Brazilian Journal of Infectious Diseases最新文献

{"title":"Neurological manifestations of acute SARS-CoV-2 infection in a reference hospital in Bahia, Brazil","authors":"Jesângeli de Sousa Dias ,&nbsp;Maria Augusta Moreira Rebouças ,&nbsp;Lilian Verena da Silva Carvalho ,&nbsp;Thais Sampaio Silva ,&nbsp;Jair Santana dos Santos ,&nbsp;Astrid Xiomara Tatiana Otero Melendez ,&nbsp;Carlos Brites","doi":"10.1016/j.bjid.2025.104542","DOIUrl":"10.1016/j.bjid.2025.104542","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104542"},"PeriodicalIF":3.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134160","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}

{"title":"Does delocalised PCR for Streptococcus B in the labour ward allow adequate administration of antibiotics to prevent early neonatal infection?","authors":"Clémentine Guetat ,&nbsp;Laetitia Roussel ,&nbsp;Marie De Antonio ,&nbsp;Marie Accoceberry ,&nbsp;Céline Houlle ,&nbsp;Fanny Petillon ,&nbsp;Marion Rouzaire ,&nbsp;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}

{"title":"Acceptability and usability of oral fluid HCV self-testing among health-facility users from Brazil: a cross-sectional study of 685 participants","authors":"Hugo Perazzo ,&nbsp;Cristiane Villela-Nogueira ,&nbsp;Maria K. Gomes ,&nbsp;Andre Daher ,&nbsp;Cristiane Siqueira-do-Valle ,&nbsp;Ketiuce Zukeram ,&nbsp;Ana Cristina G. Ferreira ,&nbsp;Karen Cristine Tonini ,&nbsp;Elton Carlos de Almeida ,&nbsp;Sandra W. Cardoso ,&nbsp;Beatriz Grinsztejn ,&nbsp;Valdilea G. Veloso","doi":"10.1016/j.bjid.2025.104544","DOIUrl":"10.1016/j.bjid.2025.104544","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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. <em>Re</em>-reading and re-testing concordances were evaluated (Cohen’s kappa, κ). Post-testing participant’s perspectives were assessed.</div></div><div><h3>Results</h3><div>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. <em>Re</em>-reading and re-testing agreements were 95.2% (κ = 0.56) and 99.7% (κ = 0.67; <em>n</em> = 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%).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104544"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144117070","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}

{"title":"Coexistence of PMQR and ESBL genes among clinical Escherichia coli isolates from community-acquired UTI in Mexicali, on the US-Mexico border","authors":"Dolores A. Marquez-Salazar ,&nbsp;Ricardo Delgadillo-Valles ,&nbsp;Gerson N. Hernandez-Acevedo ,&nbsp;Edwin Barrios-Villa ,&nbsp;Raquel Muñiz-Salazar ,&nbsp;Gilberto Lopez-Valencia ,&nbsp;Paulina Haro ,&nbsp;Enrique Trasviña-Muñoz ,&nbsp;Rafael Martinez-Miranda ,&nbsp;Jonathan Arauz-Cabrera","doi":"10.1016/j.bjid.2025.104554","DOIUrl":"10.1016/j.bjid.2025.104554","url":null,"abstract":"<div><div><em>Escherichia coli</em> is an opportunistic pathogen and a leading cause of Community-Acquired Urinary Tract Infections (CA-UTIs). <em>E. coli</em> can harbor multiple genetic resistant determinants, such as Extended Spectrum Beta-lactamases (ESBL) and Plasmid-Mediated Quinolone Resistance (PMQR) genes, complicating the empirical treatment of UTIs with β-lactams and quinolones. The aim of his study was to characterize ESBL and PMQR genes among <em>E. coli</em> isolates from CA-UTI in Mexicali, Mexico Isolates were collected from January to December 2023. Identification was performed by MALDI-TOF, and ESBL-producing determination and antimicrobial susceptibility by Vitek 2. Detection of ESBL and PMQR, and phylotyping were performed by PCR. Genetic diversity was determined by Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR). Eighty-nine <em>E. coli</em> isolates were collected from CA-UTIs. All exhibited resistance to ciprofloxacin, ceftriaxone, and cefotaxime, while being susceptible to carbapenems and ceftazidime/avibactam. All isolates tested positive for an ESBL gene, with <em>bla_CTX−_M</em> (98.9 %) being the most prevalent. Five isolates tested negative for PMQR genes; the remaining showed <em>aac(6′)-lb-cr</em> present in 85.3 %. Coexistence between ESBL and PMQR genes was noted in 95.5 %. Most prevalent plylogenetic group was group B2 (74.2 %). This study provides valuable regional data, highlighting a public health problem due to the high prevalence of ESBL and PMQR genes in <em>E. coli</em> responsible for CA-UTI, which are linked to multidrug resistance. Genetic diversity was found, suggesting multiple sources of resistant strains in the community. These findings underline the need for surveillance and control to limit the spread of resistant <em>E. coli</em>, locally and globally.</div></div><div><h3>Data summary</h3><div>The authors confirm all supporting data, code, and protocols have been provided within the article or through supplementary data files.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104554"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144117069","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}

