Canadian Journal of Infectious Diseases & Medical Microbiology最新文献

COVID-19, caused by the SARS-CoV-2 virus, is not only characterized by respiratory symptoms but is also associated with a wide range of systemic complications, including significant hematologic abnormalities. This is a comprehensive review of the current literature, using PubMed and Google Scholar, on the pathophysiology and incidence of thromboembolic events in COVID-19 patients and thromboprophylaxis. COVID-19 infection induces a prothrombotic state in patients through the dysregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, elevated von Willebrand factor (vWF), and a dysregulated immune response involving the complement system and neutrophil extracellular traps (NETs). As a result, thromboembolic complications have emerged in COVID-19 cases, occurring more frequently in severe cases and hospitalized patients. These thrombotic events affect both venous and arterial circulation, with increased incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), systemic arterial thrombosis, and myocardial infarction (MI). While DVT and PE are more common, the literature highlights the potential lethal consequences of arterial thromboembolism (ATE). This review also briefly examines the ongoing discussions regarding the use of anticoagulants for the prevention of thrombotic events in COVID-19 patients. While theoretically promising, current studies have yielded varied outcomes: Some suggest potential benefits, whereas others report an increased risk of bleeding events among hospitalized patients. Therefore, further large-scale studies are needed to assess the efficacy and safety of anticoagulants for thromboprophylaxis in COVID-19 patients.

Introduction: Bacterial infections exhibit seasonal variation, particularly in respiratory pathogens; however, whether similar trends exist for bacterial infections and resistance in Japan is unclear. This study examined seasonal and annual patterns of bacterial isolation rates and antimicrobial resistance in Japanese hospitals, utilizing data from the Ministry of Health, Labour, and Welfare's Nosocomial Infection Control Surveillance Project (JANIS) between 2014 and 2020. Methods: Data from JANIS included isolation rates and antimicrobial resistance for four bacterial species: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. We modeled seasonal and annual trends using a generalized autoregressive conditional heteroskedasticity (GARCH) (1, 1) model, controlling for hospital size. Analyses examined seasonal and annual trends in isolation rates and resistance patterns, including methicillin-resistant S. aureus (MRSA), multidrug-resistant P. aeruginosa (MDRP), and carbapenem-resistant P. aeruginosa (CRPA), among others. Results: The isolation rate of S. aureus decreased annually, with the most pronounced decline observed from the second to the fourth quarters, particularly in smaller hospitals. The isolation rates of E. coli and K. pneumoniae increased annually, with significant seasonal peaks in the third and fourth quarters. Antimicrobial resistance showed annual declines for MRSA, MDRP, and CRPA, particularly in smaller hospitals. However, resistance rates for third-generation cephalosporin-resistant E. coli and K. pneumoniae increased during the study period. Conclusion: This study demonstrates the distinct seasonal and annual trends in bacterial isolation and antimicrobial resistance in Japan. Smaller hospitals showed higher resistance rates, likely because of limited antimicrobial stewardship resources, underscoring the need for targeted interventions in these settings. These findings highlight the importance of monitoring seasonal patterns in bacterial infections and resistance to inform effective infection control and antimicrobial stewardship strategies.

Background: Occupational needle stick and sharp injuries (NSSIs) are significant public health concerns in the healthcare systems of developing countries. In Ethiopia, healthcare facilities commonly underreport these incidents. Therefore, this study aimed to assess occupational exposure to NSSIs and utilization of postexposure prophylaxis (PEP) among healthcare professionals at Mizan-Tepi University Teaching Hospital (MTUTH) in southwest Ethiopia. Methods: A cross-sectional study was conducted among 196 healthcare professionals from September 1 to 15, 2021, at the MTUTH in southwest Ethiopia. The data were collected using a self-administered questionnaire. SPSS Version 21 was used for the data entry and analysis. Logistic regression was employed to identify the factors associated with the dependent variable, with significance set at p < 0.05. Results: The magnitude of NSSIs was 18.9% (n = 37/196; 95% CI 13.4%, 24.4%). The proportion of injured participants who underwent PEP was 43.2% (n = 16/37). Being married [AOR = 2.89, 95% CI (1.11, 7.48)] and not undergoing infection prevention (IP) training [AOR = 4.32, 95% CI (1.40, 13.4)] were associated with an increased likelihood of NSSIs. Conversely, having good knowledge of IP [AOR = 0.17, 95% CI (0.07, 0.42)] was linked to a decreased likelihood of NSSIs. Conclusion: Approximately one in five healthcare professionals experienced NSSIs. Factors associated with NSSIs include being married, receiving IP training, and possessing knowledge of IP. These findings underscore the importance of comprehensive IP training to enhance awareness of IP. Such interventions are critical for minimizing NSSIs and ensuring the safety of healthcare personnel.

