New Microbiologica最新文献

In this fast-evolving era of antiretroviral chemotherapy, the single-tablet regimen (STR) BIC/FTC/TAF, an oral regimen including a potent INSTI (strand-transfer integrase inhibitors) like Bictegravir plus two different NRTIs (Nucleoside Reverse Transcriptase Inhibitors), is increasingly challenged by new oral combinations. Furthermore, long-acting injectable drugs have also been developed and others are being under development. Notably, no new STR consisting of two NRTIs plus a 3rd drug like an INSTI are in the industrial pipeline. However, many People with HIV (PWH) still need potent multidrug regimens, especially those newly diagnosed with advanced HIV (defined late presenters), which represent over 50% of new infections. The asymmetrical comparison between a potent STR like BIC/FTC/TAF and new combinations is difficult to make. By comparing the STR BIC/FTC/TAF, the most representative of potent multi-drug regimens, with all approved new options, we can distinguish some features that are worthy of attention. The stronger genetic barrier and the better forgiveness resulting from BIC/FTC/TAF is self-evident, with the extra coverage here provided by the remarkable pharmacologic properties of TAF, consisting of great diffusion into target cells, long persistence at high concentration, and a much lower plasma exposure. On the pharmacokinetic side, the main difference is between oral and long-acting injectable regimens. Pk of long-acting injectables consists of a single peak (followed by a slow decrease in drug concentration), while with oral regimens daily C max - C trough fluctuations take place instead. The latter property of oral regimens should be taken into account whenever the Pk exposure is suboptimal, as it might allow inhibition of the growth of quasi-species that are less sensitive. The choice of the new combinations including long acting injectables instead of the STR BIC/FTC/TAF might be made for sure for several reasons, but compared to the past when combinations included TDF, toxicity by TAF is no longer an issue today. The size of the tablet and its net weight may be disproportional to the number of drugs, as there are multidrug regimens like the STR BIC/FTC/TAF whose weight may be lower than those of the new oral combinations INSTI-based for both naive and switching PWH. Although multi-drug regimens like the STR BIC/FTC/TAF are no longer in development, their use in clinical practice will still remain substantial for a long time and knowledge of their properties is necessary to properly select the most appropriate regimens for PWH.

The time of re-implantation of removed CIED for local infection or endocarditis has been debated because no randomized studies are available. Many authors prefer to delay reimplantation to the time of blood culture negative or clinical stability. In this case report we describe the case of E. faecalis CIED endocarditis treated with the combination ampicillin plus ceftobiprole and one-stage removal and re-implantation with early follow-up without relapse of infection. In case of E. faecalis infection, we hypothesize that ampicillin plus ceftobiprole combination might have bactericidal and anti-biofilm activity, therefore allowing one state re-implantation without relapse.

The SARS-CoV-2 virus appeared and was discovered in the year 2019, marking its significance. The spread of the virus also had serious consequences for national safety; members of the Police and Fire Brigade contracted the infection and therefore the efficiency of their operational activity decreased. Since the beginning of 2020, the biological laboratory of the Chemical Biological Radiological Nuclear (CBRN) unit of Milan's Fire Brigade headquarters performed thousands of serological tests to monitor the health of the Fire Brigade and various branches of the Police Forces. The aim of this study is to evaluate the degree of concordance and interchangeability between a lateral flow immunochromatographic assay (LFIA) and an automated laboratory immunoassay with different viral targets by comparing the data gathered from a sample group of firemen and policemen participating in a serological screening campaign. The serological tests used in this study are the LYHER® Novel Coronavirus (2019-nCoV) IgM/IgG Antibody Combo Test Kit and the Elecsys® Anti-SARS-CoV-2. The degree of concordance was computed using Cohen's kappa, with a result of 0.78 (CI 95%, 0.661-0.898), which is equivalent to a substantial agreement measured between the two tests. Additionally, the sensitivity of both serological tests was found to be 97%.

Numerous drugs are known to alter the colour of human body fluids. Although drug-induced bronchial secretions staining is normally harmless, it may frighten the patient and could lead to unnecessary clinical inquiries. Cefiderocol is often removed renally as an unmodified drug; bronchial secretion staining has not been seen at doses used in clinical practice. We report a possible first case of bronchoalveolar lavage staining occurred during Cefiderocol treatment in a critical patient.

