Brazilian Journal of Infectious Diseases最新文献_第3页

Indications and prescriptions of penicillins in a population of Colombia: A cross-sectional study 哥伦比亚人群中青霉素的适应症和处方：一项横断面研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-07-16 DOI: 10.1016/j.bjid.2025.104572

Luis Fernando Valladales-Restrepo , Brayan Stiven Aristizábal-Carmona , Luisa María Londoño-Toro , Mariavictoria del Valle Jaramillo-Lima , Mariana Osorno-Ríos , Jorge Enrique Machado-Alba

Inappropriate use of antibiotics plays a key role in increasing bacterial resistance. The aim was to determine the prescription patterns and approved and unapproved indications for the use of penicillins in a group of patients from Colombia. This was a cross-sectional study on the use of penicillins in outpatients. The subjects were identified from a population-based drug dispensing database. Approved and unapproved indications were determined from records of the Food and Drug Administration (FDA) of the United States and the National Institute of Food and Drug Surveillance (INVIMA) of Colombia. Descriptive and multivariate analyses were performed. A total of 137,070 patients were identified; the average age was 35.8 ± 23.5 years, and 56.2 % were women. Amoxicillin (73.4 %), dicloxacillin (11.7 %) and sultamicillin (6.0 %) were the most prescribed penicillins, mainly for upper respiratory tract infections (43.0 %). In 68.9 % cases, penicillins were used for approved indications, especially to treat Helicobacter pylori (17.3 %). In 31.1 % of cases, penicillin prescriptions were used for unapproved indications (acute rhinopharyngitis: 8.1 %). Patients with skin and soft tissue infections (aOR = 2.82; 95 % CI 2.57‒3.09), with lower respiratory tract infections (aOR = 2.02; 95 % CI 1.89‒2.16), and those treated with dicloxacillin (aOR = 2.84; 95 % CI 2.07‒3.89) were more likely to be prescribed penicillins for unapproved indications. Amoxicillin was the most widely used penicillin in outpatients. Penicillins were frequently used for unapproved indications not recommended by drug regulatory agencies.

不适当使用抗生素在增加细菌耐药性方面起着关键作用。目的是确定哥伦比亚一组患者使用青霉素的处方模式以及已批准和未批准的适应症。这是一项关于门诊病人使用青霉素的横断面研究。受试者是从基于人群的药品调剂数据库中确定的。根据美国食品和药物管理局（FDA）和哥伦比亚国家食品和药物监测研究所（INVIMA）的记录确定了已批准和未批准的适应症。进行了描述性和多变量分析。共有137,070名患者被确定；平均年龄35.8±23.5岁，女性占56.2%。阿莫西林（73.4%）、双氯西林（11.7%）和舒他西林（6.0%）是处方最多的青霉素类药物，主要用于上呼吸道感染（43.0%）。在68.9%的病例中，青霉素用于批准的适应症，特别是治疗幽门螺杆菌（17.3%）。在31.1%的病例中，青霉素处方被用于未经批准的适应症（急性鼻咽炎：8.1%）。皮肤软组织感染患者(aOR = 2.82；95% CI 2.57-3.09)，下呼吸道感染(aOR = 2.02；95% CI 1.89-2.16)，双氯西林组(aOR = 2.84；95% CI 2.07-3.89)更有可能在未经批准的适应症中使用青霉素。阿莫西林是门诊使用最广泛的青霉素。青霉素经常被用于药物监管机构不推荐的未经批准的适应症。

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引用次数: 0

Health resource use and epidemiologic profile of herpes zoster outpatients aged 50 years or older: a modified Delphi consensus panel in Brazil 50岁或以上的带状疱疹门诊患者的卫生资源使用和流行病学概况：巴西修改的德尔菲共识小组

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-07-04 DOI: 10.1016/j.bjid.2025.104560

Ângela Maria Bagattini , Michelle Quarti Machado da Rosa , Jorge A. Gomez , Jamile Ballivian , Agustín Casarini , Ariel Bardach , Cristiana Maria Toscano

