Infection and Drug Resistance最新文献

{"title":"Advancing Precise Syphilis Diagnosis: A Nontreponemal IgM Antibody-Based Model for Latent Syphilis Staging","authors":"Jia-Wen Xie, Yin-Feng Guo, Ya-Wen Zheng, Mao Wang, Qiu-Yan Xu, Yu-Yan Chen, Li-Rong Lin","doi":"10.2147/idr.s467982","DOIUrl":"https://doi.org/10.2147/idr.s467982","url":null,"abstract":"<strong>Purpose:</strong> Accurate differentiation between early and late latent syphilis stages is pivotal for patient management and treatment strategies. Nontreponemal IgM antibodies have shown potential in discriminating latent syphilis staging by differentiating syphilis activity. This study aimed to develop a predictive nomogram model for latent syphilis staging based on nontreponemal IgM antibodies.<br/><strong>Patients and Methods:</strong> We explored the correlation between nontreponemal IgM antibodies and latent syphilis staging and developed a nomogram model to predict latent syphilis staging based on 352 latent syphilis patients. Model performance was assessed using AUC, calibration curve, Hosmer–Lemeshow χ 2 statistics, C-index, Brier score, decision curve analysis, and clinical impact curve. Additionally, an external validation set was used to further assess the model’s stability.<br/><strong>Results:</strong> Nontreponemal IgM antibodies correlated with latent syphilis staging. The constructed model demonstrated a strong discriminative capability with an AUC of 0.743. The calibration curve displayed a strong fit, key statistics including Hosmer–Lemeshow χ² at 2.440 (P=0.486), a C-index score of 0.743, and a Brier score of 0.054, all suggesting favorable model calibration performance. Decision curve analysis and clinical impact curve highlighted the model’s robust clinical applicability. The external validation set yielded an AUC of 0.776, Hosmer–Lemeshow χ² statistics of 2.440 (P=0.486), a C-index score of 0.767, and a Brier score of 0.054, further underscored the reliability of the model.<br/><strong>Conclusion:</strong> The nontreponemal IgM antibody-based predicted model could equip clinicians with a valuable tool for the precise staging of latent syphilis and enhancing clinical decision-making.<br/><br/><strong>Keywords:</strong> syphilis, latent syphilis, latent syphilis staging, nontreponemal IgM antibody, predictive model<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141587814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azithromycin Effectiveness in Children with Mutated Mycoplasma Pneumoniae Pneumonia","authors":"Jie Cheng, Ya Liu, Guangli Zhang, Liping Tan, Zhengxiu Luo","doi":"10.2147/idr.s466994","DOIUrl":"https://doi.org/10.2147/idr.s466994","url":null,"abstract":"<strong>Objective:</strong> <em>Mycoplasma pneumoniae</em> (MP) is highly resistant to macrolides in China. However, macrolides still exhibit clinical effectiveness in some macrolide-resistant patients. We tend to explore azithromycin effectiveness in <em>Mycoplasma pneumoniae</em> pneumonia (MPP) children with A2063/2064G mutation.<br/><strong>Methods:</strong> This retrospective observational cohort study was conducted at the Children’s Hospital of the Chongqing Medical University. Children with macrolide-resistant mutations (A2063/2064G) diagnosed as MPP were retrospectively enrolled. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to evaluate and identify independent risk factors for treatment failure (progress to refractory <em>Mycoplasma pneumoniae</em> pneumonia [RMPP]) in macrolide-unresponsive <em>Mycoplasma pneumoniae</em> pneumonia (MUMPP) children with the A2063/2064G mutation.<br/><strong>Results:</strong> One hundred fifty-five children were retrospectively enrolled. More than 20% (36/155, 23.23%) of patients experienced defervescence within 3 days of azithromycin treatment. RMPP was diagnosed in 54 patients (54/155, 34.84%) and the incidence of RMPP during hospitalization was 22.72 per 1000 person-days. Logistic regression analysis showed that lactate dehydrogenase (LDH) ≥ 399 (U/L) was an independent risk factor for RMPP (odds ratio [OR] 4.66, 95% confidence interval [CI] 1.31– 17.10, P=0.017). During the year followed, RMPP patients had a significantly higher incidence of bronchiolitis obliterans and bronchiectasis than non-RMPP patients (16.67% vs 1.98%, P=0.001; 9.26% vs 0.00%, P=0.005, respectively).<br/><strong>Conclusion:</strong> Azithromycin was effective in children with MPP with the A2063/2064G mutation. For MUMPP children with A2063/2064G mutation, children with LDH ≥ 399 (U/L) had significant higher risk for progression to RMPP, and should consider to be treated with alternative antibiotics (eg tetracyclines, and fluoroquinolones).