Infection and Drug Resistance最新文献

{"title":"Molecular Epidemiology and Genetic Characterization of Carbapenem-Resistant <i>Acinetobacter baumannii</i> Isolates from the ICU of a Tertiary Hospital in East China.","authors":"Lili Liu, Yuan Huang, Yaping Wang, Yunlan Jiang, Kang Liu, Zhongxia Pei, Zhiping Li, Yuqiong Zhu, Dan Liu, Xiaoyue Li","doi":"10.2147/IDR.S491858","DOIUrl":"https://doi.org/10.2147/IDR.S491858","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical characteristics, antimicrobial resistance (AMR) phenotypes and genotypes, and homology features of carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) in intensive care unit (ICU) and to provide basis for effectively prevention, control and treatment of nosocomial infections caused by CRAB.</p><p><strong>Methods: </strong>A total of 39 CRAB strains isolated from hospitalized patients in the ICU and neurosurgical ICU (NICU) between 2020 and 2023 were subjected to antimicrobial susceptibility testing and whole-genome sequencing (WGS). Virulence factor genes (VFGs), antimicrobial resistance genes (ARGs), multilocus sequencing typing (MLST), complete genome multilocus sequencing typing (cgMLST), average nucleotide identity (ANI), and single nucleotide polymorphism (SNP) analyses were performed using WGS.</p><p><strong>Results: </strong>All CRAB strains were 100% resistant to ciprofloxacin, ceftazidime, piperacillin/tazobactam, and ticarcillin/clavulanic acid. A total of 48 antimicrobial resistance genes (ARGs) were found in the 39 CRAB strains, including <i>bla</i>OXA-66, <i>bla</i>OXA-23, <i>bla</i>ADC-30, <i>bla</i>ADC-73, <i>gyrA, ant(3″)-IIa, aph(3″)-Ib, aph(6)-Id, tetB, tetR, sul1, sul2, LpxC and LpxA</i> which confered resistance to carbapenems, cephalosporins, fluoroquinolones, aminoglycosides, tetracycline and sulfonamides. There were 128 VFGs, including genes encoding the AdeFGH efflux pump, lipopolysaccharide (LpsBLC), outer membrane protein A (OmpA), penicillin-binding protein (PbpG), biofilm-associated proteins (bap, pgaBCD, CsuABCDE), type VI secretion system protein (Tss), quorum sensing protein (AbaI/AbaR). Six clonal lineages were identified by Oxford MLST method, whereas one sequence type (ST2) was identified using the Pasteur MLST method. ANI analysis, heat map of SNP analysis, and phylogenetic tree based on core SNP revealed six clusters, and the strain classification results were consistent with these different methods. Ten clonal lineages were identified by cgMLST.</p><p><strong>Conclusion: </strong>The CRAB strains were ST2 clones accompanied by severe resistance to commonly used antibiotics and abundant ARGs and VFGs in genotype. Strict measures should be implemented to prevent and control transmissions and infections. CgMLST and SNPs analyses showed excellent discriminatory power in homology analysis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5925-5945"},"PeriodicalIF":2.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Antibiotic Susceptibility of Pathogenic Enterobacteria Strains from Three Biotopes in the City of Ouagadougou (Burkina Faso).","authors":"Sanhitouo Charlemagne Dabiré, Marius K Somda, Léon W Nitièma, Dinanibè Kambiré, Samiratou Kiemtoré, Serge Théophile Soubeiga, Abdou Azaque Zouré, Konan Kouakou Toussaint Yao, Tegwindé Rebeca Compaoré, Henri Gautier Ouedraogo, Mamoudou H Dicko","doi":"10.2147/IDR.S485200","DOIUrl":"https://doi.org/10.2147/IDR.S485200","url":null,"abstract":"<p><strong>Purpose: </strong>The emergence of antibiotic resistance in pathogenic <i>Enterobacteriaceae</i> is a public health problem in tropical countries such as Burkina Faso. Antibiotic resistance could be identified using a variety of approaches. This study aimed to estimate the prevalence of pathogenic enterobacteria strains from three sources, as well as their antibiotic resistance profile to biotope and climatic season.</p><p><strong>Material and methods: </strong>The methodological approach consisted of identifying <i>Enterobacteriaceae</i> from human (urine, stool), animal (eggs, milk, fish), and environmental (soil, lettuce) samples, followed by assessing their antibiotic susceptibility. Samples were collected from February to December 2023. Bacterial species were isolated and phenotypically identified (morphologically, culturally, biochemically, and antigenically) using standard methods. The prevalence of bacterial susceptibility to ten antibiotics was determined using the agar disk diffusion method. The collected data were analyzed with IBM SPSS Statistics 25 software.