Journal of Microbiology Immunology and Infection最新文献

Background: This study aimed to evaluate the ability of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) to predict progression of latent tuberculosis (LTBI) to active tuberculosis.

Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library for cohort studies published until October 6, 2024, that used both IGRA and TST to detect LTBI and reported data on active TB development. We assessed the predictive value of IGRA and TST for disease progression by calculating the risk ratio (RR), which compares the progression rates between positive and negative individuals for each test.

Results: Out of 2650 potentially eligible studies, 260 were reviewed in full text, and 44 studies with 25637 individuals were included. The pooled RR for disease progression was higher with IGRA than with TST (5.38 [95 % CI: 3.44-8.40] vs. 3.03 [95 % CI: 1.20-4.10]), although this difference did not reach statistical significance (p = 0.0713). PPV with IGRA vs TST: 2.50 % [95 % CI: 1.20 %-4.10 %] vs 1.30 % [95 % CI: 0.60 %-2.40 %] (p = 0.4852). NPV with IGRA vs TST: 99.70 % [95 % CI: 99.40 %-99.90 %] vs 99.60 % [95 % CI: 99.30 %-99.90 %] (p = 0.9630). Furthermore, the PPV of IGRA was similar to the progression rate of IGRA+/TST+ (2.00 % [95 % CI: 0.05 %-4.40 %] vs. 2.50 % [95 % CI: 0.40 %-6.10 %]). Finally, while IGRA identified fewer positive individuals (23.90 % [95 % CI: 18.50 %-29.80 %] vs. 52.20 % [95 % CI: 34.30 %-69.80 %]), the number of positive individuals progressing was similar (265 vs. 268), with similar results also observed in the untreated population.

Conclusions: IGRA appears to have superior predictive value for TB progression compared to TST. Additionally, incorporating TST alongside IGRA does not seem to significantly enhance predictive accuracy. IGRA effectively reduces the number of individuals requiring treatment while seemingly not missing those at risk of progression.

Background: ED-initiated outpatient parenteral antimicrobial therapy (OPAT) aims to reduce admissions and relieve ED boarding. In practice, however, OPAT may be used as a "middle-ground" alternative to oral therapy, complicating assessment of its true value. Because studies using matched inpatient and outpatient comparators with longitudinal endpoints are scarce, we evaluated the effectiveness, safety, and medical costs of an ED-initiated OPAT program in Taiwan.

Methods: This retrospective cohort study analyzed ED-initiated OPAT patients from two teaching hospitals (2017-2019). Using coarsened exact matching, we created two comparison groups: inpatient-matched (assessing effectiveness) and outpatient-matched (assessing safety). The primary outcome was net hospital days saved over 30 days, derived from daily hospital-prevalence trajectories. Secondary outcomes were 14-day cumulative incidence of ED revisits/readmission and a stratified cost analysis over the treatment course.

Results: Of 1409 OPAT patients, 986 were matched. In the inpatient-matched cohort (n = 416), OPAT saved a net 8.9 hospital-days per patient over 30 days. In the outpatient-matched cohort (n = 570), OPAT showed a transiently higher risk of return visits at day 7 (risk difference +5 %; p = 0.008) without increases in severe adverse events or 14-day readmissions. OPAT reduced costs by NT$34,367 per patient when substituting for hospitalization but increased costs when compared with standard outpatient care.

Conclusions: For appropriately selected patients requiring admission-level care, ED-initiated OPAT can be a cost-saving substitute for hospitalization. Given limited safety data, benefits remain conditional on rigorous patient selection to avoid overuse and on structured early reassessment to mitigate early revisit risks.

Background: People with diabetes (PWD) exhibit a higher prevalence of Hepatitis C virus (HCV) infection, making them a crucial population for HCV screening and micro-elimination efforts. In light of the first published interdisciplinary consensus on managing/screening HCV in PWD, this study aims to evaluate the results and identify effective strategies for incorporating HCV screening and treatment into an existing diabetes care model managed by case managers.

Methods: This multicenter prospective program, initiated by a diabetes society, involved eighteen centers in Taiwan. Each center developed strategies to enhance HCV screening and streamline linkage to HCV care for PWD. Data on screening, diagnosis, and direct-acting antiviral (DAA) treatment were collected. Hospitals were ranked by the average number of monthly DAA treatments, and the strategies of the top five centers were compared with others.