Herpes Zoster (HZ) and its complications, such as Postherpetic Neuralgia (PHN), are associated with significant burden in elderly. In Brazil, data on economic and epidemiologic HZ burden is still limited. We conducted a Delphi panel to assess healthcare resource use in HZ outpatients aged 50-years and older. Diagnosis and treatment resources, proportion of referral and hospitalization were estimated considering HZ, PHN, ophthalmic and neurologic zoster typical cases. A diverse group of 20 medical specialists was selected, and responded anonymously to an online questionnaire. Consensus was met if ≥ 75 % agreement was reached in the 1st round, and if not met, a 2nd round was held. Summary statistics are reported stratified by age-groups and healthcare system (public and private). Responses were obtained from 19 and 17 panel members in the 1st and 2nd rounds, respectively. The proportion HZ outpatients with PHN increased significantly with age (4 % in 50‒59; 14 % in ≥ 80 years). Ophtalmic and neurological complications ranged from 5 %‒13 % across age groups. Absenteeism was high, ranging from 30 %‒68 % of patients depending on the clinical presentation. HZ patients required 2‒3 medical visits, and referral to another medical specialty varied from 10 %‒22 % across age ranges, doubling for NPH patients. Proportion of hospitalization varied from 1–8 %. HZ diagnosis was mainly clinical (93 %). Acyclovir (95 %) and valaciclovir (80 %) were the therapy of choice in the public and private systems, respectively. Pain management included dipyrone and codeine (63 %), pregabalin (58 %), and gabapentin (Neurontin) (48 %). Our results report significant healthcare resource utilization by elderly HZ patients in Brazil.

带状疱疹（HZ）及其并发症，如带状疱疹后神经痛（PHN），与老年人的重大负担相关。在巴西，关于HZ的经济和流行病学负担的数据仍然有限。我们采用德尔菲法评估50岁及以上HZ门诊患者的医疗资源使用情况。考虑HZ、PHN、眼科和神经系统带状疱疹典型病例，评估诊断和治疗资源、转诊和住院比例。20名医学专家组成的多元化小组被选中，并匿名回答了一份在线问卷。如果在第一轮中达成≥75%的共识，则达成共识，如果未达成共识，则举行第二轮。摘要统计数据按年龄组和医疗保健系统（公立和私立）分层报告。评审小组在第一轮及第二轮分别收到19位及17位成员的回应。伴有PHN的HZ门诊患者比例随年龄的增长而显著增加(50-59岁为4%；≥80年的14%)。眼科和神经系统并发症在各年龄组中占5% - 13%。缺勤率很高，根据临床表现，缺勤率从30% - 68%不等。HZ患者需要2-3次就诊，转诊到其他医学专科的比例在不同年龄范围内从10% - 22%不等，NPH患者的比例翻了一番。住院比例从1 - 8%不等。HZ主要是临床诊断（93%）。阿昔洛韦（95%）和伐昔洛韦（80%）分别是公立和私立系统的首选治疗方法。疼痛治疗包括双吡隆和可待因（63%），普瑞巴林（58%）和加巴喷丁（Neurontin）（48%）。我们的研究结果报告了巴西老年HZ患者显著的医疗资源利用率。

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引用次数: 0

Validation of immunochromatographic test in broth-enriched rectal swab specimens 免疫层析试验在富含肉汤的直肠拭子标本中的验证

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-06-30 DOI: 10.1016/j.bjid.2025.104559

Camila Loredana P.A.M. Bezerra , Barbara de Almeida Lessa Castro , Camila Rizek , Sania Alves dos Santos , Juliana Januário Gaudereto , Ana Paula Cury , Natashia Reese , Fernanda C. Lessa , Susan Bollinger , Matias Chiarastelli Salomão , ICT validation Study Group

Rapid detection of Carbapenemase-Producing Enterobacterales (CPE) is essential for informing infection prevention and control actions to curb the spread of antimicrobial resistance. Immunochromatographic Tests (ICTs) offer a quick and cost-effective alternative to molecular methods but are typically designed for bacterial isolates rather than direct clinical specimens. We developed a protocol using the O.K.N.V.I. RESIST-5 ICT (Coris Bioconcept, Gembloux, Belgium) to detect KPC, NDM, OXA-48, VIM, and IMP carbapenemases from broth-enriched mock rectal swabs. A total of 35 well-characterized carbapenemase-producing isolates were inoculated into a 10 % stool matrix to create mock swabs. Swabs were incubated in Brain-Heart Infusion (BHI) broth, with and without a 10 μg meropenem disk, at 37 °C for 4 and 6 h. After incubation, broths were centrifuged, and pellets were tested using the ICT. Sensitivity, specificity, and accuracy were calculated for each method (with/without meropenem disk and incubation period). Optimal performance was achieved with swabs incubated in BHI broth without meropenem for 6 h, showing 100 % sensitivity, specificity, and accuracy for all the five enzymes tested. Incubation with meropenem or shorter incubation times resulted in lower sensitivities, with per-enzyme sensitivities ranging from 0 % to 100 %. The developed protocol enables rapid and accurate detection of five common carbapenemases directly from broth-enriched rectal swabs within 6 h. This method offers a practical alternative to culture-based and molecular techniques, potentially enhancing infection control measures through timely identification of CPE.