<br/><br/><strong>Keywords:</strong> azithromycin effectiveness, A2063/2064G mutation, <em>mycoplasma pneumoniae</em> pneumonia, children<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141587813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Clinical Decision Support System in Infectious Disease Control: Combatting Multidrug-Resistant Klebsiella pneumoniae with Machine Learning","authors":"Ming-Jr Jian, Tai-Han Lin, Hsing-Yi Chung, Chih-Kai Chang, Cherng-Lih Perng, Feng-Yee Chang, Hung-Sheng Shang","doi":"10.2147/idr.s470821","DOIUrl":"https://doi.org/10.2147/idr.s470821","url":null,"abstract":"<strong>Purpose:</strong> The World Health Organization has identified <em>Klebsiella pneumoniae</em> (KP) as a significant threat to global public health. The rising threat of carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) leads to prolonged hospital stays and higher medical costs, necessitating faster diagnostic methods. Traditional antibiotic susceptibility testing (AST) methods demand at least 4 days, requiring 3 days on average for culturing and isolating the bacteria and identifying the species using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), plus an extra day for interpreting AST results. This lengthy process makes traditional methods too slow for urgent clinical situations requiring rapid decision-making, potentially hindering prompt treatment decisions, especially for fast-spreading infections such as those caused by CRKP. This research leverages a cutting-edge diagnostic method that utilizes an artificial intelligence-clinical decision support system (AI-CDSS). It incorporates machine learning algorithms for the swift and precise detection of carbapenem-resistant and colistin-resistant strains.<br/><strong>Patients and Methods:</strong> We selected 4307 KP samples out of a total of 52,827 bacterial samples due to concerns about multi-drug resistance using MALDI-TOF MS and Vitek-2 systems for AST. It involved thorough data preprocessing, feature extraction, and machine learning model training fine-tuned with GridSearchCV and 5-fold cross-validation, resulting in high predictive accuracy, as demonstrated by the receiver operating characteristic and area under the curve (AUC) scores, laying the groundwork for our AI-CDSS.<br/><strong>Results:</strong> MALDI-TOF MS analysis revealed distinct intensity profiles differentiating CRKP and susceptible strains, as well as colistin-resistant <em>Klebsiella pneumoniae</em> (CoRKP) and susceptible strains. The Random Forest Classifier demonstrated superior discriminatory power, with an AUC of 0.96 for detecting CRKP and 0.98 for detecting CoRKP.<br/><strong>Conclusion:</strong> Integrating MALDI-TOF MS with machine learning in an AI-CDSS has greatly expedited the detection of KP resistance by approximately 1 day. This system offers timely guidance, potentially enhancing clinical decision-making and improving treatment outcomes for KP infections.<br/><br/><strong>Keywords:</strong> carbapenem, colistin, diagnostic accuracy, antibiotic stewardship, MALDI-TOF MS<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Age and the 28-Day All-Cause Mortality in Tuberculosis Complicated by Sepsis in ICU Patients: A Retrospective Cohort Study [Corrigendum]","authors":"Kunping Cui, Yi Mao, Shuang Feng, Haixia Luo, Jiao Yang, Ruyi Xu, Lang Bai","doi":"10.2147/idr.s486225","DOIUrl":"https://doi.org/10.2147/idr.s486225","url":null,"abstract":"<strong>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rapid PCR-Based Diagnostic Method for Skin Infection with Mycobacterium marinum","authors":"Yanan Li, Yahui Feng, Dongmei Li, Dongmei Shi, Guanzhi Chen","doi":"10.2147/idr.s463798","DOIUrl":"https://doi.org/10.2147/idr.s463798","url":null,"abstract":"<strong>Objective:</strong> The increasing incidence of chronic skin infections caused by <em>Mycobacterium marinum</em>, coupled with the time-consuming and low detection rates nature of traditional culture and histological-based diagnostic methods, underscores the need for an expedited approach. The study aims to develop a rapid and efficient method for detecting <em>M. marinum</em> with PCR technology.<br/><strong>Methods:</strong> We designed four pairs of primers based on DNA sequences from GeneBank and prior studies, we utilized both PCR and Real-time PCR to identify <em>M. marinum</em>. Specificity and sensitivity assessments were conducted in vitro by DNAs extracted from <em>M. marinum</em> and other bacterial or fungal cultures. Further validation was performed through the implementation of a mouse skin infection model to optimize and confirm the efficacy of the detection method in both fresh and paraffin-embedded skin tissues. The same PCR testing system was further confirmed with paraffin-embedded skin tissues samples from patients as well.