Results: Over a median period of 6.1 months, 28,436 patients were screened, and 1379 (4.8 %) tested positive for anti-HCV antibodies (Ab). A total of 333 (24.1 %) patients were positive for HCV RNA, of whom 288 (86.4 %) received DAA treatment. Overall, 25 strategies were adopted, with the more effective being: the involvement of multidisciplinary healthcare professionals in the program, automation of information technology to search for HCV history, and patient recall for HCV Ab screening.

Conclusions: This program pioneered the evaluation of integrating of HCV screening and treatment in PWD, providing strategic insights into HCV micro-elimination through efficient patient identification and collaborative HCV management.

Community-associated methicillin-resistant Staphylococcus aureus ST8/SCCmecIVl occasionally causes invasive infections. Only severe cases harbored p32kb, with repA1, oriT-based recombination with conjugative pWtra, and a virulence gene cluster with varying citABC positivity associated with intramuscular and non-intramuscular infections. Our findings highlight the potentially critical role of citA (CitA superantigen), which may be applied as a potential severity marker.

Background: Endophthalmitis is an ophthalmic emergency. In recent years, the incidence of endogenous endophthalmitis (EE) has increased. This study aims to elucidate the clinical characteristics and risk factors associated with the visual prognosis of EE.

Methods: This study included 111 patients (121 eyes) diagnosed with EE who received intraocular and systemic treatment at Huashan Hospital, Fudan University, between January 2014 to December 2023. We conducted a comprehensive review of the demographic and clinical characteristics of the cohort and analyzed the risk factors linked to poor visual prognosis.

Results: A total of 111 patients (121 eyes) were included in this study, of whom 101 eyes (83.5 %) had identifiable pathogenic microorganisms, with Klebsiella pneumoniae (KP) was the most common pathogen. Compared to conventional culture methods (sensitivity 47.6 %), metagenomic next-generation sequencing (mNGS) demonstrated significantly higher sensitivity (97.6 %) in vitreous samples. Outcome analysis indicated that mNGS played a critical role in guiding clinical antibiotic adjustments, and patients receiving targeted therapy showed significant visual improvement (P = 0.002), with stable systemic recovery. Furthermore, vitreous surgery had a positive effect on visual prognosis (P < 0.001). Regression analysis revealed that poor initial visual acuity (VA) (OR: 20.622, 95 % CI: 3.894-109.2) and KP infection (OR: 3.398, 95 % CI: 1.096-10.538) were independent risk factors for poor final VA.

Conclusion: Our findings identify KP as the most common causative pathogen of EE. Infections caused by KP and poor initial VA are significant risk factors for poor visual outcomes. Looking ahead, mNGS holds promise as a crucial tool for the clinical diagnosis of EE.

Background: Aspergillus-specific immunoglobulin G (IgG) positivity typically indicates exposure to Aspergillus species, but its clinical significance among chronic lung diseases remains uncertain.

Methods: This prospective study enrolled patients with bronchiectasis, chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD) in Taiwan between July 2019 and June 2023. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured at baseline and repeated 1 year later. Lung function rapid decline was defined as FEV1 decline ≥ 60 mL/year or FVC decline ≥ 10 % predicted/year based on previous literature.

Results: A total of 97 patients were enrolled, including 75 (77.3 %) with bronchiectasis, 42 (43.3 %) with COPD, 26 (26.8 %) with asthma, and 6 (6.2 %) with ILD. Higher Aspergillus-specific IgG levels were significantly associated with greater FEV1 decline (r = 0.34, P < 0.001) but not with greater FVC decline (r = 0.10, P = 0.327). Multivariable analysis demonstrated that higher Aspergillus-specific IgG levels were an independent risk factor for rapid FEV1 decline (odds ratio = 1.04; 95 % confidence interval [CI]: 1.01-1.08; P = 0.007). The area under the receiver operating characteristic curve of Aspergillus-specific IgG for predicting FEV1 rapid decline was 0.72 (95 % CI: 0.61-0.82). A cutoff of 30 mgA/L provided a sensitivity of 63.64 % and specificity of 71.43 % in predicting rapid FEV1 decline.

Conclusions: Higher Aspergillus-specific IgG levels may be associated with rapid FEV1 decline in patients with chronic lung diseases, although this association requires further validation in larger, disease-specific cohorts.

Objectives: To explore factors significantly associated with plasma procalcitonin (PCT) concentration elevation among patients with monomicrobial Gram-negative bacteremia.