{"title":"Ventilator-associated events criteria in the assessment of Ventilator-Associated Pneumonia (IMPACTO MR-PAV): A prospective cohort","authors":"Giovanna Marssola Nascimento ,&nbsp;Daniela Laranja Gomes Rodrigues ,&nbsp;Filipe Teixeira Piastrelli ,&nbsp;Maysa Yukari Cheno ,&nbsp;Katia Cristina Camondá Braz ,&nbsp;Lucas Bassolli de Oliveira Alves ,&nbsp;Bruno Martins Tomazini ,&nbsp;Viviane Cordeiro Veiga ,&nbsp;Beatriz Arns ,&nbsp;Bruno Adler Maccagnan Pinheiro Besen ,&nbsp;Antonio Paulo Nassar Junior ,&nbsp;Alvaro Avezum ,&nbsp;Renata Karoline Lima da Silva ,&nbsp;Conceição de Maria Pedrozo e Silva de Azevedo ,&nbsp;Maria Luiza Santana de Oliveira Silva ,&nbsp;Graziela Regina Kist ,&nbsp;Fernanda Borges Salgado ,&nbsp;Maria Tereza Farias de Moura ,&nbsp;Emerson Boschi ,&nbsp;Pedro Martins Pereira Kurtz ,&nbsp;Haliton Alves de Oliveira Junior","doi":"10.1016/j.bjid.2025.104543","DOIUrl":"10.1016/j.bjid.2025.104543","url":null,"abstract":"<div><h3>Background</h3><div>Ventilator-Associated Pneumonia (VAP) is a critical healthcare-associated infection, but no universal surveillance standard exists. In 2013, the CDC revised its criteria, incorporating Ventilator-Associated Events (VAEs) with VAPs as a subset. In Brazil, however, the Health Regulatory Agency (ANVISA) chose to retain the traditional VAP criteria. This study aimed to evaluate the incidence of VAP using both the traditional and revised criteria.</div></div><div><h3>Method</h3><div>We conducted a prospective multicentric cohort of critically ill adult patients who required mechanical ventilation in 12 Brazilian Intensive Care Units (ICU) over six months. We evaluated the level of agreement between the two criteria considering frequency and kappa coefficient. This study was registered at ClinicalTrials.gov, NCT05589727.</div></div><div><h3>Results</h3><div>The study included 987 patients and revealed that 85.7 % of VAP reported by the centers according to ANVISA criteria were not confirmed by the adjudicators. Among the adjudicators, a 16.7 % disagreement (kappa = 0.32) suggested subjectivity in applying VAP criteria. Between the two sets of criteria, an 11% disagreement (kappa = 0.12) was observed. However, manual adjudication of automatically generated VAEs showed only a 4 % disagreement, indicating greater objectivity in the VAE criteria. Despite the high agreement in VAE adjudication, this did not necessarily translate to a more reliable exclusion of non-events, which is essential for accurate surveillance.</div></div><div><h3>Conclusion</h3><div>The findings highlight the challenges in identifying and classifying VAP, emphasizing the need for improved surveillance methods. The results could inform enhancements in VAP monitoring in Brazil and potentially impact other countries using similar criteria.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104543"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107560","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}

