New Microbiologica最新文献

Choosing the appropriate treatment regimen for Helicobacter pylori (Hp) depends on knowing or predicting regional antibiotic resistance rates. In this study, we aimed to determine the frequency of Hp and clarithromycin (Cla) resistance rates by PCR analysis in formalin-fixed paraffin-embedded (FFPE) gastric biopsies of patients diagnosed with gastritis. Hp DNA and Hp Cla resistance (ClaR) were analyzed by PCR method. Diagnostic examination of gastric biopsy samples was evaluated according to the Updated Sydney System. Hp positivity was detected in 68 of 149 samples (45.6%). ClaR was detected in 29 Hp-positive samples (42.6%). A decrease in the resistance rate to Cla in HP was observed with increasing age (p = 0.08). The risk of resistance was higher in women (OR 1.1, 95% CI: 0.41-2.90, p = 0.86). The ClaR was higher in the 18-40 age group than in the over-60 age group (OR 5.5, 95% CI: 1.16-26.14, p = 0.03). The ClaR rate was found to be 42.6% by molecular method, indicating that classical triple therapy containing Cla is not a suitable option. Since resistance may vary according to geographical regions and years, regional studies with large populations are needed to determine antibiotic resistance rates before treatment planning.

Nocardia is an opportunistic pathogen affecting immunosuppressed patients. This case report aims to present a primary brain abscess due to Nocardia cyriacigeorgica in an immunosuppressed kidney transplant patient. An 48-year-old female patient presented to the emergency department with complaints of sudden onset of headache and confusion. The patient had a history of renal transplantation (one year previously). CT scans were performed due to blurred consciousness, with an appearance compatible with a cystic necrotic lesion with haemorrhagic densities around the left parietooccipital. Since the patient was immunosuppressive, broad-spectrum antibiotics were started. All necessary medical examinations were completed immediately and the patient underwent a transcranial operation. The abscess fluid and lesion were completely removed along with the capsule. The surgical material was sent to the Microbiology laboratory. The culture reported Nocardia cyriacigeorgica as the pathogen. The patient died on the 17th postoperative day due to clinical presentation of DIC. As a conclusion, considering CNS nocardiasis, routine contrast-enhanced brain imaging and rapid microbiological diagnosis are of vital importance, especially in immunosuppressed patients. Resistance was largely species-specific for Nocardia spp. Identification of Nocardia at the species level and early initiation of treatment with the most appropriate drug according to its antimicrobial susceptibility will lead to success in treatment and reduce mortality rates.

Alkhurma hemorrhagic fever virus (AHFV), a novel flavivirus, was first identified in the Alkhurma district, Jeddah, Saudi Arabia in 1995. It belongs to the Orthoflavivirus genus of the Flaviviridae family, and can be transmitted through contact with infected livestock animals or via tick bites. The initial symptoms resemble influenza along with hemorrhagic manifestations, which are less common but not unheard of in cases similar to encephalitis. Unfortunately, there are no specific treatments or vaccines available for AHFV infection. This review provides insights into the epidemiology, prevalence, transmission, clinical manifestations, diagnosis, control strategies, and preventive measures for AHFV disease in the Kingdom of Saudi Arabia.

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli are widely distributed in the community. Notably, ESBL-producing E. coli have high-frequency early mother-to-child transmission. The current study determined the treatment and intervention measures among neonates with ESBL-producing E. coli meningitis. Five neonates (4 males and 1 female) with meningitis caused by ESBL-producing E. coli admitted to our center from June 2020 to July 2023 were retrospectively reviewed. The clinical characteristics and treatment effects were analyzed. There were 4 cases of early- onset sepsis and 1 case of a catheter-related bloodstream infection. Four of 5 cases were premature infants with gestational ages between 27 and 33 weeks. The clinical manifestations included fevers (n=5), lethargy (n=5), dyspnea (n=4), and microcirculation disorders (n=4). Meropenem was infused intravenously in 2 patients with a median duration of 120.5 d (range, 98-143 d) at an early dose of 40 mg/kg every 12 h and an extended infusion. Three patients were infused with 40 mg/kg every 8 h for a median duration of 28 d (range, 21-61 d). Two neonates had recurrent illnesses, three neonates developed hydrocephalus, one neonate had a cerebral hemorrhage, and one neonate had convulsions during treatment. The follow-up results showed 4 neonates had normal neuromotor development and 1 neonate had a 2-month lag in neuromotor development. Maternal perinatal infections, premature delivery, and catheter-related bloodstream infections are high-risk factors for ESBL-producing E. coli meningitis. Children with fevers and lethargy should be monitored closely. ESBL-producing E. coli infections in children with meningitis are prone to recurrences and secondary hydrocephalus. Attention should be paid to ensuring the correct high dose of the antibiotic.

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.