<br/><strong>Results:</strong> The results of the study indicate promising outcomes for the four-pair primers system. It demonstrated 100% sensitivity in detecting <em>M. marinum</em> from purified cultures, including typical strains and nine clinical isolates, while achieving a specificity of 100%. This specificity was evidenced by the absence of PCR products from 12 bacterial species, 12 fungi species, and six other non-tuberculous mycobacterium (NTM) species. In the animal model, the PCR assay exhibited high detection efficacy for both infected fresh tissues and paraffin-embedded tissues, with a slight superiority observed in fresh tissues. However, the PCR assay exhibited high detection efficacy for clinical paraffin-embedded tissues. These findings collectively underscore the robust detection capabilities of our four-pair primers in both in vitro and in vivo settings.<br/><strong>Conclusion:</strong> A sensitive and highly specific rapid detection system has been successfully developed that can be used to detect <em>M. marinum</em> in both infected fresh tissues and paraffin-embedded tissues.<br/><br/><strong>Keywords:</strong> <em>Mycobacterium marinum</em>, bacteria, infected tissue, paraffin-embedded tissue, PCR technique<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distribution Patterns and Antibiotic Resistance Profiles of Bacterial Pathogens Among Patients with Wound Infections in the Jiaxing Region from 2021 to 2023","authors":"Chun Wang, Xiaoqin Niu, Siwen Bao, Weifeng Shen, Chaoyue Jiang","doi":"10.2147/idr.s470401","DOIUrl":"https://doi.org/10.2147/idr.s470401","url":null,"abstract":"<strong>Purpose:</strong> To systematically assess the distribution and antimicrobial susceptibility of pathogens in wound infections, and analyze risk factors associated with multidrug resistance (MDR).<br/><strong>Patients and Methods:</strong> Retrospectively analyzing Jiaxing-region medical records between January 2021 and December 2023, we identified a cohort of 461 wound infection patients. Cultures were grown on various agars, with bacteria identified via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. The antimicrobial susceptibility of the organisms were conducted by VITEK 2 system, Kirby-Bauer disk diffusion method and Epsilometer test. Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical analysis. Multivariable logistic regression models were developed to pinpoint risk factors for multidrug-resistant organism (MDRO) infections and predict occurrences.<br/><strong>Results:</strong> From 461 patients, 549 bacterial pathogens were isolated, predominantly consisting of <em>Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Enterobacter cloacae</em>, and <em>Enterococcus faecalis</em>. Vancomycin, linezolid, and tigecycline maintained their efficacy against <em>Staphylococcus aureus</em> and <em>Enterococcus species</em>, while <em>Pseudomonas aeruginosa</em> demonstrated sensitivity to aminoglycosides. Conversely, <em>Escherichia coli</em> exhibited high amoxicillin resistance (85.4%). More than half of the isolates were resistant to levofloxacin, ceftriaxone, cotrimoxazole, and gentamicin, with <em>Acinetobacter baumannii</em> strains showing considerable resistance (65.8– 68.4%) to advanced cephalosporins and carbapenems. Within this group, 58 MDROs were detected, primarily originating from Burn Plastic Surgery, Emergency, and Intensive Care Unit (ICU) departments. Multivariate logistic regression identified hyperglycemia, hypoalbuminemia, surgery, extended hospitalization, and exposure to multiple antibiotic classes as independent risk factors for MDRO wound infections. Based on these findings, a predictive model for MDRO occurrence in wounds was constructed, which had a sensitivity of 0.627, specificity of 0.933, and an Area Under the Curve (AUC) of 0.838.<br/><strong>Conclusion:</strong> <em>Staphylococcus aureus</em> and <em>Pseudomonas aeruginosa</em> dominated in wound infections with differential antibiotic resistance. Independent risk factors included hyperglycemia, hypoalbuminemia, surgery, extended hospitalization, and polyantibiotic use. We urge prioritizing culture, susceptibility tests, and personalized antibiotic strategies to address MDRO risks and improve wound infection management specificity and efficacy.