产碳青霉烯酶肠杆菌（CPE）的快速检测对于告知感染预防和控制行动以遏制抗微生物药物耐药性的传播至关重要。免疫层析测试（ict）提供了一种快速且具有成本效益的分子方法替代方法，但通常是为细菌分离物而不是直接临床标本设计的。我们开发了一种使用O.K.N.V.I. resistance -5 ICT （Coris Bioconcept, Gembloux, Belgium）检测富含肉汤的模拟直肠棉签中KPC、NDM、OXA-48、VIM和IMP碳青霉烯酶的方案。将35株具有良好特征的产碳青霉烯酶分离株接种到10%的粪便基质中制备模拟棉签。拭子在脑-心灌注（BHI）肉汤中（含和不含10 μg美罗培南盘），37℃孵育4和6 h。孵育后，肉汤离心，用ICT检测微球。计算每种方法（含/不含美罗培南圆盘和潜伏期）的灵敏度、特异性和准确性。棉签在不含美罗培南的BHI肉汤中孵育6 h，获得最佳性能，对所有五种酶的敏感性、特异性和准确性均为100%。用美罗培南孵育或更短的孵育时间导致较低的敏感性，对酶的敏感性从0%到100%不等。开发的方案能够在6小时内直接从富含肉汤的直肠拭子中快速准确地检测五种常见的碳青霉烯酶。该方法提供了一种基于培养和分子技术的实用替代方法，通过及时识别CPE，有可能加强感染控制措施。

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引用次数: 0

Single nucleotide polymorphisms associated with benzimidazole resistance of the β-tubulin isotype 1 gene in Ascaris lumbricoides isolated in South Africa 南非蛔虫β-微管蛋白同型1基因与苯并咪唑抗性相关的单核苷酸多态性

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-06-28 DOI: 10.1016/j.bjid.2025.104556

Teniel Ramkhelawan , Pragalathan Naidoo , Zilungile L. Mkhize-Kwitshana

Background

Ascariasis is a parasitic infection caused by Ascaris lumbricoides and infects over 1.2 billion people worldwide. Benzimidazole (BZ) drugs remain the standard treatment in large-scale deworming programs globally. The prevalence of Single Nucleotide Polymorphisms (SNPs) in the β-tubulin gene of A. lumbricoides (F200Y, E198A and F167Y) is increasing due to the widespread use of BZ drugs.

Aim

To investigate the prevalence of the above-mentioned SNPs in a South African adult population.

Methods

This was a sub-study of the main cross-sectional study with participants (n = 414) who had been recruited from five public health clinics in the peri‑urban areas South of Durban, KwaZulu-Natal, South Africa. For the current study, a purposive selection of 20 stool samples that were positive for A. lumbricoides eggs was made. A. lumbricoides worm extracts (n = 4) were used as a positive control. Sanger sequencing and RFLP-PCR were used to identify the presence of mutations.

Results

No mutations were detected, and all genotypes observed at codons F167Y, E198A and F200Y were the homozygous wild-type genotype.

Conclusion

Although no mutations were found in this small study, the potential occurrence of mutations in a larger sample subset cannot be ruled out.

蛔虫病是一种由类蛔虫引起的寄生虫感染，全世界有超过12亿人感染。苯并咪唑（BZ）药物仍然是全球大规模驱虫计划的标准治疗方法。由于BZ类药物的广泛应用，蚓类β-微管蛋白基因（F200Y、E198A和F167Y）单核苷酸多态性（snp）的发生率越来越高。目的调查上述snp在南非成年人群中的流行情况。方法：这是主要横断面研究的一项亚研究，参与者（n = 414）从南非夸祖鲁-纳塔尔省德班南部城郊地区的五个公共卫生诊所招募。在目前的研究中，有目的地选择了20个粪便样本，这些粪便样本对蚓状拟虫卵呈阳性。阳性对照为4只拟南麻虫提取物。使用Sanger测序和RFLP-PCR来鉴定突变的存在。结果未发现突变，密码子F167Y、E198A和F200Y基因型均为纯合野生型。结论虽然在这个小的研究中没有发现突变，但不能排除在更大的样本子集中发生突变的可能性。

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引用次数: 0

Risk factors associated with syphilis among patients at a sexual health center in Brazil: A retrospective study 巴西性健康中心患者中与梅毒相关的危险因素：一项回顾性研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-06-28 DOI: 10.1016/j.bjid.2025.104558

Cristhiane Campos Marques , Fabiana Nunes de Carvalho Mariz , Thaisa Campos Marques , Juliana Tessari Dias Rohr , Berenice Moreira , Paula Beatriz Santiago , Nathália Araujo Varela da Costa , Juliana Marques de Oliveira , Otávio Toledo Nóbrega , Carla Nunes de Araújo

