Infectious diseases (London, England)最新文献

Background: Whether a detected virus or bacteria is a pathogen that may require treatment, or is merely a commensal 'passenger', remains confusing for many infections. This confusion is likely to increase with the wider use of multi-pathogen PCR.

Objectives: To propose a new statistical procedure to analyse and present data from case-control studies clarifying the probability of causality.

Methods: We conducted a case-control study in US outpatient settings that enrolled patients aged 18 to 75 years with acute lower respiratory tract infection and controls without respiratory symptoms. Patients underwent multi-pathogen PCR testing. The positive etiologic predictive value was calculated to estimate the probability that each potential pathogen was the cause of symptoms. The outcome was illustrated using a modified forest plot and by classifying pathogens into five categories clarifying the probability for causality.

Results: We enrolled 618 adult cases and 497 asymptomatic controls. The modified forest plot and the classification of risk for causality aimed to facilitate understanding. Pathogens likely to be causative when present included influenza A and B, SARS-CoV-2, rhinovirus, and parainfluenza viruses, while Staphylococcus aureus is almost always commensal. Broad confidence intervals for the positive etiologic predictive value made it difficult to draw conclusions for potential pathogens with low prevalence.

Conclusion: This pilot study shows that the proposed statistical approach is likely to be practical for analysing larger case-control studies or for a meta-analysis of multiple studies. This method may help when interpreting the results from multi-pathogen PCR.

Human Metapneumovirus (HMPV) is a re-emerging respiratory pathogen causing significant morbidity and mortality, particularly among young children, the elderly, and immunocompromised individuals. First identified in 2001, HMPV has since been recognised as a leading cause of acute respiratory tract infections (ARTIs) worldwide. Its transmission occurs through droplets, direct contact, and surface contamination, with crowded spaces and healthcare facilities serving as key environmental amplifiers. HMPV's clinical manifestations, ranging from mild cold-like symptoms to severe pneumonia, often overlap with those of other respiratory pathogens like RSV and COVID-19, complicating timely diagnosis and management. Despite advancements in molecular diagnostics, the limited accessibility of these tools in low-resource settings presents a challenge. Preventive measures, such as hygiene practices and physical distancing, remain critical, as no approved vaccines or targeted antiviral therapies are currently available. However, promising innovations, including AI-guided vaccine design and portable diagnostic tools, highlight the potential for future breakthroughs. This article highlights the urgent need for enhanced surveillance, scalable diagnostics, and intensified research into vaccines and therapeutic strategies. By addressing these gaps, HMPV's global burden can be significantly mitigated, improving outcomes for high-risk populations, and strengthening preparedness against respiratory virus outbreaks.

Background: Severe infection is the most frequent disease underlying disseminated intravascular coagulation (DIC). To improve understanding of the clinical course, we examined the association between infection type and short-term mortality in patients with infection-associated DIC.

Methods: Patients with infection-associated DIC registered in the Danish Disseminated Intravascular Coagulation (DANDIC) cohort were categorised by infection type: pulmonary, intra-abdominal, urogenital, others, multiple infection sites and unknown foci. The Kaplan-Meier method was used to create survival curves and compute 30-day and 90-day mortality; logistic regression was used to compute odds ratios, as a measure of relative risk, with corresponding 95% confidence intervals. Regression models were adjusted for age, sex, comorbidities and surgery within one week before DIC diagnosis. Pulmonary infection, the most frequent infection type, was used as the reference group.

Results: In total, 1,853 patients had infection-associated DIC. The most common types of infection were pulmonary (35.1%), intra-abdominal (25.6%) and urogenital (12.6%). Thirty-day mortality ranged from 19.7% in patients with urogenital infections to 55.1% in patients with unknown foci. The 30-day mortality odds ratio with respect to pulmonary infection was 0.22 (95% CI, 0.15-0.32) for urogenital infection, 0.57 (95% CI, 0.39-0.82) for other infection types, 0.60 (95% CI, 0.36-1.00) for multiple infection sites, 0.73 (95% CI, 0.56-0.97) for intra-abdominal infections and 1.41 (95% CI, 1.02-1.95) for unknown foci.

