Infectious diseases (London, England)最新文献

Background: Soluble thrombomodulin, a marker of endothelial cell injury, is released into the circulation during endothelial damage and has been observed at elevated concentrations in bacterial infections. This study aimed to investigate the correlation of thrombomodulin concentrations in plasma and sputum with disease severity and etiology in bacterial community-acquired pneumonia (CAP).

Methods: A prospective study was conducted on adults hospitalized with radiologically confirmed bacterial CAP. Plasma and sputum samples were collected upon admission, and thrombomodulin concentrations were quantified using an enzyme-linked immunosorbent assay. The study included a multivariate analysis to assess whether thrombomodulin concentrations were associated with disease severity and/or bacterial etiology.

Results: Of 111 patients with bacterial CAP, including 15 with severe CAP (as defined by the American Thoracic Society/Infectious Diseases Society of America criteria) and 63 with pneumococcal etiology, thrombomodulin was measured in plasma in all patients and in sputum in 42 patients. Elevated plasma thrombomodulin concentrations were independently associated with severe CAP. Stratification by bacterial etiology showed that higher plasma thrombomodulin concentrations were linked to severe pneumonia only in patients with pneumococcal infection. The area under the receiver operating characteristic curve for detecting severe pneumococcal CAP was 0.87. Conversely, sputum thrombomodulin concentrations showed no association with disease severity or bacterial etiology.

Conclusions: Plasma thrombomodulin is a promising biomarker for identifying severe pneumococcal CAP. Sputum thrombomodulin did not correlate with disease severity or bacterial etiology. These findings support further investigation into the diagnostic and prognostic role of plasma thrombomodulin in bacterial infections.

Background: Acute respiratory infections (ARIs) are a major global health concern, particularly for children and the elderly. Although rhinoviruses are the primary pathogens causing ARIs, their epidemiology during reduced population mobility and behavioral changes is not well understood. This study aimed to assess whether the Swedish COVID-19 measures changed the epidemiology of Rhinovirus and ARI-causing viruses other than SARS-CoV-2 in the western part of Sweden in 2020.

Methods: A total of 13,791 nasopharyngeal samples from ARI-patients were analyzed for 19 different viruses and bacteria by qPCR. Of the 3,607 samples positive for any virus, 2,018 were positive for rhinovirus (RV) and enterovirus (EV), and 106 contained adenoviruses. Among the EV/RV reactive samples, 249 strains were typed using partial sequencing of 5'UTR and 204 by VP1 or VP4-VP2.

Results: After week 12 when the interventions were implemented, most of the ARI-causing viruses were EV/RV and adenoviruses, besides SARS-CoV-2. In September-October 2020, an outbreak caused by RV-A strains predominantly infected children younger than 13 years and individuals within the age range of their parents. RV-A strains were identified in 118 of 242 (49%) RV-positive samples, followed by RV-C (36%) and RV-B (10%). Before the first wave of SARS-CoV-2, a RV-C outbreak affected all age groups.

Conclusions: This study shows that the moderate Swedish interventions against SARS-CoV-2 were more effective against the spread of ARI-causing virus among adults over 56 years than among young children. These results suggest the need for new strategies for preventing the spread of ARI pathogens like RV and EV, which cause disease in all age groups and can lead to large outbreaks.

Background: Non-β-hemolytic streptococci (NBHS) cause blood stream infections (BSI) which can be complicated by infective endocarditis (IE). To stratify the risk for IE in NBHS BSI and to guide the use of echocardiography in this condition, two risk stratification systems (RSSs), the HANDOC score (HANDOC), and the Chamat-Hedemand algorithm (CH-A) have been developed.

Objectives: To compare the sensitivity and the specificity of HANDOC and CH-A and to describe how the utilization of transesophageal echocardiography (TEE) would be affected using either HANDOC or CH-A.

Methods: A retrospective, population-based cohort study of patients with blood cultures positive for NBHS during 2018 was performed. Medical records of the included patients were studied for classification of the episodes according to HANDOC, CH-A, and the Duke-ISCVID criteria.

Results: Three hundred and twenty-five episodes of NBHS BSIs involving 308 patients were included. Twenty-one episodes (6.5%) met the Duke-ISCVID criteria for definite IE. TEE was performed in 26% of episodes. HANDOC had a sensitivity of 95% and a specificity of 73% for definite IE whereas CH-A had a sensitivity of 90% and a specificity of 63%. The CH-A outcome 'any echocardiography' had a sensitivity of 100% for definite IE, but the specificity was only 24%. In this cohort, implementation of the RSSs would lead to an increase in the utilization of TEE compared to the real-life use, both when using HANDOC (+22%) and CH-A (+60%).

