Infection and Chemotherapy最新文献

Background: Albumin administration in patients with septic shock has shown potential benefits, but its association with the development of pulmonary complications remains unclear. We aimed to evaluate the impact of albumin administration on acute respiratory distress syndrome development in patients with septic shock.

Materials and methods: We analyzed clinical data from the Medical Information Mart for Intensive Care IV database and included adult patients with septic shock. Propensity score matching was used to balance the covariates between the albumin and non-albumin groups. The primary outcome was the development of moderate-to-severe acute respiratory distress syndrome within 7 days. Survival analysis using the log-rank test compared acute respiratory distress syndrome development rates between the groups. Subgroup analysis was used to evaluate the effect of albumin administration on the primary outcome in various subgroups.

Results: Among the 2,132 eligible patients, 1,572 (73.7%) did not receive albumin, whereas 560 (26.3%) received albumin. After propensity score matching, the primary outcome was not significantly different between the two groups (17.5% in the albumin group vs. 16.3% in the non-albumin group; P=0.708). The Kaplan-Meier curve demonstrated no difference in the primary outcome between the groups. Subgroup analysis showed no significant association between albumin administration and increased acute respiratory distress syndrome development rate across various subgroups.

Conclusion: No significant difference in acute respiratory distress syndrome development was found between albumin and non-albumin groups of patients with septic shock. Albumin administration in patients with septic shock should be considered when clinically indicated, without undue concerns about acute respiratory distress syndrome development.

The association between reactogenicity and long-term immunogenicity after coronavirus disease 2019 (COVID-19) vaccination remains unclear. This study investigated whether adverse reactions to ChAdOx1 nCoV-19 or BNT162b2 vaccines correlate with neutralizing antibody responses in severe acute respiratory syndrome coronavirus 2 infection-naïve healthcare workers. Blood samples were collected at three time points to measure neutralizing antibodies. Among 123 participants (ChAdOx1 nCoV-19, n=88; BNT162b2, n=35), local and systemic reactions were not significantly associated with antibody responses at six months post-vaccination for either vaccine type. No significant interactions between symptoms, time points, or age were observed. These findings suggest that adverse reactions might not predict long-term neutralizing antibody levels following COVID-19 vaccination.

Background: There is still unclear method for identifying people with human immunodeficiency virus (HIV) who will develop tuberculosis (TB). This study aimed to investigate the role of vitamin D receptor (VDR) gene FokI allele f and associated risk factors in HIV-TB coinfection.

Material and methods: This case control study was conducted with 60 total subjects consisting 30 subjects of HIV-TB patients as the case group and 30 subjects HIV without TB as the control. VDR gene FokI polymorphism was detected by polymerase chain reaction and sequencing, whereas light chain 3 (LC3) and caspase-3 levels were measured by enzyme-linked immunosorbent assay, and CD4 T cell by flowcytometry. Data analysis for different proportions used bivariate analysis and relationship analysis tests using logistic regression.

Results: The VDR gene FokI (rs2228570) polymorphism proportion of f alleles in the case group were 26 (86.7%) and control 13 (43.3%). Low LC3 (LC3 ≤30 ng/mL) found in 27 (90.0%) of the cases and 9 of the controls (30.0%). Low caspase-3 (Caspase3 ≤3 ng/mL) found 28 (93.3%) in cases and 15 (50.0%) in the controls. The logistic regression analysis revealed that f allele of FokI VDR gene polymorphism, low LC3, low caspase-3 and low CD4 T cells are risk factors for HIV-TB co-infection as follows respectively; (odds ratio [OR], 6.921; 95% confidence interval [CI], 1.199-39.936; P=0.031); (OR, 16.257; 95% CI, 2.568-102.928; P=0.003) and (OR, 7.448; 95% CI, 0.851-65.211; P=0.070); (OR, 6.227; 95% CI, 0.36-37.419; P=0.046).

Conclusion: VDR gene FokI polymorphism alleles f, low LC3, caspase-3, and low CD4 T cell count were identified as risk factors for HIV-TB Coinfection.

