which were tested against antifungals. SPSS V29.0.1.0 and Excel 2019 were used for statistics. Results: Of the patients, 17 (12.88%) had candiduria with C. auris (35.30%) most prevalent. Of 180 water samples, C. tropicalis (44.4%) was isolated from input water, while C. glabrata (22.2%) and C. parapsilosis (22.2%) were found in input and pretreated water. C. albicans (11.1%) was isolated at the RO output. Antifungal susceptibility testing of 35 Candida isolates showed that water isolates of C. glabrata, C. parapsilosis, and C. albicans were 100% susceptible to fluconazole and ketoconazole. C. tropicalis from water exhibited resistance to fluconazole. C. auris from urine was resistant to all antifungals tested. None were susceptible to itraconazole or amphotericin B. Conclusion: This study emphasizes the critical need for rigorous maintenance and monitoring of water used in hemodialysis to prevent transmission of antifungal-resistant Candida to vulnerable patients.

Background: The global impact of COVID-19 has presented challenges to health systems, affecting both physical and psychological well-being. Nonhospitalized patients, constituting the majority, can benefit from pulmonary rehabilitation through breathing exercises. This study aims to evaluate the effect of breathing exercises delivered via social media on the general health of nonhospitalized individuals with mild COVID-19. Methods: In a randomized controlled trial conducted at university hospitals, ninety patients aged 18-65 without prior respiratory or other specified disorders were included. The intervention group learned breathing exercises from online videos on Instagram, while the control group received brochures. Both groups practiced 6 days a week for three sessions a day. Results were evaluated using General Health Questionnaire (GHQ-28), Patient Health Questionnaire (PHQ-15), Barthel Index (BI), and Visual Analogue Scale (VAS). Results: Both groups improved significantly in terms of GHQ-28 and all of its subscales, PHQ-15, and VAS (p-value < 0.05), but none achieved significant improvements in BI (p-value > 0.05). The effect size was large in all criteria except for GHQ-28 depression symptoms in the Online group (Cohen's d = 0.347; 95% CI 0.103, 0.59), and GHQ-28 anxiety/insomnia (Cohen's d = 0.794; 95% CI 0.494, 1.095) and GHQ-28 depression symptoms (Cohen's d = 0.453; 95% CI 0.135, 0.771) in the Brochure group. The differences between the Online and Brochure groups were insignificant in all assessed criteria (p-value: GHQ-28 = 0.231; PHQ-15 = 0.166; VAS = 0.385; BI = 0.165). Conclusions: Breathing exercises through social media and brochures significantly improve physical and psychological aspects in mild COVID-19 patients. While comparison with face-to-face interventions was not possible, the results are promising, encouraging physicians to consider this intervention, especially for underdeveloped countries and patients facing access barriers. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20201204049600N1.

Background: This study evaluated the efficacy and safety of vancomycin (VAN) or daptomycin (DAP) combined with β-lactams (BLs) versus monotherapy (STAN) for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Methods: PubMed, Web of Science, Embase, and Cochrane Library were searched until September 30, 2024, for RCTs or cohort studies comparing combination therapy (COMBO) and STAN in adult MRSA bacteremia. Outcomes included all-cause mortality, 30-day mortality, clinical failure, and safety. Subgroup and trial sequential analyses were performed. Results: Among 22 studies (3214 patients), the COMBO group did not reduce all-cause mortality (RR = 1.16, 95% CI: 0.91-1.48, p=0.24) and 30-day mortality (RR = 1.18, 95% CI: 0.86-1.62, p=0.31). Subgroup analyses suggested increased all-cause mortality in high-quality studies (RR = 1.29, 95% CI: 1.00-1.67, p=0.05). Additionally, when VAN/DAP was administered randomly, COMBO was associated with higher all-cause mortality (RR = 1.37, 95% CI: 1.05-1.78, p=0.02) and 30-day mortality (RR = 1.41, 95% CI: 1.01-1.96, p=0.02). However, the COMBO reduced clinical failure rate (RR = 0.78, 95% CI: 0.65-0.93, p=0.006), persistent bacteremia (RR = 0.70, 95% CI: 0.54-0.92, p=0.01), and relapsed bacteremia (RR = 0.62, 95% CI: 0.48-0.80, p=0.0003). No differences were observed in the microbiological failure rate, duration of bacteremia, or length of hospital stay. Furthermore, the COMBO group showed no significant increase in the incidence of acute kidney injury (AKI). Conclusions: COMBO did not lower mortality in MRSA bacteremia and may increase risk in certain subgroups. However, it improved microbiological outcomes without raising AKI risk. However, these microbiological advantages must be weighed against two concerning findings: a nonsignificant trend toward increased Clostridium difficile infection (CDI) risk and elevated mortality signals in high-quality subgroup analyses. Given conflicting mortality signals, cautious clinical application and further RCTs are needed.