Syphilis has reemerged worldwide, and knowledge about at-risk populations can assist in disease prevention and control. This study aimed to estimate the prevalence of syphilis among attendees at a Brazilian sexual health center and explore the association between sociodemographic and sexual behavioral factors with syphilis infection. A cross-sectional study was conducted at a Counselling and Testing Center (CTC) in Goiás, Brazil. We collected data from January to December 2018 to conduct a population-based study. Of 3526 patient records included in the analysis, 344 (9.8 %) belonged to participants who had syphilis, mainly at the age of 20 to 39 years old (63.1 %, p = 0.0683) and not married (62.1 %, p = 0.0042). Individuals who reported having homosexual relationships (Odds Ratio [OR = 2.93], p < 0.0001), previous sexually transmitted infections (OR = 2.36, p < 0.0001), and use of drugs (OR = 1.29, p < 0.0001) were more frequently diagnosed with the disease. Among patients with syphilis, MSM had a higher HIV co-infection rate (OR = 2.37, p = 0.0195) and also higher co-infection rates with other previous STIs (OR = 2.84, p = 0.00883). A high prevalence of syphilis among patients who attended the CTC in Goiás was revealed. Effective control of syphilis among populations at higher risk needs to be addressed to achieve disease control in Brazil.

梅毒在世界范围内重新出现，对高危人群的了解有助于疾病的预防和控制。本研究旨在估计巴西性健康中心参与者中梅毒的患病率，并探讨社会人口统计学和性行为因素与梅毒感染之间的关系。在巴西Goiás的咨询和测试中心（CTC）进行了一项横断面研究。我们收集了2018年1月至12月的数据，进行了一项基于人群的研究。在纳入分析的3526例患者记录中，344例（9.8%）属于梅毒患者，主要是20至39岁（63.1%,p = 0.0683）和未婚（62.1%,p = 0.0042）。报告有同性恋关系的个体(优势比[OR = 2.93], p <；0.0001)，既往性传播感染(OR = 2.36, p <；0.0001)和药物使用(OR = 1.29, p <；0.0001)更常被诊断为该疾病。梅毒患者中，男男性行为者HIV合并感染率较高（OR = 2.37, p = 0.0195），与其他性传播感染合并感染率较高（OR = 2.84, p = 0.00883）。在Goiás参加CTC的患者中发现了梅毒的高患病率。为在巴西实现疾病控制，需要在高风险人群中有效控制梅毒。

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引用次数: 0

SARS-CoV-2 sublineages recovered from southern Brazilian cases during Omicron wave in 2023, early introduction of JN.1 SARS-CoV-2亚谱系在2023年欧米克隆波期间从巴西南部病例中恢复，早期引入了jn1

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-06-25 DOI: 10.1016/j.bjid.2025.104557

Mellanie Fontes-Dutra , Micheli Filippi , Meriane Demoliner , Alexandre Sita , Fernando Rosado Spilki

Since the emergence of the novel coronavirus SARS-CoV-2, public health measures have adapted as the virus evolve and acquired greater transmissibility and escape from the previous immune response. Genomic surveillance is a reliable and decisive tool for monitoring the evolutionary dynamics of the virus and its nucleotide diversity. Rio Grande do Sul is a southern Brazilian state that borders Argentina and Uruguay, and genomic and epidemiological surveillance led to early detection of COVID-19 variants, as seen in P.1 lineage. The study aimed to investigate the genetic characterization of SARS-CoV-2 Omicron sublineages in Rio Grande do Sul, Brazil, during 2023. By obtaining viral RNA from nasopharyngeal swabs positive for SARS-CoV-2, we performed high-throughput sequencing and data were analyzed using bioinformatic approaches. Our results revealed a dynamic change in Omicron sublineages during 2023, with the occurrence of JN.1+JN.1* reads during December 2023, parallel to the first JN.1 official record in Brazil, occurred in Ceará state, which is in the northeast region of Brazil. These data revealed a distinct nucleotide diversity in S gene of JN.1 reads, highlighting the importance of genomic surveillance in Rio Grande do Sul for the early detection of the entry of future SARS-CoV-2 variants into Brazil.

