Infection and Chemotherapy最新文献

The association between varicella-zoster virus (VZV) reactivation and coronary artery disease (CAD) remains uncertain. We enrolled 107 patients (mean age 66.5±10.8 years; 72% male) who underwent coronary angiography due to suspected CAD and assessed subclinical VZV reactivation via salivary VZV PCR. Patients were divided into three groups: acute coronary syndrome, chronic coronary syndrome, and insignificant CAD. VZV DNA was detected in three patients (3%) -one in the acute group and two in the chronic group (P=0.469). Although not statistically significant, these findings warrant further investigation into the potential link between VZV reactivation and CAD.

In this retrospective study over eight years involving 25 immunocompromised adults, computed tomography pulmonary angiography (CTPA) demonstrated vascular invasion sign in 80% of proven or probable invasive mold pneumonia (IMP) cases (12/15), while absent in all bacterial pneumonia cases (0/10). These findings suggest that angioinvasion-related features on CTPA may serve as a valuable diagnostic adjunct in differentiating IMP from bacterial pneumonia in high-risk population.

Background: Urinary tract infections (UTIs) pose significant risks to children's health, with potential for kidney damage if untreated. Morganella morganii is an uncommon but important pathogen in pediatric UTIs. We aimed to describe the clinical characteristics, risk factors, and antibiotic susceptibility patterns of M. morganii UTIs in Jordanian children.

Materials and methods: We conducted a retrospective review of pediatric patients (aged 0-18 years) diagnosed with M. morganii UTIs at King Abdullah University Hospital from 2017 to 2022. Data collected included demographics, clinical presentation, laboratory findings, imaging studies, antimicrobial susceptibility profiles, and treatment offered.

Results: Nine patients were identified, 77.8% of whom were female, with a median age of 3.35 years (interquartile range, 2-14.5). The most common symptoms were fever (55.6%), malodorous urine (44.4%), and vomiting (22.2%). A high prevalence of underlying urological abnormalities, particularly neurogenic bladder and myelomeningocele (44% each), was noted. Eight cases involved lower UTIs. M. morganii isolates were uniformly sensitive to amikacin, cefepime, and piperacillin-tazobactam but resistant to amoxicillin-clavulanate and nitrofurantoin.

Conclusion: M. morganii should be considered in pediatric UTIs, especially among children with urinary tract anomalies or catheter use. Awareness of its distinct resistance profile is critical for selecting appropriate empiric therapy.

Background: People living with human immunodeficiency virus (PLHIV) commonly experience psychological issues, including anxiety disorders and depression, which may affect their adherence to antiretroviral therapy. This study aimed to explore the mental health status of PLHIV and identify the factors associated with poor compliance (PC) with antiretroviral therapy.

Materials and methods: A structured questionnaire survey was administered to PLHIV who were regularly followed up at a university hospital from September 19 to 20, 2020. The survey encompassed assessments of depression (by using the Patient Health Questionnaire-9), anxiety (by using the Beck Anxiety Inventory-Primary Care), suicidality, and meaning in life (by using the Meaning in Life Questionnaire). For participants who provided consent for identification, demographic information was merged to facilitate the analysis. PC was determined based on whether individuals made themselves available for routine clinical visits.

Results: Among 327 eligible PLHIV, 150 individuals (45.9%) completed the survey. Forty-one out of the 150 individuals (27.3%) screened positive for depression, while 52 (34.7%) screened positive for anxiety disorders. Thirty-two participants (21.3%) presented with symptoms indicative of both depression and anxiety. The most prevalent depressive symptom was trouble sleeping, accounting for 29.3% of respondents, followed by fatigue (26.0%). Over nervousness was the most commonly reported anxiety symptom (22.7%). Furthermore, 32 individuals (21.3%) reported experiencing suicidal ideation or engaging in self-injury. Among the 123 participants who agreed to identify themselves, suicide attempts and low CD4 counts were positively correlated with PC (adjusted odds ratio [aOR], 3.34; 95% confidence interval [CI], 1.29-8.91 and OR, 5.46; 95% CI, 1.27-24.78, respectively), and younger age was found to be associated with PC (aOR, 0.93; 95% CI, 0.88-0.97; P=0.004). When measures of anxiety disorder and depression were incorporated into the analysis, depression exhibited an OR of 14 for PC (aOR, 13.98; 95% CI, 3.29-98.65; P=0.001). Anxiety disorders were found to be inversely associated with PC. History of opportunistic infection and Meaning in Life Questionnaire scores were not significantly associated with PC.