The clinical challenge of staphylococcal treatment is increasing globally, making it critical to find effective strategies to hinder the spread of resistant isolates, particularly methicillin-resistant Staphylococcus aureus (MRSA). Niosomal drug delivery systems, known for their controlled release profiles and other advantageous features, can enhance the efficacy of antimicrobial ability of loaded agents. This study aims to propose a novel drug delivery system for combating staphylococcal resistance challenge through examining the antibacterial and antibiofilm properties of myrtenol-loaded niosomal system against MRSA isolates. The niosomal formulation was prepared using the thin-film hydration process, and its physicochemical characteristics were assessed through entrapment efficiency (EE %), in vitro release profile, field-emission scanning electron microscopy (FE-SEM), and dynamic light scattering (DLS). In addition, minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) were measured and compared with free myrtenol to evaluate the anti-MRSA activity of the formulated niosomal myrtenol. Furthermore, the effectiveness of niosome containing myrtenol against MRSA biofilms was investigated by examining biofilm minimum inhibitory and eradication concentrations (BMIC/BMEC). Additionally, the cytotoxicity of synthesized niosomes was assessed on the human foreskin fibroblast cell line (HFF). Results from FE-SEM showed that myrtenol-loaded niosomes were spherical with a diameter of 122.1 nm, while the hydrodynamic size reported from DLS was 130.8 nm. The surface charge and EE% of the prepared niosomal formulation were -53.6 mV and 62.90%, respectively. The niosomal myrtenol formulation demonstrated the increased antibacterial activity in comparison with free myrtenol formulation. Furthermore, myrtenol-loaded niosomes reduced the biofilm formation potential in all MRSA isolates and effectively eradicated bacterial biofilms at equivalent concentrations of the non-niosomal formulation. According to this study, niosomes exhibit high potential for drug delivery due to several favorable characteristics, including a sustained-release profile, nontoxicity, small size, and high EE%. Niosomal delivery system presents a novel approach to combat bacterial infections, particularly those caused by MRSA isolates by enhancing antibacterial and antibiofilm activities of free myrtenol.

Background: This study aims to determine the molecular features and antimicrobial resistance of Streptococcus agalactiae (Group B streptococcus, GBS) causing invasive and noninvasive infections in Korean adults. Methods: Sequence type (ST), capsular serotype, pilus island typing, and antimicrobial susceptibility were analyzed for GBS isolates obtained at a hospital laboratory that processed the primary clinical specimens collected from Korean adults between 2021 and 2024. Results: Among the 90 isolates, Serotype VIII (34.4%) was the most common, followed by V (17.8%), Ia (12.2%), VI (11.1%), II (10.0%), and Ib (6.7%). Every isolate contained at least one PI gene, of which PI2a (37.8%) was the most frequently observed combination. The combination of PI1 and PI2b was present in 34.4% of isolates, followed by PI1 and PI2a (24.4%) and PI2b alone (3.3%). Among the 18 STs identified, the capsular serotype VIII/ST2-clonal complex 1 (CC1) was dominant (34.4%), followed by V or VI/ST1 (12.2%). All isolates were susceptible to both ampicillin and vancomycin, while antibiotic resistances were observed for erythromycin (27.8%), levofloxacin (13.3%), clindamycin (25.6%), and tetracycline (47.8%), respectively. Conclusions: These data are key elements to help design prevention and treatment strategies for GBS infection in Korean adults.

