BMC Infectious Diseases最新文献

Background: Data are limited regarding use of narrow-spectrum agents for the treatment of complicated urinary tract infections (cUTIs). We sought to evaluate cefazolin compared with ceftriaxone for the empiric treatment of patients with cUTIs in an inpatient setting.

Methods: We conducted a retrospective, single-center, cohort study involving patients with cUTI treated with cefazolin or ceftriaxone at a Veterans Affairs (VA) medical center between November 1, 2019 and September 30, 2022. The primary outcome was 30-day clinical success, defined as resolution of signs and symptoms of infection without re-initiation of antibiotics during hospitalization or relapse within 30 days after cUTI diagnosis. Secondary outcomes included hospital length of stay and Clostridioides difficile infection (CDI) within 30 days of the end of antibiotic therapy.

Results: We identified 113 patients with cUTI treated with cefazolin (n = 52) or ceftriaxone (n = 61) meeting study criteria. The study arms had similar demographics, although patients treated with ceftriaxone more frequently had subjective fever on admission or nephrolithiasis while cefazolin-treated patients had more altered mental status as the only UTI symptom reported, urinary catheter, and had a single dose of another antibiotic prior to starting the study medication. Clinical success was achieved in 47/52 (90%) and 53/61 (87%) in the cefazolin and ceftriaxone groups, respectively (P = 0.56). Additionally, there were no statistically significant differences in length of stay and development of CDI.

Conclusions: In this retrospective cohort study of patients with cUTI at a VA medical center, empiric therapy with cefazolin appears to be a safe and effective treatment option.

Background: Monotherapy with the drug isoniazid (INH) was for a long time the main therapeutic regimen used for tuberculosis preventive treatment (TPT). Research is progressing into the use of new therapeutic regimens that provide more complete TPT. The objective was to analyze the completion and safety of TPT with the drug INH in the form of 300 mg tablets.

Methods: Pragmatic, randomized, non-blinded, multicenter clinical trial conducted in Brazil from January 2019 to December 2022. Subjects over the age of 18 years with an indication for TPT was included and those whose index case of active tuberculosis was in retreatment, multidrug-resistant and extremely resistant, transferred, and people deprived of their liberty was excluded. The intervention was TPT with 1 INH 300 mg tablet and the control group with 3 INH 100 mg tablets. The primary outcome was TPT completion. Pearson's chi-square test was used to analyze the association of TPT completion. The risk of TPT completion was estimated by Poisson regression. The mean treatment effect was calculated. The results were expressed as a risk ratio (RR) with a 95% confidence interval (95%CI).

Results: A total of 207 individuals were included, 103 (49.7%) in the intervention group. Seventy-two (69.9%) of the individuals who used INH 300 mg completed TPT. The risk ratio for completing TPT was 1.39 times higher in the group that used the INH 300 mg treatment (RR 1.39, 95%CI 1.08 to 1.79). The mean effect of the intervention was 19% (Coefficient 0.19, 95%CI 0.06 to 0.32). There was no significant difference in adverse events between the groups.

Conclusion: The pragmatic use of INH 300 mg in TPT showed a positive effect on the treatment completion rate and is a safe presentation for use in INH monotherapy regimens.

Trial registration: The protocol is registered in the Brazilian Registry of Clinical Trials under the code RBR-2wsdt6 in September 2019 10th.

Background: Cervical cancer, primarily caused by persistent high-risk human papillomavirus (hrHPV) infections, is a significant health burden, particularly in low-resource settings such as Sarawak, Malaysia. Effective prevention depends on effective vaccination and early hrHPV detection. This study compares the performance of the point-of-care test (POCT) SD Biosensor Standard™ M10 HPV and laboratory-based Seegene Anyplex™ II HPV HR assay, focusing on their ability to detect and genotype hrHPV in self-collected high vaginal swab samples.

Methods: A total of 151 archived self-sampled high vaginal swabs from the Sarawak Urban and Rural Action for Cervical Cancer Elimination Programme (Program SUARA) were analyzed. hrHPV detection and genotyping were performed using Anyplex, which identifies 14 hrHPV genotypes, and M10, which detects HPV16, HPV18, and other hrHPV categorized into six genogroups. Agreement between the assays was evaluated using Cohen's Kappa (κ), McNemar's test, and overall agreement percentages. Statistical significance was determined with p-values, and discordant results were further analyzed for potential diagnostic implications.