Respiratory syncytial virus (RSV) remains a significant health burden in infants, with limited prevention options. Palivizumab, the monoclonal antibody (mAb) currently used for high-risk infants, requires a five-dose regimen, costing caregivers 47,260-642,000 Korean won (KRW) under the health insurance system, depending on the remaining season and infant's weight. Nirsevimab, the first approved long-acting RSV mAb, offers season-long protection with a single dose and costs 435,000-600,000 KRW. Direct cost comparisons indicate that nirsevimab might be more economical for infants born between April and November. Policy adjustments are needed to ensure equitable RSV protection through national immunization programs.

Enterobacter hormaechei has emerged as a major bacterial pathogen implicated in neonatal sepsis, with several strains acquiring resistance to commonly used antibiotics. In this study, we provide the antibiotic resistance profile and genomic analysis of a multidrug-resistant E. hormaechei AH1-NIMR isolated from a neonate presenting with sepsis in a tertiary hospital in Lagos, Nigeria. E. hormaechei AH1-NIMR was resistant to ten of twelve antibiotics that were tested. Whole-genome sequencing and bioinformatics analysis revealed that the isolate harboured several antimicrobial resistance determinants, including plasmids IncHI2-1 and Col(pHAD28). Enhanced surveillance and screening for E. hormaechei in sepsis cases are recommended.

Background: Patients in long-term care facilities experience greater risk of infections, along with use of long-lasting invasive devices and colonization of multidrug resistant organisms. This study aims to analyze surveillance and clinical specimen culture results and trends in antimicrobial susceptibility among long-term hospitalized pediatric patients.

Materials and methods: Data were collected retrospectively from January 2015 to December 2024 from a long-term care facility dedicated to children with chronic underlying diseases. All hospitalized patients that underwent clinical specimen collection as part of infection surveillance or clinical evaluation were included.

Results: From 2015 to 2024, 759 admissions (357 new, 402 readmissions) were recorded, and 4,623 clinical specimens were collected. A total of 216 bacterial isolates were identified (4.7% positivity rate) from 130 medically complex pediatric patients, 98.8% of whom were bedridden. Between 2019 and 2024, 14 bloodstream infection (BSI) episodes occurred in 12 patients, with 85.7% suspected to be catheter-related. The BSI isolation rate was 0.21 per 1,000 resident-days, and the BSI-attributable mortality rate was 14.3%. From 2016 to 2024, methicillin-resistant Staphylococcus aureus (MRSA) nasal/sputum positivity increased from 3.5% to 5.9%, and the MRSA isolation rate rose significantly from 0.128 to 0.367 per 1,000 resident-days (P=0.009). Rectal carbapenem-resistant Enterobacteriaceae (CRE) positivity increased significantly from 0% to 3.4% (P=0.004), with isolation rates rising from 0 to 0.149 per 1,000 resident-days (P=0.012).

Conclusion: This 10-year study highlights a low incidence of BSIs in a medically complex pediatric long-term care population, likely due to proactive infection control measures. However, rising trends in MRSA and CRE colonization underscore the need for continued surveillance and the development of pediatric-specific infection prevention strategies.

Background: Bacterial meningitis is a serious infection leading to increased morbidity and mortality every year due to delayed diagnosis and treatment. Previous literatures had shown that cerebrospinal fluid (CSF) procalcitonin outweighs serum procalcitonin to diagnose bacterial infections of the central nervous system. Current meta-analysis aims to find the diagnostic accuracy of serum and CSF C-reactive protein (CRP) to diagnose bacterial meningitis.

Material and methods: PubMed, Google Scholar, Cochrane Library and Google databases were searched from 1st January 1980 to 30th June 2022. Observational studies, prospective or retrospective focusing on C-reactive protein as a biomarker for bacterial meningitis in adult patients were searched. The articles related to serum and CSF CRP for diagnosing bacterial meningitis were explored and retrieved separately, by two independent experts from the published studies available in the electronic search engines. The risk of bias and scholarly quality of studies were evaluated by QUADAS-2.