{"title":"Enteral versus intravenous antibiotics for critically ill patients: A pilot study","authors":"Dayana dos Santos Oliveira ,&nbsp;Julia Vitória da Rocha ,&nbsp;Juliano Gasparetto ,&nbsp;Carolina Hikari Yamada ,&nbsp;Joao Paulo Telles ,&nbsp;Felipe Francisco Tuon","doi":"10.1016/j.bjid.2025.104538","DOIUrl":"10.1016/j.bjid.2025.104538","url":null,"abstract":"<div><h3>Background</h3><div>While there are valid concerns regarding the use of Enteral Antibiotics (EN) in the Intensive Care Unit (ICU), the evidence opposing this practice has not been thoroughly evaluated in prior research.</div></div><div><h3>Aim</h3><div>This study aimed to evaluate the transition from sequential Intravenous (IV) antibiotics to EN antibiotics in critically ill patients with infections.</div></div><div><h3>Methods</h3><div>This was a prospective, multicenter, randomized, unblinded clinical trial involving patients with infections who received antibiotic therapy. The study compared sequential IV antibiotic treatment to EN therapy in patients who continued standard IV therapy in the intensive care unit. Primary outcome measures included mortality and clinical improvement assessed on days 3, 5, and 10. Secondary outcomes encompassed hospital and ICU length of stay, costs, and evaluation of microbiological failure.</div></div><div><h3>Results</h3><div>A total of67 patients were included in the EN group and 60 patients in the IV group. Most patients were classified as infected (66.1 %), with 33.1 % diagnosed with sepsis. In-hospital mortality rates were comparable between the two groups, with 31 % in the EN group and 30 % in the IV group. Clinical outcomes assessed on days 3, 5, and 10 showed no significant differences between the groups. Among the 67 patients in the EN group, 7 (10.5 %) required a return to intravenous antibiotic therapy. Notably, drug costs in the IV group increased by 207 %.</div></div><div><h3>Conclusion</h3><div>This is the first controlled and randomized study to evaluate the oral/enteral route of antibiotic administration in the ICU. The findings indicate no significant differences in clinical outcomes or survival rates between the two groups, while demonstrating reduced costs and comparable safety with EN antibiotics.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104538"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948619","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}