Background: Brucellosis typically spreads from animals to humans through contact with infected animals or their byproducts. This zoonotic disease can have serious consequences and is often caused by contact with infected livestock or their products, such as contaminated dairy, posing significant risks during pregnancy. This study aimed to evaluate the prevalence of Brucella infection among pregnant women residing in the Burao City area of northeast Somaliland, in environments where human-animal interaction is a frequent occurrence. Therefore, it is important to identify the factors that contribute to its occurrence. Methods: From January to June 2024, this cross-sectional study was conducted at five healthcare facilities that provide antenatal care. Pregnant women who attended these facilities were invited to participate in this study. A structured questionnaire was used to collect data on sociodemographic background, obstetric history, behaviors, and practices related to brucellosis. The presence of Brucella antibodies in the serum was detected using the Rose Bengal Plate Test (RBPT), and positive samples underwent further analysis with enzyme-linked immunosorbent assays (ELISA) to distinguish between IgG and IgM antibodies. Bivariate analysis was conducted to identify variables associated with Brucella seropositivity, whereas multivariable logistic regression was used to determine independent factors linked to Brucella seropositivity after adjusting for other variables. Results: A total of 216 participants were included in the study. The overall prevalence of Brucella infection, determined using the RBPT, was 25.93% (56 out of 216). Among those who tested positive, 61.14% (34 out of 56) had IgG antibodies and 21.42% (12 out of 56) had IgM antibodies against Brucella, as confirmed by ELISA, and IgM ELISA testing revealed 5.6% of pregnant women had recent Brucella infections. Brucella seropositivity was found to be less likely for individuals who frequently interacted with manure, as indicated by an adjusted odds ratio of 0.052 and a 95% confidence interval of 0.016-0.169. Consumption of raw animal milk (AOR 4.84, 95% CI 2.24-10.42), and involvement in assisting animals during childbirth (AOR 4.26, 95% CI 1.065-17.0) significantly increased the risk of Brucella seropositivity. Conclusion: Brucellosis poses a considerable public health threat to pregnant women residing in areas with frequent human-animal interactions. Factors such as the consumption of raw animal products, intimate contact with animals, and involvement in assisting with animal birth escalate this risk. These findings emphasize the importance of implementing strategies aimed at reducing exposure and enhancing the timely detection of brucellosis among pregnant women.

Background: Postoperative complications in individuals with a prior history of COVID-19 infection have been insufficiently investigated. This study is conducted to explore the postoperative complications of prostate biopsy in patients following a COVID-19 infection. Materials and Methods: Data from individuals who underwent a prostate biopsy at a tertiary hospital in Taizhou city from 1 February to 15 November 2023 were collected, including a history of COVID-19 infection, a history of chronic disease, and postoperative complications of prostate biopsy. Results: A total of 526 participants were enrolled in the study, with 325 individuals having a prior history of COVID-19 infection. The interval between infection and prostate biopsy was 29.25 ± 12.75 weeks, with a fluctuation range from 0.71 to 87.57 weeks. In individuals with a history of COVID-19 infection, 72 were asymptomatic, 110 experienced respiratory symptoms, and 145 had fever. In total, 198 patients reported postoperative complications, which showed no statistically significant difference with a history of COVID-19 infection (p=0.217). The top three reported postoperative complications were hematuria, perineal pain, and urinary retention, which tended not to be related to a history of COVID-19 infection (p=0.448, p=0.991, and p=0.277, respectively). Conclusion: The incidence of postoperative complications of prostate biopsy in post-COVID-19 patients, who currently have no symptoms of COVID-19 infection, was comparable to patients with no history of COVID-19 infection. In clinical practice, for males with a history of controlled COVID-19 infection, the risk of postoperative complications from prostate biopsy should not be a major concern.