</p><p><strong>Results: </strong>A total of 615 <i>Enterobacteriaceae</i> isolates were collected, including 300, 168, and 147 samples from human, animal, and environmental sources respectively. Phenotypic characteristics allowed to partially identify 43 species, among these 29.76% belonged to <i>Escherichia coli</i>, 24.72% <i>to Enterobacter cloacae</i>, 13.<i>82% to Klebsiella pneumoniae, 3.41% to Enterobacter sakazakii</i> and 2.6% to <i>Klebsiella oxytoca</i>. Bacterial resistance rates were: aminopenicillins (54.8%), first-generation cephalosporins (35.3%), sulfonamides (33.3%), third-generation cephalosporins (30.7%), fourth-generation cephalosporins (22.5%), fluoroquinolones (21.8%), phenicols (16.8%), and carbapenems (16.2%). The distribution of antibiotic resistance was 45.3% from human sources, 19.3% from animal sources, and 13.8% from environmental sources.</p><p><strong>Conclusion: </strong>The results indicate that resistant bacteria can come from any of the three biotopes, with human origin being the most frequent. The high prevalence of resistance to the antibiotics tested in isolated bacteria raises interest in investigating the genetic factors responsible.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5909-5924"},"PeriodicalIF":2.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Pharmacokinetics and Dosing Optimization of Norvancomycin for Chinese Patients with Community-Acquired Pneumonia.","authors":"Yaqian Li, Xiaodan Jiao, Guozhu Sun, Fuxu Wang, Xikun Wu, Weichong Dong, Wenpeng Lu, Zhiyong Zhang, Yadong Yuan, Zhiqing Zhang","doi":"10.2147/IDR.S496776","DOIUrl":"10.2147/IDR.S496776","url":null,"abstract":"<p><strong>Purpose: </strong>Determining the optimal dosage of norvancomycin (NVCM) for Chinese patients with community-acquired pneumonia (CAP) caused by gram-positive cocci remains uncertain. This research aimed to identify influential factors affecting NVCM pharmacokinetics and explore optimal dosage regimens via population pharmacokinetic (PPK) analysis.</p><p><strong>Patients and methods: </strong>A prospective analysis was conducted at the Second Hospital of Hebei Medical University (Shijiazhuang, China). CAP patients aged ≥18 years and receiving intravenous NVCM were enrolled. Each patient underwent the collection of 3-8 blood samples for analysis during the treatment. Nonlinear mixed effect model (NONMEM) software was used to develop PPK models, while Monte Carlo simulations were employed to optimize dose regimens. Pharmacokinetic-pharmacodynamic (PK/PD) breakpoint was defined as daily area under the concentration on the second day of therapy to minimum inhibitory concentration ratio (AUC_24-48h/MIC) ≥361, and a steady-state AUC to MIC radio (AUC_ss,24h/MIC) ≥361.</p><p><strong>Results: </strong>A prospective PPK analysis of 231 NVCM concentrations was performed in 34 patients. A two-compartment model with first-order elimination adequately described the pharmacokinetics. The population typical clearance (CL) of NVCM was 3.15 L/h, and the central volume of distribution was 12.3 L. Notably, CL exhibited significant correlations with age and serum creatinine (Scr) levels. For mild or moderate CAP patients, the recommended doses were 400-800 mg every 12 h to achieve the target exposure with AUC_ss,24h/MIC ≥361. For community-acquired methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA) pneumonia, the suggested dosage regimen was 600-800 mg every 8 h, which could achieve the target exposure preferably within the initial 24 to 48 h.</p><p><strong>Conclusion: </strong>Age and Scr levels significantly influenced the pharmacokinetic parameters of NVCM in CAP patients. Our model-informed precision dosing approach may help for early optimization of NVCM exposure. Further prospective studies with larger samples will be needed.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5881-5893"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Lumbar Drug-Resistant Tuberculosis: A Case Report and Review of Literature.","authors":"Tao Li, Shaohua Liu","doi":"10.2147/IDR.S504519","DOIUrl":"10.2147/IDR.S504519","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis is prevalent in high-burden countries. However, spinal multi-drug resistant tuberculosis (MDR-TB) in patients with normal immune function is a disease that is prone to misdiagnosis and even delayed diagnosis. Recently, we successfully treated one such patient.