Conclusion: Infection-associated DIC had a high short-term mortality, which varied among infection types, thus suggesting that infection type is an important predictor of the clinical course of DIC.

Background: Electronic surveillance systems (ESSs) may assist infection prevention and control (IPC) teams in detecting and monitoring patients infected or colonised by pathogens to prevent healthcare-associated infections. We aimed to assess the impact of implementing an ESS on compliance with isolation precaution measures for bacterial infections or colonizations.

Methods: A quasi-experimental before-after study was conducted using interrupted time series analysis from 1 March 2018 to 31 July 2024 at the University Hospital of Nancy (France). The ESS was implemented in October 2022. The results of audits conducted by IPC nurses to investigate isolation measures for inpatients that required isolation precautions were aggregated monthly.

Results: 1379 audits were included in the study. The implementation of the ESS had no significant immediate impact on isolation measures, except for an increase in the presence of adequate hand hygiene products (+10.1%, p < 0.01). After the COVID-19 period, all isolation measures decreased. The implementation of the ESS was associated with positive changes in trends of isolation measures, particularly for the prescription of isolation precautions (+1.1%/month, p < 0.01), the isolation signage (+1.2%/month, p < 0.001), the hand hygiene products (+0.8%/month, p < 0.01), and full compliance with isolation measures (+1.1%/month, p < 0.0001). The audit rate significantly increased in the first 7 months of ESS use but then decreased.

Conclusions: The positive impact of ESS on compliance with isolation measures was likely due to the increased presence and communication of the IPC team in care wards, which was facilitated by the time saved in the surveillance and detection of carriers through the ESS.

Background: This study was done with objectives of determining the predictors of mortality in patients with Gram-Negative Bacilli (GNB) Blood stream Infection (BSI) along with estimating mortality attributable to carbapenem resistance (CR).

Methods: In this prospective cohort study (January 2023-September 2024), done in 3 tertiary care centres in India, patients found to have mono-microbial GNB BSI were included. Primary outcome was crude mortality at day 30 of onset of BSI.

Results: Out of 604 patients, mortality at day 30 happened in 140 (23.2%) patients. Intergroup analysis between patients alive (n = 464) and dead (n = 140) at day 30 revealed that lower age (p = 0.014), higher Sequential Organ Failure Assessment Score (SOFA) score (p < 0.001), higher Pitts Bacteraemia score (p < 0.001), acquisition of BSI in hospital (p = 0.003) and CR in Enterobacterales (Escherichia coli & Klebsiella pneumoniae[CRKP] and Acinetobacter baumannii (CRAB) and DTR (defined as non-susceptibility to carbapenems, β-lactam-β-lactamase inhibitor combinations, and fluoroquinolones) in Pseudomonas aeroginosa [DTR-PA] (CR E. coli, p = 0.034; CRKP, p = 0.012; CRAB, p < 0.001; DTR-PA, p < 0.001) was associated with higher mortality. On multivariate logistic regression analysis, higher SOFA score (p < 0.001) and BSI due to DTR-PA (p = .006) and CRAB (p= .017) were found to be independent predictors of mortality. Attributable mortality of CR in E. coli and K. pneumoniae and DTR in PA was 7.32, 8.43 and 52.4% respectively.

Conclusion: We did not find CR as a major contributing factor for death among patients with BSI due to Enterobacterales in our study cohort.

Purpose: Infective endocarditis (IE) is diagnosed using the Duke criteria, which were updated in 2023. In the Duke-ISCVID 2023 criteria, Gemella was recognised as a typical IE pathogen. This study investigates the impact of this change and compares the clinical characteristics of Gemella IE to IE caused by other pathogens.

Methods: Data on IE caused by Gemella species and other pathogens was retrieved from the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of Gemella IE were compared to episodes of IE caused by non-beta haemolytic streptococci, by Staphylococcus aureus and by enterococci.