自新型冠状病毒SARS-CoV-2出现以来，随着病毒的进化，公共卫生措施已经做出了调整，并获得了更大的传播能力，并摆脱了先前的免疫反应。基因组监测是监测病毒进化动态及其核苷酸多样性的可靠和决定性工具。南大德州是巴西南部的一个州，与阿根廷和乌拉圭接壤，基因组和流行病学监测导致早期发现了COVID-19变体，如在P.1谱系中所见。该研究旨在调查2023年巴西巴西大德州里约热内卢地区SARS-CoV-2基因组亚系的遗传特征。通过从SARS-CoV-2阳性的鼻咽拭子中获取病毒RNA，我们进行了高通量测序，并使用生物信息学方法对数据进行了分析。我们的研究结果显示，在2023年期间，随着JN.1+JN的发生，Omicron亚系发生了动态变化。1*读数在2023年12月，与巴西的第一个JN.1官方记录平行，发生在巴西东北部地区的塞埃尔州。这些数据揭示了JN.1 reads中S基因的明显核苷酸多样性，突出了巴西大德州里约热内卢基因组监测对于早期发现未来SARS-CoV-2变体进入巴西的重要性。

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引用次数: 0

Emergency and persistence of Escherichia coli ST131 as community-onset antimicrobial resistant urinary tract infection in Rio de Janeiro, Brazil 在巴西里约热内卢，大肠杆菌ST131作为社区发病的抗微生物药物耐药性尿路感染的紧迫性和持久性

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-06-14 DOI: 10.1016/j.bjid.2025.104555

Eduardo Moreira de Castro , Isadora Silva Barcellos , Guilherme Santoro-Lopes , Ana Paula de Souza da Silva , Luís Guilherme de Araújo Longo , Mariana Anjo Barbosa , Gabriela Camarano de Oliveira , Lucas Cecílio Vilar , Adriana Lúcia Pires Ferreira , Karla Rodrigues Miranda , Beatriz Meurer Moreira

Urinary Tract Infections (UTI) are among the most common public health problems worldwide, mostly caused by Escherichia coli. High-risk pandemic clones, especially ST131, are known for their association with multidrug resistance. A better understanding of epidemiologic and molecular characteristics may provide insights into the dissemination and evolution of this pathogen. The present study aims to investigate selected clonal characteristics of a large collection of UTI-causing E. coli isolates from Rio de Janeiro, an urban center in Brazil. We set up a collection of 992 E. coli isolates from patients with UTI in 2019. We determined antimicrobial susceptibility, Extended Spectrum Betalactamase (ESBL) production and clonal composition of isolates and compared results with data from 2015. Frequencies of four most isolated pandemic clones (ST131, ST69, ST73 and ST95) were determined by PCR; ST131 clades were determined by PCR and fimH gene sequence; ESBL-producing isolates underwent MLST. Resistance frequencies were > 30 % for ampicillin and ciprofloxacin. ST131 isolates were the most frequent clone (14 %), increasing significantly from 2015, comprising 52 % of all ESBL-producing strains. Clade C formed most ST131 isolates (56 %), including 40 % of all ESBL-producing isolates, most in Clade C2; almost all fimH30. ST131, formed by heterogeneous lineages, was established as a major source of ESBL isolates in the community, with a major contribution to antimicrobial resistant UTI.

尿路感染（UTI）是世界范围内最常见的公共卫生问题之一，主要由大肠杆菌引起。众所周知，高风险大流行克隆，特别是ST131，与多药耐药性有关。更好地了解流行病学和分子特征可能有助于深入了解这种病原体的传播和进化。本研究旨在研究从巴西城市中心里约热内卢里约热内卢分离的大量引起尿路感染的大肠杆菌的克隆特征。我们收集了2019年从尿路感染患者中分离的992株大肠杆菌。我们检测了分离株的抗菌敏感性、扩展谱β -内酰胺酶（ESBL）产量和克隆组成，并将结果与2015年的数据进行了比较。采用PCR法测定了4个分离最多的大流行克隆（ST131、ST69、ST73和ST95）的频率；通过PCR和fimH基因序列测定ST131支系；产生esbl的分离株进行MLST。电阻频率为>；氨苄西林和环丙沙星30%。ST131分离株是最常见的克隆（14%），较2015年显著增加，占所有产esbl菌株的52%。进化支C形成了大多数ST131分离株（56%），包括所有产生esbl的分离株的40%，大部分在进化支C2；几乎所有的时间。由异质谱系形成的ST131被确定为社区中ESBL分离株的主要来源，对耐药UTI有重要贡献。

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引用次数: 0

Neurological manifestations of acute SARS-CoV-2 infection in a reference hospital in Bahia, Brazil 巴西巴伊亚州某参考医院急性SARS-CoV-2感染的神经学表现

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-05-26 DOI: 10.1016/j.bjid.2025.104542

Jesângeli de Sousa Dias , Maria Augusta Moreira Rebouças , Lilian Verena da Silva Carvalho , Thais Sampaio Silva , Jair Santana dos Santos , Astrid Xiomara Tatiana Otero Melendez , Carlos Brites

Background

Neurologic manifestations of Coronavirus Disease-19 (COVID-19) have been associated with patients’ disease severity and outcome. This study aimed to describe the frequency and characteristics of the neurological manifestations in a group of hospitalized individuals with COVID-19 and their associations with patient outcomes.

