Infection and Chemotherapy最新文献

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.

Given the global threat of antimicrobial-resistant organisms, an effective antimicrobial stewardship program (ASP) is essential. Infectious disease (ID) physicians and ID-trained pharmacists are prioritized as critical core members of ASP in hospital settings, but securing these ID-trained professionals in all settings is challenging. Alternative champions and personnel for implementation may be needed. This narrative review highlights the efficacy of ASP when non-ID-trained physicians and pharmacists are engaged in ASP, showcasing various studies demonstrating significant improvements in antimicrobial utilization, cost, and patient outcomes. Additionally, it discusses the impact of network-based models, such as the Duke Antimicrobial Stewardship Outreach Network, which provides structured support and resources to lower-resourced hospitals to ensure the successful implementation of ASP. Ultimately, this narrative review provides insights into how to structure accountability and pharmacy/stewardship expertise in establishing and expanding ASP nationwide in Korea, where ASP is still in its early stages. In addressing this issue, government initiatives to actively support this effort are essential, and striving to develop evidence-based policies is necessary.

Annual influenza vaccination is strongly recommended for immunocompromised individuals, who are at a higher risk of severe infection. The Korean Society of Infectious Diseases has revised its influenza vaccination recommendations for solid organ transplant recipients, advocating for the use of highly immunogenic vaccines, such as high-dose inactivated influenza vaccines or MF59-adjuvanted inactivated influenza vaccines, to enhance vaccine efficacy. While further research is needed to extend these recommendations to other immunocompromised populations, these vaccines have demonstrated improved immunogenicity without compromising safety. Expanding vaccination guidelines to additional immunocompromised groups should be considered as more evidence emerges.

Background: Although infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) could induce natural immunity, previously infected individuals were suggested to have additional vaccination to enhance immune responses against the new variants of concern (VOCs). In this study, we determined the effects of a single dose of inactivated vaccine and viral vector-based vaccine on the neutralizing antibody (NAb) and T cell responses against the wild type (WT) and VOCs in the post-infection individuals.

Materials and methods: The levels of NAb and specific T cell responses against the WT and VOCs of the previously infected individuals were determined before and after vaccination with a single dose of CoronaVac (CoVac) or ChAdOx-1 (ChAd) vaccine.

Results: Eighteen subjects, with nine participants in each vaccination group, were recruited in this study. The CoVac group was significantly older (53.3±12.8 vs. 34.4±14.0 years, P=0.009) and had shorter disease-vaccination time (111.0 vs. 186.0 days, P <0.001) than the ChAd group. Before vaccination, both groups had median NAb against WT, Alpha, Beta, and Delta variants, but not Omicron BA.4 and.5 variants, above the detection threshold. After vaccination, the NAbs and the CD4 and CD8 T-cell responses against the tested variants were demonstrated. However, the NAb in the CoVac arm was lower than in the ChAd arm. In contrast, the CoVac vaccine-induced T-cell responses are better than the ChAd vaccine.

Conclusion: In post-SARS-CoV-2 infection, ChAd vaccination induced a better antibody response, but the CoVac vaccine induced greater T-cell responses. Vaccination is valuable in boosting immunity, particularly against some VOCs, in individuals with prior SARS-CoV-2 infection.

Trial registration: This study was registered by the Clinical Trials Registry TCTR20210822002.

Human metapneumovirus (HMPV) is a significant respiratory pathogen that contributes to acute respiratory infections, particularly in vulnerable populations such as children, the elderly, and immunocompromised individuals. Since its discovery in 2001, HMPV has become a global health concern, with epidemiological data revealing seasonal peaks and notable genetic diversity. The virus is associated with a wide range of respiratory illnesses, including bronchiolitis, pneumonia, and asthma exacerbations, leading to substantial hospitalization rates and healthcare costs. This review examines the epidemiology of HMPV, focusing on pre- and post-coronavirus disease 2019 (COVID-19) trends, transmission patterns, and the impact on at-risk populations. Notably, the COVID-19 pandemic has influenced the seasonality of HMPV, with altered patterns of viral circulation and co-infection with other respiratory pathogens, such as respiratory syncytial virus and influenza. Despite its considerable impact, HMPV remains under-recognized and lacks specific antivirals or vaccines, leaving management largely supportive. Advances in molecular diagnostics, including RT-PCR and potential serological methods, offer hope for improved detection and epidemiological tracking. Moreover, research into monoclonal antibodies, antiviral treatments, and vaccines is ongoing, with promising results in preclinical models. Enhanced surveillance systems and integrated approaches to monitor co-circulating viruses are essential for mitigating the burden of HMPV. This review underscores the need for continued research, public health strategies, and global collaboration to address the challenges posed by HMPV, particularly in high-risk populations and regions with limited healthcare infrastructure.