Results: In the SRIE, 29 episodes of Gemella IE were identified among a total of 7677 registered episodes, corresponding to 0.4% of all cases. The most common species were Gemella morbillorum (47%) and Gemella bergerii (27%). The proportion of episodes meeting the criteria for definite IE increased from 13 (45%) with the modified Duke criteria to 21 (72%) with the Duke-ISCVID criteria. Median age of patients with Gemella IE was 70 years, 40% were females and 90% hade native valve IE. One third of the patients underwent heart valve surgery and only one patient (3%) died. Many clinical aspects of IE caused by Gemella resembled those of IE caused by non-beta haemolytic streptococci.

Conclusions: Gemella IE is a rare condition and shares several characteristics with IE caused by non-beta haemolytic streptococci. The prognosis of IE caused by Gemella appears to be relatively favourable.

The ongoing mpox outbreak in sub-Saharan Africa has highlighted the critical need for equitable vaccine access and robust logistical support. However, these factors alone are insufficient to ensure the success of vaccination campaigns in regions characterized by unique epidemiological and immunological challenges. One significant issue is the high prevalence of helminth infections, which are known to impair immune responses to vaccines, potentially reducing both short-term efficacy and long-term antibody titers. This paper explores the implications of helminthiasis for mpox vaccination in sub-Saharan Africa, emphasizing the need for integrated strategies to address this co-infection. We discuss whether combining deworming programs with vaccination campaigns could enhance vaccine responses and examine the applicability of emerging data on single-dose mpox vaccination in the context of endemic helminth infections. Furthermore, we highlight the importance of real-time surveillance to monitor vaccine effectiveness and identify breakthrough infections in regions with high helminth prevalence. Our findings underscore the necessity of a context-specific approach to mpox vaccination policies, one that considers the intricate interplay between helminth infections and vaccine efficacy. Addressing these challenges is essential to ensure the success of vaccination efforts and to mitigate the broader public health impact of mpox in Africa and beyond.

Background: Although recommended isolation periods for Coronavirus disease 2019 (COVID-19) have been shortened as the pandemic has subsided, prolonged Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) shedding remains common in immunocompromised patients. This study estimated the probability of viral clearance in these patients based on elapsed days and specific risk factors.

Methods: We prospectively enrolled immunocompromised patients with a confirmed COVID-19 diagnosis from January 2022 to May 2023 during the Omicron variant era. We collected weekly respiratory specimens for viral load measurement and culture. We identified significant predictors of viral culture negative conversion through univariate and multivariate analyses and estimated viral clearance probabilities using a Cox time-varying proportional hazard model.

Results: Among 70 patients with serial 319 respiratory specimens with positive SARS-CoV-2 genomic polymerase chain reaction results that underwent cell culture, ∼69% (48) had haematologic malignancies and 31% (22) underwent solid organ transplants. B-cell depleting agents and viral copy number significantly influenced viral culture negative conversion. The probability of culture-negative conversion for immunocompromised patients not treated with B-cell-depleting agents increased over time, with over 90% achieving negative conversion by Day 84. Patients treated with B-cell depleting agents showed lower conversion rates. By Day 84, <90% of patients with cycle threshold values 23-28 [4.85-6.35 log copies/mL] achieved culture-negative conversion. The results indicate more prolonged shedding than in patients without B-cell depletion.

Conclusion: Estimating SARS-CoV-2 clearance probabilities based on specific risk factors can guide individualised isolation decisions for immunocompromised patients, tailoring policies to each patient's delayed viral clearance risk.

Crimean-Congo Hemorrhagic Fever (CCHF) presents significant global health challenges, highlighted by its sporadic nature and high fatality rates. The manuscript emphasizes the disease's tendency to be under-recognized and the diagnostic challenges it poses, often mimicking other illnesses and leading to frequent misdiagnosis. There is a noted absence of robust diagnostic tools, specific treatments, or vaccines, leaving only supportive care generally available. The necessity for increased international cooperation and a coordinated strategy to enhance disease surveillance, public health preparedness, and community education is stressed.