Results: The overall agreement between M10 and Anyplex for hrHPV detection was 92.05% (κ = 0.84, 95% CI 0.75-0.93), indicating almost perfect agreement. M10 demonstrated comparable sensitivity for detecting HPV16, HPV18, and other hrHPV genotypes, achieving 96.91% agreement (κ = 0.89, 95%CI 0.73-1.00) in hrHPV classification when discordant results were excluded. Genogrouping also showed almost perfect agreement (κ = 0.91, 95% CI 0.82-0.98). McNemar's test indicated no significant difference in hrHPV detection rates (p > 0.05), affirming their comparable performance in detecting clinically significant hrHPV infections.

Conclusion: The SD Biosensor Standard™ M10 HPV POCT and the Seegene Anyplex™ II HPV HR assay demonstrated almost perfect agreement in hrHPV detection and classification, supporting their complementary roles in cervical cancer prevention. M10's rapid, field-deployable design makes it suitable for resource-limited settings, while Anyplex provides enhanced genotyping capability in laboratory environments, allowing informed vaccine strategy. Incorporating both assays into cervical cancer prevention programs can improve screening coverage and accessibility, particularly in underserved areas. These findings align with the World Health Organization's cervical cancer elimination goals, reinforcing the importance of adaptable diagnostic tools in diverse healthcare contexts.

Introduction: Query fever (Q fever), a zoonotic disease, caused by Coxiella burnetii, is an infectious disease that has long been considered a rare and regionally restricted disease. It can be responsible for endocarditis and endovascular infections. Systemic capillary leak syndrome (SCLS), a rare disease of unknown etiology that most commonly develops in adults 50-70 years of age, is diagnosed clinically based on a characteristic symptomatic triad of hypotension, hemoconcentration (elevated hemoglobin or hematocrit), and serum hypoalbuminemia resulting from fluid extravasation. Although Q fever has increasingly been recognized and reported in recent years, the treatment of Q fever complicated by SCLS, with an etiological diagnosis aided by metagenomic next-generation sequencing (mNGS), remains uncommon.

Case presentation: This report describes a case of acute Q fever with concurrent SCLS in a 54-year-old male who worked in a slaughterhouse. The patient presented with fever, chest tightness, and shortness of breath, accompanied by severe headache. His condition rapidly deteriorated, leading to acute fever, generalized weakness, and hypotension. Due to respiratory failure and shock, he was admitted to the intensive care unit (ICU) for treatment. Despite empirical antibiotic therapy along with fluid resuscitation, his blood pressure continued to decline, and metabolic acidosis and respiratory distress worsened. As his condition failed to improve, tracheal intubation was performed. mNGS detected both Coxiella burnetii in his BALF and blood samples. Based on the mNGS results, he was started on doxycycline, alongside penicillin antibiotics, vasopressors, and continuous renal replacement therapy (CRRT). The patient's condition gradually improved, and he was discharged home after 12 days of treatment. At his 90-day follow-up, he had nearly fully recovered to his pre-illness status.

Conclusions: mNGS plays a crucial role in assisting the diagnosis of Q fever, which enables the timely treatment of the underlying disease triggering SCLS. This, combined with restrictive fluid resuscitation strategies, is essential for improving patient outcomes.

Background: Outbreaks of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have been documented at multiple sites worldwide. Several studies have reported an elevated infection rate of CA-MRSA infections in men having sex with men (MSM), suggesting CA-MRSA can behave as a sexually transmitted infection (STI). To assess the potential public health impact of CA-MRSA transmission amongst MSM, a systematic review of the literature was conducted to identify risk factors and prevalence of CA-MRSA colonization and infection in MSM.

Methods: The electronic database Embase.com (containing Embase and Medline) was systematically searched to identify studies investigating CA-MRSA colonization and infection from inception up to 19 January 2024. Two independent reviewers selected potentially relevant articles for full-text screening. Only English-language articles meeting the inclusion criteria were considered. In case of reviewer disagreement, a third independent reviewer was consulted. Information regarding prevalence, strains, and risk factors for CA-MRSA colonization and infection were extracted by one reviewer and checked by a second reviewer.

