Journal of Microbiology Immunology and Infection最新文献

Background: Third-generation cephalosporin-resistant Enterobacterales is a recognized global concern. This study investigated the molecular epidemiology of β-lactamase genes and antimicrobial susceptibility patterns among ceftriaxone-resistant Enterobacterales causing intra-abdominal and urinary tract infections in Taiwan between 2009 and 2019.

Methods: Data from the SMART surveillance program were analyzed, including Enterobacterales isolates with ceftriaxone minimum inhibitory concentrations ≥4 μg/mL. β-lactamase genes were detected using multiplex polymerase chain reaction assays.

Results: The overall ceftriaxone-resistant rate among Enterobacterales was 28.2 %, with a significant annual increase in ceftriaxone-resistant Klebsiella pneumoniae in both community- and hospital-acquired infections. Among the 2614 ceftriaxone-resistant isolates, the most common species were Escherichia coli (58.4 %), K. pneumoniae (16.3 %), and Enterobacter cloacae (9.9 %). Of all ceftriaxone-resistant isolates, 27.8 % carried only AmpC genes, 38.8 % carried only ESBL genes, and 16.2 % harbored both. High carriage rates of AmpC-encoding genes were observed in E. coli (38.9 %) and K. pneumoniae (48.9 %), with an overall prevalence of 44 %. The most common genotypes were bla_CMY (41.2 %), bla_DHA (31.8 %), and bla_ACT/bla_MIR (27 %). Ceftolozane/tazobactam showed poor susceptibility against ceftriaxone-resistant isolates carrying only AmpC (20.1 %) and most ceftriaxone-resistant Enterobacterales (<55 %), except E. coli. Ertapenem demonstrated low susceptibility to K. pneumoniae, E. cloacae (both approximately 50 %), and isolates harboring only AmpC genes (57.9 %).

Conclusions: A high prevalence and diversity of AmpC genes were observed in E. coli and K. pneumoniae. The limited activity of ertapenem and ceftolozane/tazobactam suggests that the molecular mechanisms underlying ceftriaxone-resistant Enterobacterales in Taiwan are complex and likely involve factors beyond AmpC and ESBL carriage.

Sexually transmitted infections (STIs) continue to pose major public health challenges globally, with millions of new cases reported annually. The asymptomatic characteristic of many STIs makes accurate and cost-effective diagnostic methods essential for screening and diagnosis. This paper evaluates the utility of enzyme-linked immunosorbent assays (ELISAs) in diagnoses of HIV, HPV, HSV, HBV, HCV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum. Compared to nucleic acid amplification tests (NAATs), ELISAs have advantages that include minimal training requirements, lower costs, and suitability for community screening programs. Despite their practical advantages, conventional ELISAs face key performance limitations, cross-reactivity, lower sensitivity, and delayed detection, that have restricted their broader adoption, reducing the potential for ELISAs to become a standard STI detection method. Currently, advancements in ultrasensitive and digital ELISA technologies have greatly improved their accuracy and may improve the dilemma. This review describes current ELISA methodologies, efficacies, and limitations as observed in and reported for clinical applications and offers a comprehensive perspective on essential STI diagnostic improvements, motivated by the belief that ELISA techniques can significantly contribute to the early detection, treatment, and containment of STIs.

Background: People living with HIV (PLWH) are at increased risk for metabolic disorders, including diabetes and prediabetes. While hemoglobin A1c (HbA1c) is widely used for glycemic assessment, its reliability in PLWH is questioned due to altered red blood cell turnover. Glycated albumin (GA) has been proposed as an alternative, but its diagnostic utility remains unclear in PLWH. This study aims to compare the correlations of HbA1c and GA with fasting plasma glucose (FPG), evaluate their diagnostic performance, and identify factors influencing discrepancies between them in PLWH.

Methods: This retrospective cross-sectional study included 236 PLWH with documented FPG, HbA1c, and GA levels. Correlations between glycemic markers were assessed using Pearson's correlation coefficients. Diagnostic performance for prediabetes and diabetes was evaluated using receiver operating characteristic (ROC) curves, and a GA cut-off was determined using the Youden index. Multivariable logistic regression was performed to identify predictors of HbA1c-GA mismatch.

Results: HbA1c showed a moderate correlation with FPG (r = 0.33, p value < 0.001), while GA had a weaker correlation (r = 0.18, p value = 0.005). The area under the ROC curve (AUC) for detecting glycemic abnormalities was 0.66 for HbA1c and 0.57 for GA. The optimal GA cut-off for prediabetes derived from ROC analysis was 12.42 %, improving sensitivity but reducing specificity. Multivariable analysis identified low mean corpuscular volume (MCV <80 fL) as an independent predictor of HbA1c-GA mismatch (odds ratio = 4.94, 95 % confidence interval: 1.95-12.50, pvalue < 0.001).