{"title":"RIMOXCLAMIN: New therapeutic regimen for Hansen’s Disease cure based on effective sensitivity recovery","authors":"Marco Andrey Cipriani Frade ,&nbsp;Gustavo Sartori Albertino ,&nbsp;Filipe Rocha Lima ,&nbsp;Natália Aparecida de Paula ,&nbsp;Fabiana Aparecida Correa Cinto ,&nbsp;Fernanda Cruz Perecin ,&nbsp;Andrezza Westin ,&nbsp;Wilson Marques Junior ,&nbsp;Helena Barbosa Lugão","doi":"10.1016/j.bjid.2025.104539","DOIUrl":"10.1016/j.bjid.2025.104539","url":null,"abstract":"<div><h3>Background</h3><div>World Health Organization (WHO) has recommended Multidrug Therapy (MDT/WHO) for Hansen’s Disease (HD) since 1982; nevertheless, relapse, antimicrobial resistance, and adverse reactions indicate the need for new therapeutic regimens. We evaluated the efficacy and safety of the new anti-HD regimen RIMOXCLAMIN (Rifampicin, Moxifloxacin, Clarithromycin, and Minocycline) compared with standard Multidrug Therapy provided by WHO (MDT/WHO).</div></div><div><h3>Methodology/principal findings</h3><div>66 multibacillary HD new cases (46: RIMOXCLAMIN / 20: MDT/WHO) were evaluated between 2015 and 2023. Patients were followed up at least bimonthly by hansenologists for neurological and cutaneous findings and side effects of treatments. Hands/feet tactile sensitivity tests by Semmes Weinstein Monofilaments (SWM) and Physical Disability Grade (PDG) were carried out on the diagnosis, 3rd, 6th, and 12th months. 84.8 % and 80 % of the patients were classified as Borderline-Borderline (BB) in RIMOXCLAMIN and MDT/WHO groups, respectively, with no significant difference between them (<em>p</em> = 0.12). Nerve thickening was reduced by palpation in both groups: in RIMOXCLAMIN, reduction occurred early (65 % to 28 % at 6-months, <em>p</em> = 0.03; 9 % at 12-months, <em>p</em> = 0.03), while in MDT/WHO, it was later (95 % to 40 % at 12-months, <em>p</em> = 0.002). The greatest difference was at 6 months (<em>p</em> &lt; 0.0001). A significant reduction was observed in pain scales on the 3rd month of treatment only with RIMOXCLAMIN; in the end, both groups showed significant reductions in pain scales, being greater in RIMOXCLAMIN group. 0.5 % reduction in the number of abnormal SWM points on the hands compared to baseline, while in the MDT/WHO group, there was an increase of abnormal points of 5.4 %. On the feet, RIMOXCLAMIN showed a reduction of 17.9 %, while in the MDT/WHO, it was 10.3 %. During follow-up, the RIMOXCLAMIN showed a significant decrease in the sum of altered SWM points compared to MDT/WHO (<em>p</em> &lt; 0.05). Only RIMOXCLAMIN improved PDG monitoring. Both groups reported mild adverse effects.</div></div><div><h3>Conclusions/significance</h3><div>The results indicate that RIMOXCLAMIN was superior to MDT/WHO in terms of quick recovery of neurological damage, evidenced by the improvement of symptoms and sensitivity in hands and feet as early as the third month, with a progressive improvement, maintained after the end of treatment, including a reduce of patients with PDG.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104539"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941658","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}

{"title":"Economic evaluation of ceftazidime-avibactam vs. polymyxin B for treatment of hospital-acquired and ventilator-associated bacterial pneumonia","authors":"Jessica Matuoka ,&nbsp;Daniela Vianna Pachito ,&nbsp;Filipe Piastrelli ,&nbsp;Lorena Cristina Correa Fehlberg ,&nbsp;Haliton Alves de Oliveira Junior","doi":"10.1016/j.bjid.2025.104545","DOIUrl":"10.1016/j.bjid.2025.104545","url":null,"abstract":"<div><div>Ventilator-associated pneumonia is one of the most common infections in Intensive Care Units (ICU). It is frequently caused by multidrug-resistant pathogens (including carbapenems) and is an important health issue. It may result in severe clinical consequences, with higher healthcare utilization and high economic burden. Timely and appropriate treatment is key to obtaining better outcomes and allocational efficiency. Currently, the treatment options for carbapenem-resistant pathogen infections are limited, usually based on polymyxin, aminoglycosides, or combination therapy, as well as novel antibiotic therapies including Ceftazidime/Avibactam (CAZ-AVI). CAZ-AVI has shown activity against gram-negative pathogens and is currently used for the treatment of Ventilator-Associated Pneumonia (VAP). To better inform healthcare professionals and help promote a rational use of antibiotic therapy, a cost-effectiveness analysis was conducted to compare the cost-effectiveness of CAZ-AVI versus polymyxin B in ICU patients with VAP from the Brazilian National Supplementary Health Agency perspective over a 5-year time horizon. CAZ-AVI had higher total costs and resulted in more Quality-Adjusted Life Years (QALY) gained when compared with polymyxin B. At a willingness-to-pay threshold of BRL 40,000.00/QALY gained, CAZ-AVI was the cost-effective strategy (ICER: BRL 35,298.65/QALY gained). Nephrotoxicity in patients treated with polymyxin B, hospitalization utility, and treatment duration were the variables that most influenced the results. In the probabilistic sensitivity analysis, CAZ-AVI was cost-effective in 55 %–89 % of the interactions. The evidence suggests that CAZ-AVI results in lower mortality and nephrotoxicity rates, which might have contributed to more QALYs gained and a favorable ICER, despite the higher costs. This study was registered on the Open Science Framework database (Protocol <span><span>https://doi.org/10.17605/OSF.IO/SP2EJ</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104545"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941659","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}