Antimicrobial resistance (AMR) is recognized as one of the top ten global public health threats. Since the coronavirus disease 2019 pandemic, there has been a notable increase in global concern regarding AMR, leading to a strong call for a government-led response to address this issue. Since 2016, the Korean government has established and implemented a robust social foundation for managing AMR. This foundation encompasses several elements: enhancing the medical environment for infection prevention, providing support for the antimicrobial stewardship program in healthcare organizations, strengthening cooperation among multidisciplinary policy ministries, requiring veterinarians to prescribe antimicrobials in non-human fields, and enhancing food safety management in livestock and aquatic products. However, as the threat of AMR has intensified during the ongoing pandemic, the necessity for implementing a National Action Plan becomes even more critical. Therefore, the Third National Action Plan 2026-2030 is crucial to take into account several critical factors: raising awareness of AMR, strengthening of antimicrobial stewardship, halting the spread of antimicrobial-resistant bacteria, strengthening surveillance of antimicrobial use and AMR rates, strengthening internal and external collaborative efforts to combat AMR, and the final factor to consider is to enhance further antimicrobial development and diagnostic technologies to better manage and prevent AMR.

Background: Cardiovascular disease is a growing concern among people living with HIV (PLHIV) due to various risk factors and the long-term effects of HIV and antiretroviral therapy (ART). This study aimed to assess the cardiovascular risk among PLHIV in the Western Region of Ghana in 2022.

Materials and methods: A retrospective cross-sectional study was performed to estimate cardiovascular risk among PLHIV in Ghana's Western Region in 2022. Data from medical records was collected from an urban and a rural hospital. The Framingham Risk Score (FRS) was used to estimate 10-year cardiovascular risk. The prevalence of cardiovascular risk factors, correlation between lab-based FRS and body mass index (BMI)-based FRS, health characteristics by settlement type and factors associated with High FRS were analysed.

Results: A total of 322 PLHIV was enrolled for this study, with a majority being female (76.1%) and aged 36-45 years (37.0%). Prevalent cardiovascular risk factors were dyslipidemia (28%), hypertension (26.3%), and diabetes (19.3%), while obesity (7.5%) and smoking (2.2%) were less prevalent. The lab-based FRS categorized 5.9% of participants as having a high cardiovascular risk. In comparison, the BMI-based FRS classified 12.1% in the high-risk category. There was a significant correlation between the lab-based FRS and BMI-based FRS. Employment status and religion were significant factors associated with cardiovascular risk.

Conclusion: Cardiovascular diseases is a growing concern among PLHIV due to various risk factors and the long-term effects of HIV and ART. The findings of this study could contribute to improve cardiovascular health outcomes in PLHIV and provide a model for addressing comorbidities in resource-limited settings.

Background: Detailed surveillance of antimicrobials' use in the community is an essential strategy to control their overuse and misuse. This study aimed to evaluate prescribing patterns of antimicrobials in Russian outpatients in 2024 and quantify the prescribing in relation to quality indicators.

Materials and methods: A point prevalence study was conducted during January-April 2024 in 14 healthcare facilities in 11 Russian cities (Chelyabinsk, Ekaterinburg, Krasnoyarsk, Moscow, Novokuznetsk, Saratov, Smolensk, Ulan-Ude, Vladivostok, Yakutsk, and Yaroslavl) in accordance with the outpatient protocol of Global-PPS project. Detailed data on antimicrobials, age, gender, and drug indications were collected for each outpatient receiving at least one agent for prophylaxis or treatment.

Results: A total of 5,084 outpatients from 149 units were surveyed, of which 487 (9.6%) received at least one antimicrobial agent. The highest rates of antimicrobial prescribing were observed at upper respiratory tract (33.2%), gastroenterology (22.6%), hematology (13.6%), ear nose and throat (13.5%), and gynecology units (11.6%). Antibacterials accounted for 63.4% of antimicrobials on average, followed by antivirals (35.4%). Penicillins (41.4%), for the most part penicillin/beta-lactamase inhibitor combinations (30.1%), cephalosporins (18.3%), including third generation (17.7%), fluoroquinolones (16.1%), and macrolides (11.5%) were the top classes of antibiotics prescribed. Umifenovir (23.8%) and amoxicillin/clavulanic acid (19.0%) were the top antimicrobials prescribed. The administered antibacterials were almost equally distributed between "access" (46.5%) and "watch" (53.5%) AWaRe groups. On average, choice of antimicrobials followed the national guidelines issued by the Ministry of Health in 73.2% of cases.

Conclusion: The pooled rates of antimicrobial prescribing in outpatient settings was 9.6% with the substantial differences in patterns of consumption overall and among the units of different types. Broad-spectrum antibacterials such as penicillin/beta-lactamase inhibitor combinations, III-IV generation cephalosporins, fluoroquinolones, and macrolides together amounted to 48% of prescriptions. Common concerns in antimicrobial drug usage included low guidelines compliance and low rate of "access" group antibacterials.