Conclusion: HbA1c or GA alone do not reliably capture glycemic abnormalities in PLWH. A lower GA cut-off (12.42 %) for prediabetes improves sensitivity but remains suboptimal. A combined approach incorporating FPG is recommended to enhance prediabetes and diabetes screening accuracy in this population.

Background: Adherence to antiretroviral therapy (ART) is critical for successful viral suppression in people living with HIV (PLHIV). The comparative effectiveness of two-drug regimens (2DRs) versus three-drug regimens (3DRs)-particularly in Asian populations-is an underexplored topic.

Methods: This retrospective cross-sectional study was conducted at two hospitals in Taiwan between November 2023 and January 2025. Adherence was measured in terms of the proportion of days covered (PDC) over 365 days. Logistic regression analyses were used to evaluate the effectiveness of viral suppression and factors associated with regimen selection.

Results: Of the 628 PLHIV included, most were men, aged between 30 and 50 years, identified as lesbian, gay, bisexual, or transgender, and had received their diagnosis of HIV >5 years prior to this study. Among the participants receiving 3DRs (81.37 %), 3.72 % had viral loads exceeding 200 copies/mL. Regarding those receiving 2DRs (18.63 %), 2.56 % exhibited similar viral loads (p = 0.781). Multivariable analysis indicated that PDC ≥75 % was strongly associated with viral suppression (adjusted odds ratio [aOR] = 45.80, p < 0.0001), with no significant difference in viral suppression rates between regimens. The participants receiving 3DRs were less likely to have >75 % adherence (aOR = 0.18, p = 0.018) and to have a long HIV history (>5 years; aOR = 0.22, p = 0.041).

Conclusion: Adherence, not regimen type, is the key factor affecting viral suppression. Nevertheless, the findings should be cautiously interpreted because of potential bias and small subgroup sizes. Further prospective studies should evaluate the comparative efficacy of these regimens.

Background: Machine learning (ML) techniques are increasingly being used in health outcome research to develop predictive models. However, ML models are often referred to as "black box models" because they lack interpretability. Our goal was to develop an ML model to predict mortality risk in patients with community-onset bacteremia.

Methods: We conducted a retrospective cohort study on 715 patients with bacteremia at a medical center in 2019. Model-agnostic methods were employed to visually explain the relationships between the predictors and the 30-day mortality risk. The model's performance was evaluated using the area under the receiver operating characteristic curve, calibration plots with the Brier score, accuracy, recall, precision, and F1 score.

Results: The top ten important predictors that significantly influenced the 30-day mortality prediction were the Pitt bacteremia score, septic shock, Charlson comorbidity index, length of stay in the ICU, neutrophil segment (%), age, neutrophil band (%), glucose, lymphocytes (%), and hemoglobin. The top three overall interaction strengths were septic shock, Charlson comorbidity index and Pitt bacteremia score, all of which significantly interacted with other predictors.

Conclusion: ML revealed risk factors for 30-day mortality, including the Pitt bacteremia score, septic shock, age, pneumonia, and comorbidity, which also had multiple synergistic effects on 30-day mortality.

Background/purpose: Severe Fever with Thrombocytopenia Syndrome (SFTS) is a tick-borne viral disease with high mortality rates. The Multiple Organ Dysfunction Score (MODS) is used for assessing organ dysfunction and predicting outcomes in critically ill patients. We aimed to evaluate the relationship between MODS and clinical outcomes in patients with SFTS.

Methods: We conducted an observational cohort study involving patients with SFTS between 2013 and 2023. Patients were categorized into four groups (0-1, 2-3, 4-5, and ≥6) based on their MODS at admission and day 7.

Results: Among the 97 patients with SFTS, the mean age was 62.4 years with 53.6 % males. The 7-day mortality rate for patients with MODS ≥6 was 37.5 %, compared to 0 % for those with MODS 0-1. Patients with MODS scores of 4-5 also showed high 7-day mortality (25.0 %). Higher MODS scores were significantly associated with elevated mortality rates. Viral loads and IL-6 levels were significantly higher in patients with MODS ≥6 than those with lower scores.

Conclusions: MODS is a valuable prognostic tool for assessing disease severity in patients with SFTS. Monitoring changes in MODS could improve outcomes by identifying patients who need aggressive treatment early in the disease course.

Background: Rifampicin (RMP), ethambutol, and pyrazinamide (PZA) for 6-9 months were recommended for the management of isoniazid-resistant, rifampicin-susceptible tuberculosis (Hr-TB), but recommendations on fluoroquinolones (FQs) were inconsistent. We investigated treatment outcomes and acquired RMP resistance in Hr-TB compared to isoniazid-susceptible TB (Hs-TB).