Conclusion: HANDOC had the highest combined sensitivity and sensitivity for IE. The utilization of TEE would increase using these RSSs, especially the CH-A.

Background: This study aimed to assess chlamydia diagnostics in different clinic types, including internet-based self-sampling (IBSS). Furthermore, we investigated the incidence of chlamydia-associated complications.

Methods: Data on Chlamydia trachomatis (CT) testing were retrieved from six healthcare regions in the years 2016-2023 across different categories of testing facilities. National data on CT diagnostics and number of PID, ectopic pregnancy and infertility cases were obtained from Swedish health authorities.

Results: The number of CT cases detected through IBSS increased by 85% from 2016 (n = 1967) to 2023 (n = 3644) when it accounted for 43% of all cases. The proportion of CT-positive individuals of all tested persons was similar for IBSS (7.0-8.5% per year); STI clinics (8.5-9.9%) and youth clinics (9.7-10.9%). In contrast, gynaecology clinics had a low proportion of CT-positive individuals (1.8-2.3%), and primary healthcare clinics a decreasing proportion (2016: 4.8%; 2023: 3.0%). For women in Sweden aged 15-39 years, there was a 33% decrease in detected CT cases from 2008 to 2022 (1577-1048 cases/100,000 women) while PID rates decreased by 63% from 2008 to 2022 (224-83 cases/100,000 women).

Conclusions: IBSS has become the most important CT case detector in Sweden. Primary care and gynaecology clinics have low positivity rates. The decrease in PID rates may be due to generous CT testing, although other explanations are possible. Considering the low positivity rates in some clinic types and that asymptomatic CT cases have a low PID rate a reduced testing may be justified.

Introduction: Dalbavancin is a lipoglycopeptide with an exceptionally long half-life that allows simplified administration, which may be of value in long-term treatment of bone and joint infections, such as prosthetic joint infections (PJIs). The objective was to determine trough (C_min) values of dalbavancin during long-term PJI treatment according to the recommendation of the Swedish National Guidelines for Bone and Joint Infections: a loading dose of 1,500 mg on day 1 and another 1,500 mg on days 8-14, followed by day 28 administration of 1,000 mg every two weeks or 500 mg per week.

Patients/methods: Twelve patients with PJI treated with at least six doses of dalbavancin were prospectively followed up, serum samples were collected, and renal function was investigated. Dalbavancin concentrations were measured using ultra-high pressure liquid chromatography coupled with unispray tandem mass spectrometry (UHPLC-MS/MS).

Results: The median serum concentration (C_min) 14 days after the first 1,500 mg dose was 36.3 mg/L (range: 6.6-62.4 mg/L). The median trough value at the date of the last given dose (1,000 mg) after a total of 6-7 doses was 53.6 mg/L (range: 32.0-97.5 mg/L). Three patients showed a tendency towards successive accumulation of dalbavancin during treatment. None of the patients showed any significant impairment in renal function.

Conclusions: Therapeutic drug monitoring during long-term dalbavancin treatment is recommended to avoid the risk of accumulation and unnecessarily high trough levels. In many cases, such monitoring can allow the dosing interval to be extended.

Background: Monoclonal antibodies (mAbs) are an important option against SARS-CoV-2, especially as pre-exposure prophylaxis (PrEP) for patients with immune system impairment. PrEP mAbs like sipavibart and pemivibart have been approved for limited use in several countries. Certain SARS-CoV-2 variants carry mutations in the spike (S) protein, conferring resistance to these mAbs.

Objectives: We aimed to examine the relative abundance of different circulating SARS-CoV-2 variants/mutations in central Sweden between 2023 and 2024, and to predict the effectiveness of sipavibart and pemivibart.

Methods: An amplicon-based Nanopore sequencing method was used for sequencing SARS-CoV-2 samples. Coronapp was used to identify mutations in these sequences. Using the published in vitro resistance data for sipavibart and pemivibart, the effectiveness of these mAbs was inferred.

Results: We have observed that the relative abundance of the KP.3.1.1 variant and the Q493E mutation started to increase in the later part of 2024 in the region. Also, since April 2024, the relative abundance of the F456L mutation reached 100% during many weeks until the end of the study period. The KP.3.1.1 variant is significantly resistant to pemivibart. Further, the presence of the F456L mutation in the Omicron subvariants confers high fold resistance towards sipavibart.

Conclusion: The use of sipavibart or pemivibart as PrEP for COVID-19 in the region may currently not be effective unless new SARS-CoV-2 variants appear not containing these resistance mutations. Further, new mAbs under development as PrEP for COVID-19 can be effectively used by routinely sequencing SARS-CoV-2 in patients to identify variants and resistance mutations.