</p><p><strong>Case presentation: </strong>A 46-year-old male patients with lower back pain associated with recurrent fever 2 months before admission. The patient was misdiagnosed as a suppurative spinal infection and failed to respond to treatment for 2 months. The muscle strength of both lower limbs decreased progressively. We performed two operations to clear the lesion and decompress the spinal canal, during which we found a fish-like inflammatory tissue mimicking a suppurative infection. Finally, the patient was diagnosed with lumbar MDR-TB by culture, Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS). The second-line anti-tuberculosis treatment (ATT) is cycloserine + para-aminosalicylic acid + ethambutol + levofloxacin + linezolid. Finally, the patient's symptoms were relieved and the muscle strength of both lower limbs recovered.</p><p><strong>Conclusion: </strong>This case prompt MDR-TB of the spine is not a typical clinical symptoms and imaging examination is the lack of specificity, when for the diagnosis of patients with spinal bone destruction unclear or treatment is invalid, can diagnostic anti-tuberculosis treatment. For patients with spinal instability or spinal canal occupying, early surgical removal of lesions, tissue culture, Xpert MTB/RIF and mNGS to identify pathogens and drug resistance, timely diagnosis and treatment can maximize the prognosis of spinal MDR-TB.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5867-5873"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Differences Between Survivors and Non-Survivors of Ventilator-Associated Pneumonia: The Roles of Sulbactam/Ampicillin and Methicillin-Resistant <i>Staphylococcus aureus</i>.","authors":"Masafumi Seki, Anna Takimoto, Manabu Inoue, Kazuya Niiyama, Ayumu Masuoka, Futoshi Kotajima","doi":"10.2147/IDR.S497536","DOIUrl":"10.2147/IDR.S497536","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is one of the most lethal complications in intensive care unit (ICU) patients. However, critical issues of non-survivors vary and are still unclear in VAP patients.</p><p><strong>Methods: </strong>The clinical differences between survivors and non-survivors of VAP were retrospectively analyzed in patients hospitalized from April 2023 to March 2024.</p><p><strong>Results: </strong>Of a total of 42 VAP patients, 22 (52.4%) survived, and 20 died. Survivors were significantly younger (69.1 vs 71.7 years, p < 0.01) and received sulbactam/ampicillin (SAM) as the initial antibiotics, significantly more (45.5% vs 10%, p = 0.006) than non-survivors. The male/female ratio and wards where they were managed were similar in both groups, but methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) was detected significantly more frequently in non-survivors (4/4 = 100%).</p><p><strong>Conclusion: </strong>These data suggest that VAP patients who survived were younger and received treatment with narrow-spectrum antibiotics, such as SAM. Isolation of MRSA might be critical. These findings could influence antibiotic protocols and ICU management strategies to prevent infection with resistant bacteria to improve the prognosis of patients with VAP.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5875-5879"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Differentiation Nomogram Model for Brucellar Spondylitis and Tuberculous Spondylitis.","authors":"Maimaitiyibubaji Abudukadier, Yuxin Zhang, Maozhao Li, Munire Muhetaer, Yibulayinjiang Mijiti, Zumulaiti Simayi, Maimaitijiang Aireti, Jingshun Tian, Maimaitishawutiaji Maimaiti","doi":"10.2147/IDR.S497404","DOIUrl":"10.2147/IDR.S497404","url":null,"abstract":"<p><strong>Background: </strong>Tuberculous spondylitis (TS) and brucellar spondylitis (BS) exhibit certain similarities in clinical presentation and imaging characteristics, making differential diagnosis challenging. Developing a reliable differential diagnosis model can assist clinicians in distinguishing between these two conditions at an early stage, allowing for targeted prevention and treatment strategies.</p><p><strong>Methods: </strong>Patients diagnosed with TS and BS were retrospectively collected and randomized into training and validation cohorts (ratio 7:3). The least absolute shrinkage and selection operator (LASSO) regression was used to reduce data dimensionality and select variables. Multivariate logistic regression was used to build predictive models. A nomogram was constructed to provide a visual representation of the model. Receiver operating characteristic (ROC) curve, calibration plots and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram.</p><p><strong>Results: </strong>A total of 183 patients included (101 cases of TB, 82 cases of BS) our study. Our results showed that these variables including time from symptom onset to admission, anorexia, adenosine deaminase (ADA) and psoas abscess were important to differentiate TS and BS. The area under the curve (AUC) of ROC curve was 0.820 [95% <i>CI</i> (0.749, 0.892)] and 0.899 [95% <i>CI</i> (0.823, 0.976)] for the training and validation cohort, respectively. The results of calibration curve and DCA confirmed that the nomogram performed well in differentiating TS patient from BS.