Methods

Patients aged 18 years or older admitted to a local hospital between April and June 2020 with SARS-CoV-2 detected by RT-PCR were included in this retrospective observational study. The characteristics of participants were collected from electronic medical records using a structured questionnaire. A Poisson regression model was used to examine the influence of neurological manifestations on mortality.

Results

A total of 305 participants with COVID-19 were included, with 57.7 % of them presenting neurological symptoms. There were 62 (20.3 %) individuals with acute encephalopathy, with a mean age of 65.5 ± 15.9 years. In this group, higher Prevalence Ratios (PR) of comorbidities (1.6) and severe disease (3.6) were present, predisposing factors for acute encephalopathy. They were also more likely to be admitted to the intensive care unit (3.1) and to die (2.4). The median Neutrophil-Lymphocyte Ratio (NLR) was 7 (Interquartile Range [IQR: 4‒12]). Fifty-two (17 %) participants presented chemosensory dysfunction, with a mean age 53.3 ± 14 years and a lower PR of comorbidity (0.8) than those without. The severe diseases’ PR was slightly higher (1.1), but the PR of ICU admission (0.7), and deaths (0.4) was lower. The LNR was 3.8 (IQR: 2.2–7.8). Poisson regression analysis revealed that severe illness (PR = 3.13), cardiopathy (PR = 1.65), acute encephalopathy (PR = 1.49), diabetes (PR = 1.46), and neutrophil-lymphocyte ratio (PR = 1.04) were associated with death. Conversely, having chemosensory disorders (PR = 0.44) and a prolonged hospital stay (PR = 0.96) were associated with survival.

Conclusion

Patients with acute encephalopathy had more severe forms of COVID-19 and higher mortality. In contrast, chemosensory dysfunction was associated with milder disease manifestations and a better prognosis.

背景：新型冠状病毒病-19 （COVID-19）的神经系统表现与患者疾病严重程度和预后相关。本研究旨在描述一组COVID-19住院患者神经系统表现的频率和特征及其与患者预后的关系。方法回顾性观察研究纳入2020年4月至6月在当地医院住院的18岁及以上的RT-PCR检测到SARS-CoV-2的患者。使用结构化问卷从电子病历中收集参与者的特征。用泊松回归模型检验神经学表现对死亡率的影响。结果共纳入305例新冠肺炎患者，其中57.7%出现神经系统症状。急性脑病62例（20.3%），平均年龄65.5±15.9岁。在该组中，存在较高的合并症患病率（PR）（1.6）和严重疾病患病率（3.6），这是急性脑病的易感因素。他们也更有可能进入重症监护病房（3.1）和死亡（2.4）。中性粒细胞与淋巴细胞比值（NLR）中位数为7（四分位间距[IQR: 4-12]）。52名（17%）参与者出现化学感觉功能障碍，平均年龄53.3±14岁，共病的PR（0.8）低于无患者。重症PR略高（1.1），但ICU住院PR（0.7）和死亡PR（0.4）较低。LNR为3.8 （IQR: 2.2-7.8）。泊松回归分析显示，重症（PR = 3.13）、心脏病（PR = 1.65）、急性脑病（PR = 1.49）、糖尿病（PR = 1.46）和中性粒细胞淋巴细胞比（PR = 1.04）与死亡相关。相反，有化学感觉障碍（PR = 0.44）和长期住院（PR = 0.96）与生存率相关。结论急性脑病患者新型冠状病毒感染形式更严重，病死率更高。相比之下，化学感觉功能障碍与较轻的疾病表现和较好的预后有关。

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引用次数: 0

Does delocalised PCR for Streptococcus B in the labour ward allow adequate administration of antibiotics to prevent early neonatal infection? 产房对B型链球菌的局部PCR检测是否允许适当的抗生素管理以预防新生儿早期感染？

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-05-24 DOI: 10.1016/j.bjid.2025.104553

Clémentine Guetat , Laetitia Roussel , Marie De Antonio , Marie Accoceberry , Céline Houlle , Fanny Petillon , Marion Rouzaire , Denis Gallot

Introduction

Streptococcus B is a commensal infectious agent of the intestinal and genitourinary tract. It is often implicated in early neonatal infections. Some 10 %–30 % of women are colonised by this bacterium. Screening for carriage in women before delivery prior to antibiotic prophylaxis is thus essential. In recent years, real-time PCR tests have been developed. Our main objective was to determine whether screening for Streptococcus B carriage by PCR on admission (gold standard GeneXpert) permits complete antibiotic prophylaxis.