Conclusion: The prevalence of depression and anxiety disorders was high in PLHIV. Depression and low CD4 counts under regular follow-up were associated with PC. Thus, screening for depression can be effective in reducing non-adherence to antiretroviral therapy.

Background: The patients affected by hospital-acquired coronavirus disease 2019 (HA-COVID-19) who were readmitted in hospital within 60 days had worse prognosis and mortality. In this study the aim was the assessment of early readmission rate in HA-COVID-19 and the role of remdesivir treatment.

Materials and methods: This observational retrospective study included patients with HA-COVID-19 hospitalized in different wards between Jan 2021 and Mar 2022. Early readmission rate was determined. A multivariate logistic regression was made to determine the predictive factors for re-hospitalization.

Results: A total of 190 patients with a confirmed diagnosis of HA-COVID-19 were included. Early readmission was documented in 22 patients (11.6%) with a consequent mortality rate of 22.7%. In multivariate analysis, the following factors were predictive of readmission: chronic pulmonary disease (odds ratio [OR], 3.187; 95% confidence interval [CI], 2.145-11.228; P<0.001), hospitalization time ≥11 days (OR, 3.556; 95% CI, 1.442-8.417; P=0.008), intensive care unit support (OR, 7.449; 95% CI, 3.901-14.782; P<0.001), and remdesivir use (OR, 0.729; 95% CI, 0.512-0.884; P=0.001).

Conclusion: Readmission cumulative rate was about one tenth with higher mortality. The remdesivir use in the first hospitalization leads to significant reduction in the odds of readmission.

Radiological evaluation is pivotal in diagnosing infectious diseases, but its inherent limitations can lead to diagnostic uncertainty and inappropriate antibiotic use, exacerbating the global challenge of antimicrobial resistance (AMR). This review examines the utility and constraints of imaging studies-computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US)-in common infectious diseases, including pneumonia, acute pyelonephritis (APN), infectious colitis, and skin and soft tissue infections (SSTI). For pneumonia, CT and lung US offer higher sensitivity than chest X-rays, but distinguishing between bacterial and viral pathogens remains challenging. In APN, contrast-enhanced CT is the standard, but routine imaging is not recommended for uncomplicated cases. CT findings in infectious colitis are often nonspecific, necessitating a comprehensive clinical assessment. For SSTIs, particularly in differentiating necrotizing fasciitis, MRI and CT demonstrate high negative predictive value, but positive findings require careful clinical correlation. Furthermore, inter-reader variability exists in interpreting subtle imaging findings. This review highlights the gap between radiological findings and definitive diagnoses, underscoring that imaging is a powerful adjunct but cannot replace comprehensive clinical judgment. A multidisciplinary approach integrating clinical data with imaging findings is essential for accurate diagnosis, responsible antimicrobial stewardship, and effective patient management in the era of AMR.

The guidelines presented herewith are based on the "Clinical Practice Guideline Recommendations for Post-Acute Sequelae of COVID-19 (PASC)" published in Infection & Chemotherapy in March 2024; these guidelines have been refined by incorporating the most recent Korean and international research findings and clinical evidence published since then. In the context of patients experiencing various physical and mental symptoms that persist long after the acute phase of coronavirus disease 2019 (COVID-19) infection, the diagnosis and management of PASC has emerged as a novel public health challenge. These guidelines are intended to provide standardized diagnostic and management recommendations applicable to the Korean healthcare setting and were developed through a comprehensive review of existing guidelines from organizations such as the World Health Organization, the United States National Institutes of Health, the United Kingdom National Institute for Health and Care Excellence, and the European Society of Clinical Microbiology and Infectious Diseases, along with the latest meta-analyses and Korean cohort studies. PASC is defined as the persistent presence of symptoms and signs lasting more than 3 months after COVID-19 diagnosis for which the symptoms cannot be explained by alternative diagnoses. The revised guidelines emphasize the importance of integrated management for patients with PASC, including a multidisciplinary approach considering risk groups, symptom-specific assessment, and rehabilitation and psychological interventions, based on a total of 32 key questions. This revision reflects rapidly evolving research trends regarding the long-term effects of COVID-19 and is expected to serve as an evidence-based standard guideline for future patient care, clinical research, and health policy development in Korea.