Results: Altogether 637 articles were recognized, out of which 22 studies selected. CSF CRP has shown better diagnostic value than serum CRP. Pooled sensitivity of CSF CRP was 0.89 (95% confidence interval [CI], 0.81-0.94), specificity 0.96 (95% CI, 0.92-0.97), area under the curve (AUC) 0.98 (95% CI, 0.96-0.99), diagnostic odds ratio (DOR) 175 (95% CI, 74-410), positive likelihood ratio (PLR) 20 (95% CI, 11.5-34.1) and negative likelihood ratio (NLR) 0.11 (95% CI, 0.06-0.21). While, pooled sensitivity of serum CRP was 0.80 (95% CI, 0.69-0.88), specificity 0.86 (95% CI, 0.74-0.93), AUC 0.89 (95% CI, 0.86-0.92), DOR 24 (95% CI, 9-62), PLR 6 (95% CI, 2.9-10.7) and NLR 0.23 (95% CI, 0.15-0.37). Heterogeneity was higher for serum CRP than CSF CRP.

Conclusion: Our meta-analysis shows that CSF CRP had higher pooled sensitivity, specificity and PLR along with higher AUC and DOR for confirming bacterial meningitis in adults than serum CRP.

Background: The prevalence of human immunodeficiency virus (HIV) is increasing globally and regionally. Despite Timor Leste is still considered as low prevalence country with less than 0.2%, it is believed that the number of people living with HIV (PLWH) are slowly on the rise. Viral load subsequently has been introduced to evaluate the effects of antiretroviral therapy (ART), to monitor viral suppression and to detect treatment failure even in low middle income countries. There have been limited studies on the prevalence and associated factors of viral load non-suppression among PLWH in Timor-Leste. This study investigated the prevalence of viral load non-suppression among PLWH on ART and its associated factors among PLWH attending in a national hospital in Dili, Timor-Leste.

Materials and methods: Retrospective case control study was performed with all PLWH above >17 years who visited to a national hospital in Timor Leste between 2022-2023. The multiple logistic regression analysis was performed identify independent factors associated with viral load non-suppression.

Results: A total of 212 subject was enrolled for this study with the mean age of 35 years old. The proportion of age group between 17-50 and ≥51 were 88% and 12%, respectively. Majority of the subject was male (72%). A total of 94 subjects (44%) had at least one episode of viral load non-suppression (>1,000 copies/mL) during study period. The multiple logistic regression analysis showed the significant factors associated with viral load non-suppression were (1) the low middle income (adjusted odds ratio [aOR], 3.403; 95% confidence interval [CI], 1.222-9.478; P=0.019), (2) the CD4+ cell counts <500 cells/mm³ (aOR, 11.622; 95% CI, 5.811-23.244; P <0.001), and (3) the opportunistic infection such as pulmonary tuberculosis (aOR, 2.382; 95% CI, 1.200-4.731; P=0.013).

Conclusion: This is the first study that evaluated the prevalence of and risk factors for viral load non-suppression in Timor Leste. Low middle income status, low CD4+ cell counts and opportunistic infections were factors associated with unsuppressed viral load in this region. Regular follow-up, support and counselling for improving adherence should be encouraged to enhance viral load suppression for those PLWH.

Background: Criteria for home management of low-risk febrile neutropenia remain challenging in supportive care. Careful selection of low-risk febrile neutropenic pediatric patients can improve outcomes and decrease complications. In the current study, we implemented a clinical pathway for pediatric patients presenting to the emergency room department with low-risk febrile neutropenia by using strict inclusion criteria.

Materials and methods: This is a prospective study from December 2021 to September 2022; all patients presented to the emergency room department were screened for pathway evaluation, and risk stratification was performed using a strict checklist. Patients were included if they met the low-risk criteria. Thorough clinical and laboratory assessments were performed on these patients. All patients started oral antibiotics and were instructed about alarming signs. Patients were followed up at the outpatient clinic on days 3 and 7.

Results: Two hundred and three patients with 200 episodes of low-risk febrile neutropenia were enrolled; one hundred and ten were males, and 90 were females; underlying hematological malignancies accounted for 54.0%. On day three, 181 patients out of 200 were afebrile for 24 hours (90.0%), and 47.5% were still neutropenic. At day seven, all study patients were afebrile, had recovering counts, and stopped antibiotics regardless of the count. Absolute neutrophil count recovery on day seven was achieved in 95.5% of patients.

Conclusion: Our inclusion criteria for patients with low-risk febrile neutropenia proved to be safe without deaths or intensive care unit admission and successful with the lowest admission rate, so it can be used for a stewardship program to avoid unnecessary patient admissions and help healthcare givers to optimize patient allocation and follow-up safely.