Materials and methods

This was an observational, retrospective study. Data set from all patients with a delocalised PCR for Streptococcus B (GeneXpert Instrument System) on arrival at the maternity hospital were collected between January 2022 and February 2023. We recorded 3467 test results, of which 344 were positive for Streptococcus B carriage. A total of 236 positive patients were included in the analysis. Antibioprophylaxis was considered complete when the patient had received at least one dose more than 4-hours before birth.

Results

Of the 236 patients, antibiotic therapy was incomplete in 53 cases (22.4 %) because vaginal delivery or caesarean section occurred less than 4-hours after the first dose. Antibioprophylaxis was not initiated in 33 cases. The main reason was for rapid labour in 28 cases (11.9 %). The 5 remaining cases did not receive antibiotics because probable omission by the team (2.1 %).

Conclusion

Delocalised PCR allows complete antibiotic prophylaxis against Streptococcus B in 63.6 % of cases, offering scope for improvement. While it will not be possible to improve antibioprophylaxis in case of rapid labour (within 3 hours after arrival), we should be able to prevent omissions (2.1 %) and, above all, reduce the birth rate before the second dose (22.4 %) by administering the first dose more quickly.

B型链球菌是肠道和泌尿生殖道的一种共感染性病原体。它通常与早期新生儿感染有关。大约10% - 30%的女性被这种细菌所感染。因此，在进行抗生素预防之前对妇女进行产前携带筛查是必要的。近年来，实时PCR检测得到了发展。我们的主要目的是确定入院时用PCR（金标准GeneXpert）筛查B型链球菌携带者是否允许完全的抗生素预防。材料与方法本研究为观察性、回顾性研究。在2022年1月至2023年2月期间，收集了所有到达妇产医院时进行B型链球菌（GeneXpert仪器系统）局部PCR检测的患者的数据集。我们记录了3467个检测结果，其中344个为B型链球菌携带者阳性。共有236例阳性患者纳入分析。当患者在出生前4小时以上接受了至少一剂抗生素预防时，被认为是完全的。结果在236例患者中，53例（22.4%）的抗生素治疗不完全，因为阴道分娩或剖宫产发生在第一次给药后不到4小时。33例未开始抗生素预防。28例（11.9%）以产程过快为主要原因。其余5例未接受抗生素治疗，原因可能是团队疏忽（2.1%）。结论脱位PCR对B型链球菌完全预防的检出率为63.6%，有进一步提高的空间。虽然在快速分娩（分娩后3小时内）的情况下不可能改善抗生素预防，但我们应该能够防止遗漏（2.1%），最重要的是，通过更快地给第一剂药，降低第二剂前的出生率（22.4%）。

{"title":"Does delocalised PCR for Streptococcus B in the labour ward allow adequate administration of antibiotics to prevent early neonatal infection?","authors":"Clémentine Guetat , Laetitia Roussel , Marie De Antonio , Marie Accoceberry , Céline Houlle , Fanny Petillon , Marion Rouzaire , Denis Gallot","doi":"10.1016/j.bjid.2025.104553","DOIUrl":"10.1016/j.bjid.2025.104553","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Streptococcus</em> B is a commensal infectious agent of the intestinal and genitourinary tract. It is often implicated in early neonatal infections. Some 10 %–30 % of women are colonised by this bacterium. Screening for carriage in women before delivery prior to antibiotic prophylaxis is thus essential. In recent years, real-time PCR tests have been developed. Our main objective was to determine whether screening for <em>Streptococcus</em> B carriage by PCR on admission (gold standard GeneXpert) permits complete antibiotic prophylaxis.</div></div><div><h3>Materials and methods</h3><div>This was an observational, retrospective study. Data set from all patients with a delocalised PCR for <em>Streptococcus</em> B (GeneXpert Instrument System) on arrival at the maternity hospital were collected between January 2022 and February 2023. We recorded 3467 test results, of which 344 were positive for <em>Streptococcus</em> B carriage. A total of 236 positive patients were included in the analysis. Antibioprophylaxis was considered complete when the patient had received at least one dose more than 4-hours before birth.</div></div><div><h3>Results</h3><div>Of the 236 patients, antibiotic therapy was incomplete in 53 cases (22.4 %) because vaginal delivery or caesarean section occurred less than 4-hours after the first dose. Antibioprophylaxis was not initiated in 33 cases. The main reason was for rapid labour in 28 cases (11.9 %). The 5 remaining cases did not receive antibiotics because probable omission by the team (2.1 %).</div></div><div><h3>Conclusion</h3><div>Delocalised PCR allows complete antibiotic prophylaxis against <em>Streptococcus</em> B in 63.6 % of cases, offering scope for improvement. While it will not be possible to improve antibioprophylaxis in case of rapid labour (within 3 hours after arrival), we should be able to prevent omissions (2.1 %) and, above all, reduce the birth rate before the second dose (22.4 %) by administering the first dose more quickly.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104553"},"PeriodicalIF":3.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acceptability and usability of oral fluid HCV self-testing among health-facility users from Brazil: a cross-sectional study of 685 participants 巴西卫生机构使用者口服液丙型肝炎自检的可接受性和可用性：一项685名参与者的横断面研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-05-23 DOI: 10.1016/j.bjid.2025.104544