Methods: Sepsis patients hospitalized in intensive care units between 2020 and 2024 were eligible for this study. Their demographic characteristics, comorbidities, development of shock and disseminated intravascular coagulation, key laboratory data-including plasma C-reactive protein (CRP) and PCT concentrations-sonographic and radiographic findings, and septic workup results were collected. To determine the median PCT level, patients with monomicrobial Gram-negative bacteremia were stratified into two equal groups.

Results: Patients with bacteremia secondary to biliary tract infection (n = 24), urinary tract infection (UTI; n = 118), and primary source (n = 71), showed high proportions of Enterobacterales species as causative etiologies. A total of 358 patients with monomicrobial Gram-negative bacteremia were included in the final analysis. Patients with plasma PCT concentrations above the median value (20.2 ng/mL) did not exhibit higher mortality rates compared to those with concentrations below the median. Additionally, diabetes mellitus, UTI associated with hydronephrosis, and shock development were identified as independent predictors for markedly elevated plasma PCT concentrations among patients with monomicrobial Gram-negative bacteremia (odds ratio [OR], 1.66, 3.83, and 2.09; 95 % confidence interval [CI], 1.02-2.70, 1.64-8.93, and 1.25-3.50; P values, 0.043, 0.002, and 0.005, respectively). In contrast, the presence of Child-Pugh class C liver cirrhosis was a negative predictor of high plasma PCT concentrations (OR 0.35, 95 % CI 0.11-0.97, and P = 0.049).

Conclusions: This study recognized factors with significant impact on plasma PCT concentrations among patients with monomicrobial Gram-negative bacteremia.

Background: Hemodialysis (HD) patients with nasal Staphylococcus aureus carriage are at an increased risk of S. aureus infection.

Purpose: This study investigated the incidence of S. aureus bacteremia and associated mortality in HD patients receiving active screening and decolonization (ASD) program for nasal S. aureus carrier in a teaching hospital HD unit.

Methods: The ASD program was divided into five stages: 1: preintervention, 2: preparation, 3: intervention, 4: interruption, and 5: reintervention. Nasal screening was conducted every 3 months in stages 3 and 5. Patients colonized with S. aureus received decolonization with mupirocin to the nares and 4 % chlorhexidine gluconate body wash. S. aureus bacteremia and mortality were assessed. Whole-genome sequencing was conducted on S. aureus isolate in stage 3.

Results: In preintervention stage, the bacteremia incidence and mortality rate were 7.8 and 3.1 cases per 100 patient-years(PY). In the intervention stage, the incidence rate decreased to 1 case per 100 PY without mortality. In the reintervention stage, the incidence and mortality rates were 2.1 and 0.6 cases per 100 PY. The rates in stages 3, 4, and 5 were significantly lower than those in preintervention stage (p < 0.05). Genomic analysis of S. aureus isolates from stage 3 revealed genetically diversity. High-level mupirocin-resistant S. aureus isolates carrying mupA-bearing plasmids were identified.

Conclusions: ASD programs for S. aureus carrier may improve clinical outcomes in HD units. However, mupirocin resistance may emerge after decolonization, indicating a need for ongoing monitoring and alternative decolonization strategies.

Background: Microbes and their metabolites are implicated in respiratory diseases, including allergic rhinitis (AR); however, the interaction between the gut and respiratory tract and the role of microbes remains unclear. We investigated the gut and nasal microbiota variations between AR and control mice and their role in the bidirectional regulation of the gut-nasal axis.

Methods: We validated the OVA-induced establishment of an AR mouse model based on nasal symptoms and histopathology. The microbiota and metabolites in the feces and nasal lavage fluid were analyzed, and a correlation analysis was performed. Structural changes in the colonic and nasal mucosa were examined using electron microscopy, and ZO-1 and Claudin 1 protein expression was assessed using immunofluorescence and western blotting. RNA-seq identified changes in gene expression in the nasal mucosa. Mendelian randomization analysis was applied to exploit the causal relationship between gut microbiota, gut microbiota-derived metabolites and AR.

Results: AR mice exhibited aggravated nasal symptoms, local histological disruption, and inflammatory cell infiltration in the nasal mucosa and gut tissues, with significant changes in the microbiota and metabolites at both sites. Correlation analysis revealed that gut microbes influenced fecal and nasal lavage fluid metabolite changes and vice versa. AR mice also have impaired nasal mucosal and colonic interepithelial junctions, reduced ZO-1 and Claudin 1 expression, and upregulated immune-inflammatory pathways in the nasal mucosa.

Conclusion: The microbiota in the gut and nasal cavity interact bidirectionally, coordinating the gut-nasal axis and contributing to AR pathology. These findings provide insights for advancing AR research and management.