Journal of Global Infectious Diseases最新文献

Introduction: Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-evaluated for safe antibiotic de-escalation.

Methods: Subjects treated with meropenem for febrile neutropenia who met Loyola University Medical Center's (LUMC) criteria for de-escalation were stratified based on whether meropenem was de-escalated, and 30-day all-cause mortality for both groups was assessed.

Results: 181 patients met criteria for meropenem de-escalation. Sixty patients (31.3%) were ade-escalated (MDE), and 121 subjects were not (NDE). The 30-day all-cause mortality was 8.3% (n = 5/60 subjects) in the MDE group and 2.4% (n = 3/121) in the NDE group but was not statistically significant (P=0.1). Median hospital length of stay was 13 days in the MDE group versus 20 days in the NDE group (P = 0.049). CDI rate was also lower in the de-escalated group. In addition, consultations by infectious diseases physicians were more common in the de-escalation group. Logistic regression model demonstrated positive culture (OR 4.78, P = 0.03), including positive blood culture (OR 8.05, P = 0.003), and GVHD (OR 19.44, P = 0.029), and were associated with high rates of appropriate de-escalation. Immunosuppression (OR 0.22, P = 0.004) was associated with lower rates of appropriate de-escalation.

Conclusion: Appropriate meropenem de-escalation in FN patients is safe and can result in improved clinical outcomes.

Introduction: Hepatitis B and C are viral infections causing chronic liver inflammation and, when left untreated, lead to cirrhosis and a risk for hepatocellular carcinoma, the most common type of primary liver cancer with high mortality. The hepatitis B virus-hepatitis C virus (HBV-HCV) coinfection leads to a faster progression to advanced liver diseases and higher hepatocellular carcinoma (HCC) risk than monoinfection. Unlike the relative risk for HCC due to either HBV or HCV, no recent analysis of the risk for HBV-HCV coinfection exists.

Methods: Based on PRISMA recommendations and guidelines, we developed a search strategy by combining the keywords ("hepatitis B") and ("hepatitis C") and ("hepatocellular carcinoma" or "liver cancer"). First, we performed a title and abstract screening and, later, a full-text screening. We extracted the demographic characteristics, such as gender, age, study design, sample size, country, and biomarkers of hepatitis B surface antigen (HBsAg), HBV DNA, HBeAg, anti-HCV, and HCV RNA. The data were assessed for quality, and the Review Manager software was used for the meta-analysis.

Results: We included 63 studies. The pooled analysis showed that the risk of HCC was significantly higher in the case-cohort who were positive for HBsAg (odds ratio [OR] = 9.70 [3.75, 25.12], P = 0.0001), HBV DNA or HBeAg (OR = 22.77 [10.00, 51.88], P = 0.0001), HBV and HCV coinfection (OR = 46.07 [26.33, 80.60], P = 0.0001) than the control cohort.

Conclusion: Chronic HBV and HCV infections are major risk factors for HCC, and their coinfection was significantly associated with an increased risk of HCC than monoinfection.

Introduction: The aim of the study was to study the clinical profile and outcomes of nocardiosis in renal allograft recipients.

Methods: This was a retrospective study of clinical outcomes in consecutive renal allograft recipients with Nocardia infection over a 22-year period (2000-2022) from a tertiary care center in Southern India. The clinical data were obtained from electronic medical records and patient files.

Results: A total of 1970 patients underwent renal transplantation at Christian Medical College, Vellore, India, between January 1, 2000, and December 31, 2022. During this period, 26 patients were diagnosed to have Nocardia infection. Half (50%) of the patients had fever and cough as their initial presentation, 7 (26.9%) patients presented with cutaneous abscesses, 2 (7.6%) patients were incidentally detected to have lung nodules during routine follow-up, 2 (7.6%) patients presented with headache accompanied by fever, and 3.8% had graft abscess. The diagnosis was made by isolating the organism in culture from one or more of the following samples: sputum, blood, pus, or lung biopsy (either computed tomography [CT]-guided or bronchoscopic aspirate culture). Eight patients required bronchoscopy and two patients required CT-guided biopsy for obtaining samples for diagnosis. All patients were similarly managed initially with a reduction of immunosuppression and appropriate antibiotics as per culture sensitivity. All 26 patients responded to induction treatment with meropenem (or imipenem) and trimethoprim-sulfamethoxazole (co-trimoxazole) followed by maintenance treatment with co-trimoxazole. Five (19.2%) out of 26 patients received Minocycline in induction and maintenance treatment regimens as in four patients isolates were resistant and one patient had allergic reaction to Cotrimoxazole. All patients had stable graft function. Two patients succumbed after 2 months of diagnosis with Gram-negative sepsis.