Hugo Perazzo , Cristiane Villela-Nogueira , Maria K. Gomes , Andre Daher , Cristiane Siqueira-do-Valle , Ketiuce Zukeram , Ana Cristina G. Ferreira , Karen Cristine Tonini , Elton Carlos de Almeida , Sandra W. Cardoso , Beatriz Grinsztejn , Valdilea G. Veloso

Introduction and objectives

HCV Self-Testing (HCVST) can be used to uptake HCV testing. We aimed to evaluate the acceptability/usability and re-reading/re-testing agreement of oral fluid HCVST among health-facility users in the Primary Care Systemin Brazil.

Materials and methods

Consecutive people aged 18‒79 years using the Primary Care System (PCS) from 04-July-2022 to 30-September-2022 were invited for this cross-sectional study. The professional use OraQuick® HCV Rapid Antibody Test was used as a HCVST prototype. Oral fluid HCVST was performed relying on a step-by-step video and written/pictorial instructions. Usability was assessed by observed errors and documented need of assistance by a Healthcare Worker (HCW). After HCVST, a second HCV test was performed by the HCW using the same test-kit. Re-reading and re-testing concordances were evaluated (Cohen’s kappa, κ). Post-testing participant’s perspectives were assessed.

Results

685 participants (74.5% female; median age = 52 [IQR 39‒61] years, 52.5% with schooling ≤ 10 years) were included. Major observed errors [%(95%CI)] were incorrect sample collection [32.8% (29.4‒36.5)] and wrong placing the test device in the tube [15.0% (12.6‒17.9)]. A total of 35.6% (95% CI 32.1‒39.3) of participants needed assistance in at least one step of HCVST. Re-reading and re-testing agreements were 95.2% (κ = 0.56) and 99.7% (κ = 0.67; n = 626 excluding invalid tests), respectively. After HCVST, 93% felt safe, 99% would be willing to test again, and 99% would recommend HCVST. Most participants rated the HCVST experience as easy (73%) or very easy (24%).

Conclusion

Oral-fluid HCVST was feasible and well-accepted among users of the PCS in Brazil. HCVST can be an alternative to scale-up HCV testing.

HCV自检（HCV Self-Testing， HCVST）可用于HCV检测。我们的目的是评估巴西初级保健系统卫生机构用户口服液HCVST的可接受性/可用性和重新阅读/重新测试协议。材料和方法：本横断面研究邀请了2022年7月4日至2022年9月30日期间使用初级保健系统（PCS）的18-79岁连续人群。专业使用的OraQuick®HCV快速抗体测试被用作HCVST原型。根据循序渐进的视频和书面/图片说明进行口腔液HCVST。可用性通过观察到的错误和记录的医疗工作者（HCW）的帮助需求来评估。HCVST后，由HCW使用相同的检测试剂盒进行第二次HCV检测。评估复读和复测的一致性（Cohen’s kappa, κ）。评估测试后参与者的观点。结果685名参与者中，女性占74.5%；年龄中位数为52岁[IQR 39-61]岁，其中52.5%受教育年限≤10年)。观察到的主要错误[%(95%CI)]是不正确的样品采集[32.8%(29.4-36.5)]和错误地将测试装置放置在试管中[15.0%(12.6-17.9)]。总共有35.6% （95% CI 32.1-39.3）的参与者在HCVST的至少一个步骤中需要帮助。复读和复测协议分别为95.2% （κ = 0.56）和99.7% (κ = 0.67；N = 626，排除无效试验)。在HCVST后，93%的人感到安全，99%的人愿意再次进行测试，99%的人会推荐HCVST。大多数参与者认为HCVST体验简单（73%）或非常简单（24%）。结论口服液HCVST在巴西的PCS用户中是可行的，并且被广泛接受。HCVST可作为扩大HCV测试的替代方案。

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引用次数: 0