Results: 54 studies were screened; 18 were included for analysis. Notably, 3 distinct CA-MRSA clusters were observed in MSM in the USA and Japan. Screening in other MSM cohorts did not reveal an elevated prevalence of CA-MRSA colonization or infection. Identifying as MSM by itself is not a risk factor for MRSA colonization and infection, but specific behavior factors such as intravenous drugs use and high-risk sexual behavior do increase this risk.

Discussion: Recognizing the potential presence of CA-MRSA in MSM experiencing (skin) infections is crucial for informed clinical decisions. In cases where a cluster of CA-MRSA infections occurs within a sexual network, eradication strategies and non-pharmaceutical interventions should be carefully considered to prevent further spreading. Given the limited available data on this topic and incomplete data on the prevalence on a global scale, further investigations should prioritize studying the impact of CA-MRSA transmission within sexual networks.

Background: Antimicrobial resistance (AMR) is a major threat to global public health, limiting treatment options for infections. AMR is particularly life-threatening for cancer patients, who are at increased risk of antibiotic-resistant infections. This review presents the first comprehensive data on the prevalence of AMR in major bacterial pathogens isolated from cancer patients.

Method: An extensive search was conducted in PubMed, Scopus, and Web of Science, focusing on studies published in English from 2000 to 2024. A single-group meta-analysis was performed to determine the resistance prevalence of major bacterial species.

Results: One hundred thirty-two full-text articles were included in the systematic review, and studies on haematological cancer patients were the most common (36.4%). The major bacterial pathogens reported were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus faecium, Streptococcus pneumoniae and Enterobacter spp. For E. coli, resistance prevalence was highest for penicillins (81.84%), followed by cotrimoxazole (65.79%) and monobactams (61.61%). For K. pneumoniae, the highest prevalence of resistance was observed for penicillins (98.99%), followed by cotrimoxazole (70.92%). Acinetobacter baumannii had high resistance prevalence to multiple antimicrobial classes, including third-generation cephalosporins (84.10%), fourth-generation cephalosporins (80.75%), carbapenems (82.58%), fluoroquinolones (80.37%), beta-lactam-beta-lactamase inhibitors (79.15%), cotrimoxazole (75.77%), and aminoglycosides (64.05%). Enterobacter spp. and Enterococcus faecium showed high resistance prevalence to penicillins at 91.77% and 90.64% respectively. P. aeruginosa had a high prevalence of resistance to third-generation cephalosporins (49.41%) while S. aureus showed high prevalence to macrolides (55.63%) and methicillin (45.29%).

Conclusion: This review indicated a high prevalence of antimicrobial resistance in bacterial pathogens isolated from cancer patients worldwide. The pronounced resistance prevalence observed, especially among ESKAPE pathogens, underscores the urgent need to improve infection prevention and antimicrobial stewardship in cancer care globally.

Background: Loss to follow-up from antiretroviral therapy reduces treatment benefits and leads to treatment failure and onward transmission of HIV. Appropriate interventions to increase adherence to the antiretroviral therapy (ART) cannot be designed and implemented without concrete evidence on the rate of loss to follow-up and the characteristics of those who disengage from the treatment. Hence, this study aimed to estimate the incidence of loss to follow-up and identify its predictors among HIV patients following ART at selected public health facilities in Southwest Ethiopia.

Methods: An Institutional-based retrospective cohort study was conducted among 357 randomly selected adult HIV patients attending antiretroviral therapy from January 2017 to December 2021 at Agaro General Hospital and Agaro Health Center. Data were entered into Epi-data version 3.1 and analyzed using STATA 14.2. To estimate and compare the survival probabilities, the Kaplan-Meier method and log-rank test were used. Cox regression analysis was fitted to identify independent predictors of time to loss to follow-up. The proportional hazard assumption was checked using the Schoenfeld residual test. The 95% CI of the hazard ratio with a corresponding p-value ≤ 0.05 was used to declare statistical significance.