Conclusions: At present, there exists no single serological test to diagnose Nocardia infection in patients. Multiple initially obtained cultures may be negative because of the slow growth of the organism and variable colony morphology. Hence, infected specimens should be obtained by aggressive approaches if the index of suspicion is high. Procedures such as bronchoscopic lavage and aspiration of abscess are invaluable toward making a diagnosis. In our study, eight patients required invasive diagnostic procedures such as bronchoalveolar lavage and CT-guided lung biopsy since initial Gram stain and sputum culture were negative. In conclusion, it is crucial to maintain a high level of suspicion and conduct thorough investigations among post renal transplant recipients. This approach facilitates early diagnosis, prompt initiation of appropriate treatment which helps prevent the spread of disease.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in neonatal intensive care units (NICUs) is a significant global health concern, leading to severe infections, extended hospital stays, and substantial economic burdens on health-care systems. To develop effective infection control strategies, we need to fill existing gaps in our understanding of MRSA epidemiology in neonates. The aim of this systematic review is to provide an extensive analysis of the proportion of MRSA colonizations in NICUs.

Methods: We used a comprehensive search strategy across databases such as Medline, Embase, Global Health, Web of Science, and Global Index Medicus, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were independently reviewed and selected based on a variety of criteria, including the inclusion of neonates tested for MRSA colonization during NICU stay, and the reporting of community-acquired and hospital-acquired MRSA (CA-MRSA and HA-MRSA) incidence levels. Exclusion criteria included studies outside NICUs, those focused on specific MRSA outbreaks or clinical infections, review studies, and those lacking abstracts or full texts. Five authors independently extracted data, which was summarized and checked for quality. Statistical analysis included a random-effects model to compute pooled proportions, stratification by geographical location, evaluation of heterogeneity, and examination of publication bias.

Results: Our systematic review evaluated 62 studies out of an initial 536 records identified. The majority of the selected studies were conducted in high-income countries, primarily in the United States. From these studies, we estimated a cumulative incidence rate of 7.2% for MRSA colonization in NICUs. When the source of MRSA was considered, CA-MRSA incidence was 2.7%, while HA-MRSA incidence was notably higher at 11%. A subgroup analysis showed geographical differences in the cumulative incidence of MRSA colonization in NICUs, with Brazil having the lowest incidence and Taiwan the highest. The proportion of HA-MRSA colonization also varied significantly by country, with South Korea reporting higher incidence rates than the United States. However, the differences in CA-MRSA colonization rates between countries and WHO regions were not statistically significant.

Conclusions: Our systematic review found a cumulative incidence of 7.2% for MRSA colonization in NICUs, with HA-MRSA (11%) being more prevalent than CA-MRSA (2.7%). Regional variations were detected, with Taiwan exhibiting the highest cumulative incidence and South Korea having both the highest CA-MRSA and HA-MRSA. These findings underline the substantial public health impact of MRSA, especially in NICUs, necessitating context-specific prevention and control strategies. Future research should strive to address these regiona

Introduction: The tools to distinguish relapse from reinfection are needed in malaria-endemic areas. We evaluated seroprevalence against sets of specific peptides to the block 2 region of Plasmodium vivax-merozoite surface protein-1 (PvMSP1) to detect parasite clones.

Methods: We applied amplicon deep sequencing (ADS) of block 2 region of the MSP-1 gene (pvmsp1) to determine cocirculating parasite clones within eight P. vivax-infected individuals. Based on this, a seroprevalence of IgM and IgG antibodies against sets of peptides of different block-2 haplotypes was validated. After, we evaluated the seroprevalence in plasma of 72 pregnant women, from which 31 had recurrent P. vivax infections.

Results: ADS revealed one block 2 haplotype clone infecting five of eight P. vivax-infected individuals. In all, IgM antibodies, not IgG, recognized only a set of peptides specific to the block 2 haplotype determined by ADS. In the other three patients, ADS determined three concurrent block 2 haplotype clones, among whom there was always one haplotype that predominated with more than 95% of high-quality reads and two other smaller haplotypes with up to 5% and the least was <1%. We observed higher IgM levels against haplotype-specific peptides corresponding to the predominant clone. The seroprevalence of pregnant women showed that anti-haplotype-specific IgM detected coinfection with parasite clones per pregnant woman and we also observed levels of anti-haplotype-specific IgM in primary infection increased in some recurrent episodes.

Conclusion: IgM against sets of peptides specific to different pvmsp1 haplotypes may be employed as a serological marker for parasite clones in vivax malaria.

Introduction: Rabies monoclonal antibody (mAb) is a life-saving immune-biological for postexposure prophylaxis (PEP) in all Category III animal exposures. A novel cocktail of mAbs derived using recombinant DNA technology is presently available for usage. The WHO recommends monitoring the clinical use and outcomes of mAb products.

Methods: An open-label, postmarketing study was conducted at the anti-rabies clinic in the southern part of India. PEP was provided to all the study participants per the national guidelines. All the subjects were assessed for any adverse events (AEs) following PEP up to 35 days; if any, were treated free of cost at the study center.

Results: The present study included 309 subjects across all age groups, 59.2% were adults, 33.3% of children, and 7.5% elderly. Majority of the patients were exposed to dogs (89.6%) and most of them had lacerations (86.3%) in different parts of their body. A total of 19 (6.2%) AEs were reported. All the AEs were local reactions, namely pain (2.6%), erythema (1.4%), tenderness (1%), induration (0.6%), and swelling (0.6%). All reported AEs were mild (Grade 1 severity) and resolved completely with symptomatic treatment.

Conclusion: The novel cocktail of mAbs was safe for PEP in Category III animal exposures across all the age groups and supports its continued and improved usage for Universal Health Coverage to prevent rabies.