Mycoplasma pneumoniae infection is a manifestation of pneumonia, which can be combined with multiple bacterial flora infection at the same time. This study explored the epidemiological characteristics and related risk factors of mixed infection in children with mycoplasma pneumonia (MP). 462 children with MP were enrolled and divided into simple infection and mixed infection groups. The mixed infection group was further divided into concurrent bacteria, virus, and chlamydia groups. Clinical data were collected to explore the epidemiological characteristics, and the related factors were analyzed by logistic regression. The co-infection rate was the highest in the mixed infection group (50.27%). Children under 1 year of age had the highest bacterial co-infection rate (40.95%). Children aged 1-5 years and >5 years had the highest viral co-infection rate (39.53%, 51.51%). Patients were more likely to be infected with virus from September to November (52.73%), and patients were more likely to be infected with bacteria from December to February (52.73%). The independent risk factors for concurrent viral, bacterial, and chlamydia infections were extrapulmonary complications, fever >10 days, high white blood cell count (WBC), and age, respectively. Conclusion: analysis of the epidemiological characteristics and risk factors of mixed infection in children with MP can provide guidance for clinicians to formulate a more reasonable diagnosis and treatment plan, reduce the occurrence of mixed infection, and improve the treatment effect.

Due to a limited range of effective treatment options, highly treatment-experienced (HTE) people with HIV (PWH) still struggle to maintain virological suppression and obtain an adequate immunological recovery. To increase the likelihood of virologic success, HTE PWH require an individualized treatment regimen based on cumulative genotypic resistance testing (GRT) data, potential drug-drug interactions, and adherence. From the PRESTIGIO Registry, we present a case of a 28-year-old man with vertically transmitted HIV-1 infection, on therapy with an ibalizumab-including regimen and desiring a treatment simplification. In January 2024, the patient was started on a lenacapavir-containing regimen along with optimized background therapy in an attempt to maintain sustained virological suppression, simplify antiretroviral regimen, and potentially increase CD4+ T-cell count. At six months follow-up evaluation, virological suppression was confirmed, and an increase in CD4+ T-cell count of 60 cells/μL was observed. Close follow-up of this patient is ongoing.

Beta-lactams are extensively used antibiotics known for their safety and effectiveness. The rise in patients who receive care in outpatient settings has increased the interest in subcutaneous administration (SA). The aim of the study is to assess the safety and pharmacokinetic (PK) profiles of SA of beta-lactams compared with other routes. The protocol was registered in the PROSPERO database and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Online databases were searched, and the quality of the eligible studies was assessed. The data extracted related to adverse events (AEs) and PK were summarised narratively. Sixteen studies were included. The reported AEs were generally mild, localised, and temporary. Although SA and intravenous administration had similar PK profiles, SA resulted in lower peak drug concentrations and slower absorption. Heterogeneity in the populations, medication delivery, outcome measures, and methodological quality emerged across the studies. The mild severity of AEs suggests that SA is a viable route. Additionally, SA appears to demonstrate effective PK profiles and delays drug release, with potential to reduce the dosing frequency and prolong the therapeutic effects. SA of beta-lactams is a promising viable alternative to intravenous administration, potentially enhancing treatment in the outpatient and long-term care settings.

Microbiota defines all microorganisms that are vital for our immunological, hormonal, and metabolic homeostasis by living symbiotically in different parts of our body. On the other hand, the microbiome is a collection of microorganisms that can be detected together. The lungs are constantly exposed to airborne microorganisms found in the upper respiratory tract. Until recently, the lower respiratory tract was considered sterile, as bacteria were rarely isolated from the lungs by conventional culture methods. Most chronic inflammatory lung diseases are caused by dysregulation of the lung microbiota, which has been discussed in many review papers. However, little is known whether microbiota dysymbiosis is a consequence or a cause of these diseases. In this review, we provide an overview of lung microbiota and lung immunity.

The flu outbreak after the coronavirus disease 2019 (COVID-19) pandemic has put a heavy burden on the medical system. We aimed to investigate the infection indicators and risk factors for influenza A virus, with the intention of offering valuable insights for clinical diagnosis and treatment. A total of 1590 throat swabs were collected from patients with influenza-like illness admitted to our hospital for treatment in March 2023. Influenza virus in infected patients was detected by the rapid antigen method and qPCR. We used statistical methods to compare clinical manifestations and laboratory tests between positive and negative patients. Among the 1590 influenza-like illness patients, 1004 (63.1%) were infected with influenza A, mainly children aged 0-9 years (52.8%); more males than females were infected, and the main clinical symptoms were fever, cough, diarrhea, nausea and vomiting, and muscle soreness. The leukocyte (WBC), lymphocyte (LYM), eosinophil (EOS), platelet (PLT), C-reactive protein (CRP) and lymphocyte/monocyte (LMR) levels in the positive group were lower than those in the negative group, while the neutrophil (NEU) and monocyte (MON) levels were higher than those in the negative group (P<0.05). Multivariate logistic regression analysis showed that age 0-9 years, cough, antiviral treatment time>48 h, and reduced PLT and LMR levels were independent risk factors for influenza A patients.

Carbapenemase-producing Enterobacteriales (CPE) represent an emerging threat for global public health and a serious problem for clinicians due to the limited available treatment options. The emergence of CPE has been recently described worldwide by describing different antimicrobial mechanisms. Here, we describe a CPE carrying dual-carbapenemase isolated in Italy and we provide a deep characterization of the antimicrobial resistance genes, virulence-factors and prophage regions within the genome.