</p><p><strong>Conclusion: </strong>The combination of time from symptom onset to admission, anorexia, ADA and psoas abscess demonstrated good differential properties for TS and BS. We developed a new nomogram model that can effectively differentiate TS and BS based on these four characteristics, which could be a valid and useful clinical tool for clinicians to aid in early differential diagnosis and targeted treatment.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5895-5907"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convergence of Hypervirulence and Multidrug-Resistance in <i>Burkholderia cepacia</i> Complex Isolates from Patients with COVID-19.","authors":"Mengjiao Du, Cheng Chi, LuYing Xiong, Jincheng Rong, Maoli Yi, Qi Zhao, Xiaohui Chi","doi":"10.2147/IDR.S495676","DOIUrl":"10.2147/IDR.S495676","url":null,"abstract":"<p><strong>Purpose: </strong><i>Burkholderia</i> is a conditioned pathogen in the medical setting and mainly affects patients with cystic fibrosis. We found co-infection with <i>Burkholderia cepacia</i> complex (Bcc) in many patients with respiratory tract infections, including H7N9 and COVID-19. However, previous studies have not focused on co-infections with BCC and respiratory viruses. Therefore, this study attempted to clarify the evolution of COVID-19-Bcc and H7N9-Bcc in terms of genetic background, antibiotic resistance, and virulence phenotypes.</p><p><strong>Methods: </strong>This study retrospectively collected 49 Bcc isolated from patients with H7N9 and COVID-19 in a tertiary hospital of Zhejiang Province, of which 42 isolates were isolated from patients with H7N9, seven isolates were isolated from patients with COVID-19. The collected isolates were tested for antibiotic susceptibility, <i>Galleria mellonella</i> infection model, and whole-genome COVID-19-Bcc Characterization.</p><p><strong>Results: </strong>The test results of 49 strains of Bcc showed that the strains isolated from COVID-19 patients accounted for 57.1% of multidrug-resistance resistant strains. Statistical analysis of the median lethal time of <i>G. mellonella</i> showed that the median fatal time for COVID-19-Bcc was shorter and more virulent than that of H7N9-Bcc (P<0.05). The results of phylogenetic analysis indicated that COVID-19-Bcc may have evolved from H7N9-Bcc.</p><p><strong>Conclusion: </strong>In this study, co-infection with BCC in many patients with respiratory tract infections, including H7N9 and COVID-19, was first identified and clarified that COVID-19-Bcc may have evolved from H7N9-Bcc and has the characteristics of hypervirulence and multidrug resistance.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5855-5866"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incomplete Immune Reconstitution and Traditional Chinese Medicine in Patients with HIV/AIDS: Challenges and Perspectives.","authors":"Xue Ding, Leilei Fan, Liran Xu, Xiuxia Ma, Pengfei Meng, Jie Li, Jiahe Li, Jingyu Yue","doi":"10.2147/IDR.S497083","DOIUrl":"10.2147/IDR.S497083","url":null,"abstract":"<p><p>Antiretroviral therapy can reduce human immunodeficiency virus (HIV) load to undetectable levels and restore CD4+ T cells to rebuild immune function in patients with HIV. However, some patients fail to achieve immune reconstitution despite treatment. Traditional Chinese medicine is an important branch of complementary and alternative medicine for the treatment of HIV infection, and a growing number of studies has demonstrated that traditional Chinese medicine can increase CD4+ T cell counts in patients, thereby promoting immune reconstitution, ameliorating symptoms and signs, and improving quality of life. Here, we review pathogenesis in immunological non-responders and research into their treatment with traditional Chinese medicine. Furthermore, we summarize potential future research directions, including elucidation of how traditional Chinese medicine can regulate CD4+ T cells to reduce opportunistic infections and improve quality of life in immunological non-responders.