Methods: We retrospectively enrolled TB patients notified from 2010 to 2018 in Taiwan. Logistic regression model was constructed to estimate the odds of favourable outcomes and acquired RMP resistance. Propensity score matching (PSM) was conducted to address selection bias.

Results: 6115 Hr-TB and 71,184 Hs-TB were included. 25.6 % of Hr-TB and 24.7 % of Hs-TB had unfavourable treatment outcomes (p = 0.149). 0.9 % of Hr-TB and 0.1 % of Hs-TB had acquired RMP resistance (p < 0.001). In Hr-TB treated with RMP and PZA throughout regimens and Hs-TB treated with RMP throughout regimens, unfavourable treatment outcomes (16.1 % vs 13.3 %, p < 0.001), and acquired RMP resistance (1.0 % vs 0.1 %, p < 0.001) was significantly higher in Hr-TB than that in Hs-TB. Among Hr-TB, treatment with FQs were significantly associated with favourable outcomes (adjOR: 3.18, 95 % CI: 2.45-4.15) and less acquired RMP resistance (adjOR: 0.16, 95 % CI: 0.05-0.55). FQs remain significantly associated with favourable outcomes (adjOR 3.44, 95 % CI 2.56-4.63) after PSM. Of the 747 Hr-TB patients treated with a FQ, one (0.13 %) had acquired FQ resistance.

Conclusions: RMP and PZA throughout regimens did not completely remove the influence of isoniazid resistance. The use of FQs was associated with better treatment outcomes and a lower risk of acquired RMP resistance in Hr-TB but acquired FQ resistance may occur.

Background: The conserved CCAAT-binding complex (CBC) specifically recognizes and binds to the CCAAT motif present in eukaryotic promoters, thereby controlling gene transcription. In Candida albicans, the CBC cooperates with another transcription factor, Hap43, to regulate iron homeostasis. Moreover, several Hap43-independent functions have also been uncovered. However, the functions of CBC have not been extensively characterized.

Methods: Deletion mutants lacking each component of the CBC were independently compared to the wild-type strain with regard to cell wall properties, composition, and structure. The effects of CBC deletion on biofilm formation were also investigated. Finally, RNA-seq analysis was performed to reveal functional divergence between the two Hap3 paralogs, Hap31 and Hap32.

Results: CBC deletion significantly impacts cell wall properties, composition, exposure of glucan and chitin, as well as cell wall remodeling. These effects appear to be associated with the small GTPase Rhb1 and the Mkc1 signaling pathway. Moreover, we showed that CBC deletion affects biofilm formation, which appears to be independent of Rhb1. RNA-seq analysis further revealed the broad roles of the Hap3 paralogs within the CBC.

Conclusion: Notably, this work provides new insights into the relationship among CBC, cell wall maintenance, and biofilm formation in C. albicans.

Purpose: Short-term dexamethasone has been used in patients with chronic hepatitis B flares to reduce inflammation in the liver. We aim to identify the potential population that may benefit from dexamethasone treatment.

Methods: A retrospective cohort study was conducted involving 856 hospitalized hepatitis B e antigen-positive patients with chronic hepatitis B flares. The primary endpoint was the 1-year incidence of hepatitis B surface antigen (HBsAg) sero-clearance after the hospital admission. The hazard ratio (HR) and 95 % confidence interval (CI) were calculated using the Cox proportional hazards regression model.

Results: Dexamethasone treatment was associated with a higher incidence of HBsAg sero-clearance (adjusted HR: 3.561, 95 % CI: 1.281-9.902, P = 0.015). These results were further confirmed using the propensity score matching method (HR: 13.115, 95 % CI: 1.705-100.886, P = 0.013). In addition, a faster total bilirubin decrease was observed under dexamethasone treatment (0.57 × upper limit of normal [ULN] per day vs. 0.11 × ULN per day, P < 0.001). Importantly, patients with alanine aminotransferase (ALT) ≥ 30 × ULN and platelet counts ≥ 110 × 10⁹/L were identified as the beneficial population for dexamethasone treatment. These patients showed a higher incidence of HBsAg sero-clearance (39.3 % vs. 11.3 %, P < 0.001; HR: 5.524, 95 % CI: 1.192-25.607, P = 0.029), and faster total bilirubin decline.

Conclusion: Our study confirmed the beneficial role of low-dose and short-term dexamethasone treatment in flare patients, particularly in patients with ALT ≥ 30 × ULN and platelet counts ≥ 110 × 10⁹/L.