Introduction: Hand, foot, and mouth disease (HFMD) is a mild self-limited childhood infectious disease caused by a variety of enteroviruses (EVs). Aim: To investigate the molecular epidemiology of EVs associated with HFMD and their clinical presentation during the HFMD outbreak that occurred in the Jenin district, Palestine, from May to August 2024. Materials and Methods: Forty-four (44) throat and vesicular swabs were tested for enteroviral infections using two RT-PCR assays targeting both the 5'NTR and the VP1-2A regions of the enteroviral genome for the diagnosis and genotyping. Patients' demographic data and clinical history were used to create an epidemiological curve. EpiInfo free software was used to draw a cluster mapping. MEGA-X was used to construct a maximum likelihood (ML) tree. PopArt 1.7 software was used to construct neighbor-joining network. Results: The mean age of the study sample was 2.08 (0.25-12 years) with 95% (42/44) under five years old. The male/female ratio was 0.9. All cases presented with typical HFMD signs and symptoms with variable sites of signs. Of the 44 samples, 36 yield positive RT-PCR targeting the 5'NTR. Seven randomly selected positive RT-PCR-5'NTR samples were sequenced using Sanger sequencing for genotyping. It was shown that all were CV-A16 sub-genogroup B1c. Phylogenetic analysis of VP1-2A region sequences showed that all Palestinian CV-A16 isolates form a pure haplogroup of CV-A16 sub-genotype B1c. Furthermore, although haplotype network analysis showed high variation between the viral sequences, the haplotype analysis supported the ML phylogenetic tree in having them all in one haplogroup. Conclusion: CV-A16, sub-genotype B1c was the virus responsible for the HFMD outbreak in the Jenin district of Palestine in the summer of 2024. Phylogenetic and haplotype analysis showed that CV-A16 strains cluster closely with each other and very close to an Indian isolate (OR437338.1), indicating the monomorphic nature of this strain with low genetic variation and the probability of virus importation.

Long-read sequencing is a valuable technique for high-precision genome analysis. Despite the widespread use of the Mycobacterium tuberculosis H37Rv genome sequence as a reference for genetic variation analysis, its suitability for comparing clinical strains is limited. Therefore, we constructed the first known whole genome of a clinical M. tuberculosis strain, PSNK363, isolated from the Democratic People's Republic of Korea, using high-quality high-fidelity (HiFi) read sequencing and compared its genetic variations to those of H37Rv. PSNK363 was cultured to obtain genomic DNA, which was subjected to de novo whole-genome assembly using PacBio Sequel II with long-read HiFi sequencing. The sequences were compared to the reference genome H37Rv. HiFi long-read sequencing of M. tuberculosis PSNK363, with an accuracy of 99.99%, revealed a single circular chromosome of 4,422,110 bp, which is 10,578 bp longer than the H37Rv chromosome. The assembly had an average G + C content of 65.6%, 4079 protein-coding sequences, 53 tRNA genes, and 3 rRNA genes. Most genes (72.7%) were assigned as putative functions, whereas the remaining 27.3% were annotated as hypothetical. Comparison with H37Rv revealed a large inversion in the PSNK363 genome, which contains most of the deletion and insertion variants. M. tuberculosis PSNK363 had a longer genome sequence, more protein-coding genes, and a larger inversion region than H37Rv. High-accuracy whole-genome sequencing of PSNK363 holds the potential for enriching virulence databases and identifying informative loci for drug resistance analysis in M. tuberculosis isolates in the Democratic People's Republic of Korea.

Coagulase-negative staphylococci (CoNS) are the major pathogen (hospital as well as environmental) and their emerging multidrug-resistant (MDR) strains complicate the treatment process. In this study, we investigated the prevalence and antibiotic resistance of CoNS on frequently touched surfaces in hospital and urban built environments (UBEs) in Vidarbha, Maharashtra, India. A total of 200 isolates screened for Staphylococcus species and 55 methicillin-resistant staphylococci isolates were identified, and among them, 19 were classified as cefoxitin-resistant CoNS. These 19 cefoxitin-resistant CoNS isolates were tested for the presence of the mecA gene by conventional PCR and only nine (47.36%) were found to be mecA-positive. mecA-positive strains were tested to check MIC for various antibiotics and three marker gene characteristics, namely, ß-lactamase, cefoxitin screen, and inducible clindamycin resistance via the VITEK 2 system. These strains were 100% resistant to benzylpenicillin and oxacillin, and approximately 50% were resistant to vancomycin. Amplified mecA gene fragments were sequenced, and SNP analysis was performed alongside a standard sequence from Staphylococcus aureus (Acc no. NG_047938.1). In total, among the 466 nucleotides, 386 sequences were found to be invariable, and 80 polymorphic variables were identified (46 singleton variable sites and 34 parsimony information sites). The spread of antibiotic resistance is very common in both UBEs and hospital environments; thus, our study concluded that a surveillance program is recommended for the Vidarbha region for the assessment of co-occurring CoNS and better infection control of the environment for future reduction in contact infection.