Background: Cyclospora cayetanensis, an opportunistic protozoan parasite, poses significant risks to immunocompromised patients, including those with cancer, transplants, or on hemodialysis. The aim of this study was to determine the pooled prevalence of C. cayetanensis in immunocompromised individuals (cancer, transplant, and hemodialysis) and assess the associated risk factors compared to nonimmunocompromised controls. Methods: A comprehensive search of international databases was conducted for studies published up to October 18, 2024, focusing on cross-sectional and case-control studies that reported Cyclospora cayetanensis prevalence in immunocompromised patients. Comprehensive meta-analysis (CMA) software was used to calculate pooled prevalence and odds ratios (ORs), with random-effects models applied to account for heterogeneity based on statistical thresholds. Sensitivity analysis was performed to assess the robustness of pooled prevalence and weighted ORs. Meta-regression analysis was used to evaluate associations between prevalence and variables such as publication year, sample size, and the Human Development Index (HDI). Subgroup analyses were conducted based on geographical regions, publication years, sample sizes, HDI values, income levels, and patient types. This systematic review included 19 studies/22 datasets, comprising 2084 immunocompromised patients and 954 controls across eight countries. Results: The pooled prevalence of C. cayetanensis in immunocompromised patients was 4% (95% CI: 2.1%-7.2%), significantly higher than the 1.2% (95% CI: 0.4%-3.4%) in controls, resulting in an OR of 5.4 (95% CI: 2.6-10.8, p < 0.001). Transplant recipients exhibited the highest pooled prevalence of C. cayetanensis at 5%, indicating the importance of targeted screening and preventive measures for this high-risk group. Conclusions: Despite the relatively low pooled prevalence of C. cayetanensis infection in immunocompromised patients, its notable occurrence compared to controls and its opportunistic nature underscore the need for enhanced surveillance and targeted prevention strategies, especially in high-risk populations and regions with higher exposure.

Introduction: As the Coronavirus Disease-2019 (COVID-19) pandemic intersects with the ongoing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) crisis, concerns have emerged regarding the susceptibility of people living with HIV/AIDS (PLWH) to severe outcomes from COVID-19. Despite global efforts to understand the interplay between HIV/AIDS and COVID-19, research on this issue remains limited in Türkiye. This study investigates the incidence of COVID-19 among PLWH in Türkiye and factors influencing infection risk. Materials and Methods: An online survey, conducted from April to June 2023, assessed COVID-19 frequency and risk factors among PLWH aged 18 years and older in Türkiye. Demographic data such as age, gender, educational background, underlying health conditions, vaccination status, and COVID-19 infection history were collected from individuals who voluntarily participated. Results: A total of 354 PLWH from 38 cities in Türkiye participated in the study. The median age was 35.8 (range 18-76); 78% were male and 65.5% were university graduates. The rate of experienced COVID-19 among PLWH was 44.6%. Logistic regression analysis revealed that vaccinated individuals had an 84% lower risk of contracting COVID-19 among PLWH. In sum, 80 participants were not vaccinated in this study; of them, 27.5% identified as vaccine opponents and 25% expressed vaccine hesitancy. Discussion: These findings suggest that vaccination status is the key determinant of COVID-19 susceptibility among young and well-educated PLWH in Türkiye. The notable level of vaccine hesitancy and opposition of PLWH highlights the need for public health initiatives aimed at addressing misinformation and enhancing vaccine confidence. Conclusion: This study underscores the urgent need to address vaccine hesitancy and vaccine opposition among educated PLWH in Türkiye. Amid evolving SARS-CoV-2 variants, vaccination remains paramount in mitigating COVID-19 risks among PLWH. Further research should delve deeper into demographic-specific vaccine concerns to optimize public health strategies and meet the unique needs of PLWH communities.