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5827-5838"},"PeriodicalIF":2.9,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic Changes and Influencing Factors of Polymyxin B in Different ECMO Modes.","authors":"Mi Xu, Na Chen, Yong-Wei Yu, Xiang-Ying Pan, Tong Li","doi":"10.2147/IDR.S486169","DOIUrl":"10.2147/IDR.S486169","url":null,"abstract":"<p><strong>Purpose: </strong>With the development of extracorporeal membrane oxygenation (ECMO) technology, the duration of ECMO support has gradually increased, leading to an increased risk of ECMO-related bacterial resistance. Polymyxin B (PMB) is used to treat drug-resistant bacterial infections. However, the pharmacokinetic (PK) parameters of antibiotics may change during ECMO, resulting in over- or under-exposure. This study aimed to clarify the changes in PK parameters and identify factors influencing PMB levels in patients receiving venovenous or venoarterial ECMO.</p><p><strong>Patients and methods: </strong>A prospective PK study was performed in 11 patients receiving ECMO with resistant bacteria. After reaching a steady state, the drug concentrations of PMB pre- and post-oxygenator were measured. Nonlinear mixed-effects modelling was used to construct a population PK model for PMB. Microbial results were assessed using repeated cultures at the end of treatment. Semiquantitative microbial culture results were used to form clearance and uncleared groups.</p><p><strong>Results: </strong>The PMB concentrations were not significantly different between pre- and post-oxygenator. A two-compartment model best described the PK of PMB. ECMO flow rate was included as a covariate of clearance (CL). Continuous renal replacement therapy (CRRT) were included as covariates on the volume of the central compartment. The PK parameters central compartment, volume of the peripheral compartment, CL, and inter-compartmental clearance or flow rate(Q) were 20.41 L, 9.86 L, 3.75 L/h, and 3.82 L/h. 7 patients (63.64%) had two consecutive negative bacterial cultures at discharge. The C_ss,avg shows a significant difference between clearance group (2.26±0.72) and uncleared group (1.25±0.24), P<0.05.</p><p><strong>Conclusion: </strong>There were no significant differences in PMB concentrations between pre- and post-oxygenator. The PK of PMB may be altered in patients receiving CRRT-ECMO. The ECMO flow rate is strongly correlated with the CL. The C_ss,avg is correlated with the bacterial clearance rate. In clinical practice, increasing the incidence of therapeutic drug monitoring may improve the clinical outcomes.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5815-5825"},"PeriodicalIF":2.9,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Meningitis Caused by <i>Brucella melitensis</i> Biovar 3.","authors":"Shuzhu Cao, Songsong Xie, Shengnan Song, Xiu Gu, Zhihua Sun, Xingmei Deng, Jia Guo, Tianyi Zhao, Yingjin Chai, Dexin Zhu, Xiafei Liu, Xiangwei Wu, Hui Zhang","doi":"10.2147/IDR.S493174","DOIUrl":"10.2147/IDR.S493174","url":null,"abstract":"<p><strong>Background: </strong>Brucellosis, a major endemic disease in northern China, is contracted by zoonosis of <i>Brucella</i>. We report a case of meningitis caused by <i>Brucella melitensis</i> biovar 3.</p><p><strong>Case presentation: </strong>A 46-year-old man was hospitalized at a local medical facility due to symptoms of fever, soreness, and weakness on April 16, 2021. The local hospital improved the relevant examinations, and the serum tube agglutination test (SAT) for <i>Brucella</i> was positive. The patient underwent a week of anti-infective symptomatic treatment with doxycycline and rifampicin, however, his symptoms continued. Subsequently, he was hospitalized in our facility following convulsions and altered consciousness. We conducted several examinations, and the lumbar puncture revealed abnormal cerebrospinal fluid (CSF) protein levels along with a positive culture. Biochemical and polymerase chain reaction (PCR) tests (based on <i>IS711</i> gene) identified the pathogen as <i>B. melitensis</i> biovar 3. Following treatment involving with moxifloxacin hydrochloride, doxycycline, rifampin, cefatriaxone, mannitol, and dexamethasone the patient's body temperature stabilized, leading to gradual improvements in his clinical status. After two months of the oral anti-infective regimen, the condition is continuing to alleviate and the laboratory indicators returned to normal. The follow-up maintained two years, the patient with no symptomatic recurrences or sequel.</p><p><strong>Conclusion: </strong>We showed that in epidemic areas of brucellosis, patients with unexplained neurological symptoms should first be examined for neurobrucellosis. Early treatment with corticosteroids and a combination of antibiotics is beneficial for the relief and satisfactory prognosis of neurological symptoms.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"17 ","pages":"5847-5853"},"PeriodicalIF":2.9,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}