Results: Among a cohort of 357 HIV patients followed for 1028 person-years at Agaro General Hospital and Agaro Health Center, 48 (13.4%) lost their ART follow-up. The overall incidence rate of loss to follow-up was 4.7 (95% CI 3.7, 7.3) per 100 adult-years. In multivariable Cox regression analysis, rural residence (adjusted hazard ratio (AHR) = 2.45; 95% CI:1.08-5.58), World Health Organization Clinical stage-IV (AHR = 2.65: 95% CI 1.13-6.26), not disclosing HIV serostatus (AHR = 2.51; 95% CI 1.19-5.29), availability of no treatment supporter (AHR = 4.90; 95% CI: 2.20-10.87), poor and fair adherence to ART follow-up (AHR = 11.28; 95% CI: 4.03-31.56) and (AHR = 5.98; 95% CI: 2.24-15.92), and being out of the catchment area (AHR = 2.70; 95% CI:1.21-6.06) were independently associated with loss to follow-up.

Conclusion: In this study, the incidence rate of loss to follow-up among adult HIV patients on ART was higher than the national average. Key predictors of loss to follow-up included rural residence, WHO Clinical stage IV, not disclosing HIV serostatus, absence of a treatment supporter, fair/poor adherence to ART, and visiting an ART clinic outside the catchment area. Therefore, to minimize loss to follow-up, targeted interventions addressing these predictors should be implemented to improve ART follow-up and care for adult HIV patients.

Background: Understanding social contact patterns is fundamental to the study of infectious disease transmission. However, in South Korea, detailed social contact data have not been publicly available. While global research on social contact patterns has expanded, there remains a critical need for more context-specific data in South Korea.

Methods: We conducted a social contact survey over two distinct weeks covering various time periods, including school vacations and national holidays. Participants provided details such as the location, duration, frequency, and type of close contact, as well as information on the contact person's age, sex, residential area and relationship with the participant. We analyzed the data using summary statistics and the Bayesian linear mixed model.

Results: A total of 1,987 participants recorded 133,776 contacts over two weeks, averaging 4.81 contacts per participant per day. The average number of contacts per day varied by age, household size, and time period. Contacts were highest in the age group 5-19, lowest in the age group 20-29, and then gradually increased up to the age group 70+. Contacts also increased with household size. Weekdays during the school semester showed the highest number of contacts, followed by weekdays during vacations, the Lunar New Year holidays, and weekends. Contact patterns differed notably by period; during the Lunar New Year holidays, closed contacts with extended family members and, therefore, subnational social mixing were enhanced.

Conclusion: Our analyses across different time periods revealed significant and some unique variations of social contact patterns in South Korea. These findings can improve our understanding of infectious disease transmission in South Korea and will be useful for tailoring regional epidemiological models.

Background: Multidrug-resistant (MDR) bacteria are a global health threat, notably in low- and middle-income countries. The aim of this review was to estimate the prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa.

Methods: In accordance with PRISMA guidelines, we searched PubMed, CINAHL, African Index Medicus, and other databases for studies published from 2010 onward. Data on MDR bacterial prevalence, study characteristics, and infection types were extracted and analyzed via R software. Subgroup analyses were performed to explore differences in prevalence across infection settings and sample types.

Results: Out of the 5,320 articles identified, 50 studies from 13 West African countries met the inclusion criteria, with the majority from Nigeria (34%) and Ghana (22%). Among the 35,820 bacteria isolated in these studies, gram-negative bacteria (GNB), particularly Escherichia coli and Klebsiella sp., were the most frequently isolated species, accounting for 63.3% of the bacteria. The overall prevalence of MDR bacteria was 59% (95% CI: 48-69%), with significant heterogeneity between studies (I² = 98%, p < 0.001). Subgroup analysis revealed a 7% increase in MDR bacteria prevalence from the first five-year period to the last two five-year periods, and a greater prevalence of MDR bacteria in nosocomial infections (65%, 95% CI: 45-81%) than in community-acquired infections (53%, 95% CI: 31-74%). The prevalence of MDR bacteria in mixed infection settings was 58% (95% CI: 44-71%). The MDR prevalence was highest in the urine samples (72%, 95% CI: 57-84%) and superficial skin samples (69%, 95% CI: 29-92%), whereas it was lowest in the nasopharyngeal samples (26%, 95% CI: 21-33%).

Conclusion: The high prevalence of MDR bacteria in West Africa underscores the need for strengthened infection control measures, improved surveillance, and stricter antibiotic use policies. Enhanced regional collaboration is essential to mitigate the spread of AMR in both healthcare and community settings.

Prospero registration number: CRD42023470363.