Background: Very few studies have characterized patients with myocardial injury due to Klebsiella pneumoniae bloodstream infections (KP-BSI). Our study aimed to investigate the clinical characteristics, risk factors and outcomes of patients with myocardial injury due to KP-BSI. Methods: A double-center retrospective cohort study of patients with KP-BSI was conducted from January 1, 2013 to December 31, 2022. The clinical data was collected by reviewing electronic medical records. Classification of patients with KP-BSI into myocardial injury and nonmyocardial injury groups based on the levels of high-sensitivity cardiac troponin I (hs-cTnI) after 48 h onset of KP-BSI. Results: Patients with myocardial injury due to KP-BSI were generally younger than those without such injuries, with the former presenting a median age of 60 versus 67 in the latter (p < 0.001). Conditions like chronic cardiac insufficiency and chronic pulmonary disease were more prevalent in the myocardial injury cohort (10.0% and 7.1%, respectively) compared to those without myocardial injury (4.7% and 2.6%, respectively; p values 0.002 and 0.001). However, the nonmyocardial injury group had a higher incidence of solid tumors (15.3% vs. 10.4%, p=0.038). Severity assessments like the acute physiology and chronic health evaluation (APACHE) II, the sequential organ failure assessment (SOFA), and the Charlson Comorbidity Index (CCI) all registered higher for the myocardial injury group (all p < 0.001). Similarly, intensive care unit (ICU) admissions, use of mechanical ventilation, and central venous catheter (CVC) placement were notably more common in this group (all p < 0.001). Regarding infection sources, the myocardial injury group had a higher incidence of pneumonia as the cause for KP-BSI (29.8% vs. 15.9%, p < 0.001), whereas liver and biliary tract infections were less frequent compared to their counterparts. Mortality rates at 7, 14, and 28 days, along with in-hospital mortality, were significantly higher for those with myocardial injury (all p < 0.001). Multivariate analysis identified age > 67 [adjusted odds ratio (aOR), 2.32; 95% confidence interval (CI), 1.59-3.38], SOFA score > 6 (aOR, 3.04; 95% CI, 2.10-4.39), mechanical ventilation (aOR, 1.67; 95% CI, 1.15-2.39), and CVC in place (aOR, 1.50; 95% CI, 0.96-2.02) as independent prognostic factors for myocardial injury in KP-BSI. Conclusions: Older age (> 67 years), higher SOFA score (> 6), mechanical ventilation, and CVC in place were found to be significantly associated with an increased risk of myocardial injury. Clinical physicians should be alert to the potential for myocardial injury in elderly critically ill patients, especially those who are on mechanical ventilation and have indwelling CVC, in the event of KP-BSI.

Diabetes mellitus (DM) is a persistent and steadily progressing metabolic condition distinguished by unregulated high levels of blood glucose. GLP1 receptor agonists have recently gained recognition as first-line therapies in selected instances, as per the updated ADA guidelines, highlighting their efficacy not only in glycemic control but also in their broader health benefits. Nonetheless, the efficacy of GLP-1 is limited by its brief duration of action, rapid clearance from the body, and challenges associated with subcutaneous administration. In this study, we examined the potential diabetes-mitigating effects of a genetically engineered strain of Escherichia coli Nissle 1917 (EcN)-GLP-1, previously developed by our group. We utilized mouse models for both Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) to assess its efficacy. In the case of T1DM mice, the results revealed that EcN-GLP-1 resulted in a notable decrease in blood glucose levels. Furthermore, it exhibited a protective influence on the structural integrity of islet β-cells; downregulated the expressions of key inflammatory markers such as TLR-4, p-NF-κB/NF-κB, and Bax/Bcl-2; promoted the insulin secretion; and reinstated the perturbed diversity of microbial species to a normal state. Similarly, EcN-GLP-1 had a pronounced impact on T2DM mice, manifesting increased presence of islet β-cells, decreased inflammatory response and apoptosis, and regulation of lipid metabolism in the liver. In summary, the genetically modified EcN-GLP-1 strain demonstrates the ability to alleviate diabetes by enhancing the islet β-cell population, mitigating inflammatory reactions and apoptosis, optimizing liver lipid metabolism, and reinstating a balanced microbial diversity. These findings hold promise as a potential avenue for treating DM.