{"title":"COVID-19 hospitalization in vaccinated and non-vaccinated patients: Clinical profile and outcomes","authors":"Laura Holtman-Ferreira ,&nbsp;Elessandra de Souza Bitencourt ,&nbsp;Betina Mendez de Alcantara Gabardo ,&nbsp;Susanne Edinger Pereira ,&nbsp;Francine Teixeira ,&nbsp;Diego da Silva Magatão ,&nbsp;Vitor Loureiro Dias ,&nbsp;Ricardo Petterle ,&nbsp;Meri Bordignon Nogueira ,&nbsp;Sonia Mara Raboni","doi":"10.1016/j.bjid.2025.104537","DOIUrl":"10.1016/j.bjid.2025.104537","url":null,"abstract":"<div><div>COVID-19, caused by SARS-CoV-2 infection, left widespread impacts worldwide. In Brazil, immunization reduced incidence rates. However, six months later, waning neutralizing antibody titers and new immune-evading variants increased cases, resulting in recurring waves. This study evaluated hospitalized COVID-19 patients after the vaccination rollout, comparing the clinical outcomes between vaccinated and unvaccinated patients. Positive samples underwent nucleotide sequencing. A total of 218 patients were included; 202 (92 %) had vaccination data, 98 received at least one dose, and 64 completed the vaccination schedule, predominantly with CoronaVac®. Vaccinated individuals were older on average since the campaign was primarily conducted among the elderly. The Gamma variant predominated during the study period. While not statistically significant, trends indicated greater respiratory assistance needs, more extended hospital stays, and increased ICU time among unvaccinated patients. Mortality was 45 % in vaccinated and 37 % in unvaccinated groups, with no notable difference. However, patients with a complete vaccination schedule showed a higher chance of survival, though not significant (<em>p</em> = 0.11). The factors significantly associated with higher mortality were older patients, those requiring vasopressor drugs, and mechanical ventilation. These findings provide clinical, epidemiological, and phylogenetic insights into COVID-19 patients during vaccination implementation. They underscore the need to evaluate vaccine effectiveness against circulating variants and highlight the importance of complete vaccination schedules for improving patient outcomes.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104537"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924915","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}

{"title":"Disseminated bartonellosis and EBV reactivation in an adolescent treated with upadacitinib","authors":"Vincent Pargny ,&nbsp;Emilie Delugre ,&nbsp;Raphael Janela ,&nbsp;Soumaya Skalli ,&nbsp;Abdeljalil Zeggay ,&nbsp;Hortense Petat","doi":"10.1016/j.bjid.2025.104536","DOIUrl":"10.1016/j.bjid.2025.104536","url":null,"abstract":"<div><h3>Background</h3><div><em>Bartonella henselae</em> is responsible for disseminated infections in immunocompromised patients. Upadacitinib is a JAK inhibitor used since 2021 for the treatment of severe atopic dermatitis in adolescents over 12-years. We report here the case of disseminated Bartonellosis in a 15-year-old male treated with upadacitinib.</div></div><div><h3>Case presentation</h3><div>This patient presented with fever and abdominal pain. Laboratory tests showed inflammation, rhabdomyolysis and acute renal failure. Imaging studies revealed lymphadenopathies, hepatosplenic, renal and pulmonary nodules, pleural and peritoneal effusions and spleen abscesses. <em>Bartonella henselae</em> serology was positive for IgG and IgM. Treatment with doxycycline resolved the symptoms. We detected a concomitant EBV reactivation.</div></div><div><h3>Conclusions</h3><div><em>Bartonella henselae</em> infection should be suspected in immunocompromised patients presenting with fever of unknown origin. Upadacitinib is responsible for rapid immunodepression, which can lead to viral reactivation and severe bacterial infections. Randomized controlled trials are needed to establish a consensus on treatments for the various forms of Bartonellosis.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104536"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892237","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}