<br/><br/><strong>Keywords:</strong> antibiotic resistance, wound infection, pathogenic bacteria, risk factor, prediction model<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Obesity on Echinocandin Effectiveness in Treating Candida Infections: A Retrospective Observational Cohort Study","authors":"Ahmad Aljohani, Saeed Alqahtani","doi":"10.2147/idr.s462301","DOIUrl":"https://doi.org/10.2147/idr.s462301","url":null,"abstract":"<strong>Introduction:</strong> Echinocandins are used to treat invasive candidiasis (IC), with FDA-approved doses indicated for both obese and non-obese patients. Pharmacokinetic (PK) studies have identified subtherapeutic exposure in obese patients receiving standard doses (SDs) of echinocandins. However, research on clinical outcome differences of echinocandins’ SDs between obese and non-obese patients is lacking. Therefore, this study aimed to evaluate the effectiveness of echinocandins’ SDs in obese compared to normal-weight patients with IC.<br/><strong>Patients and Methods:</strong> This retrospective cohort study was conducted at King Saud University Medical City (KSUMC) from Jan 2017 to Feb 2023. The study included adult patients diagnosed with <em>Candida</em> infections who received ≥ 4 doses of echinocandins. Patients with body mass index (BMI) less than 18 kg/m² were excluded from the study. The primary and secondary outcomes included the total length of stay (LOS), IC duration, frequency of clinical resolution and all-cause mortality.<br/><strong>Results:</strong> This study included 132 patients (47 obese; 85 non-obese) with a median age of 61 years. The median BMI and weight were different between the obese (34.5 kg/m², 88 kg) and non-obese (24 kg/m², 65 kg) groups (P= 0.01). Micafungin and caspofungin were used in 63.6% and 36.4% of patients, respectively. The total LOS and length of IC infections were similar between both groups, with median values of 29.5 days (P= 0.896) and 18 days (P = 0.160), respectively. The clinical improvement percentages were 68.1% for obese and 65.9% for non-obese patients (P= 0.797), with all-cause mortality rates at 44.7% and 42.4%, respectively (P= 0.796).<br/><strong>Conclusion:</strong> The study found no clinical outcome differences between obese and non-obese patients, with Similar effectiveness of the echinocandins’ SDs in both groups. Further research in multi-centre settings is recommended to detect any potential differences between the two groups.<br/><br/><strong>Keywords:</strong> echinocandins, <em>candida</em>, obesity, effectiveness<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Bacteria in Urine and Stones from Patients Treated with Percutaneous Nephrolithotomy and Association with Postoperative Infection","authors":"Min Lei, Zheng Jiang, Peng Xu, Zhenglin Chang, Yuyan Zhang, Shike Zhang, Lingyue An, Shujue Li, Tao Zeng, Hans-Göran Tiselius, Yuhao Zhou, Guohua Zeng, Wenqi Wu","doi":"10.2147/idr.s462257","DOIUrl":"https://doi.org/10.2147/idr.s462257","url":null,"abstract":"<strong>Background:</strong> The purpose of this study was to identify bacterial differences between urine cultures (UC) and stone cultures (SC) in patients with complex kidney stones and to determine any correlation with post-percutaneous nephrolithotomy Systemic Inflammatory Response Syndrome (SIRS).<br/><strong>Methods:</strong> Perioperative data of 1055 patients with complex kidney stones treated with first-stage Percutaneous Nephrolithotomy (PCNL) from September 2016 until September 2021 were included. Preoperative mid-stream urine samples and surgically obtained stone material were subjected to bacterial culture and antibiotic sensitivity tests. Preoperatively, antibiotic usage was determined by the UC or local bacterial resistance patterns. After PCNL treatment, antibiotic selection was guided by stone bacterial culture result and clinical symptoms. The effect of different preoperative antibiotic regimens based on urine cultures and postoperative antibiotic treatment based on stone cultures were assessed.<br/><strong>Results:</strong> Positive stone cultures (SC+) were significantly more common than positive urine cultures (UC+) (31.9% vs 20.9%, p &lt; 0.05). <em>Escherichia coli</em> (<em>E. coli</em>) was the most common uropathogen in both urine (54.3%) and stones (43.9%). The difference was statistically significant (p &lt; 0.05). Moreover, UC+SC-, UC-SC+, UC+SC+, and preoperative serum creatinine were independent risk factors of postoperative SIRS. The incidence of SIRS in the UC+SC+ patients with different bacteria in stones and urine (51.6%) was higher than that in other culture groups. The antibiotic resistance of <em>E. coli</em> inside the stone was increased when prolonged preoperative antibiotics were administered to UC+ patients.<br/><strong>Conclusion:</strong> The bacterial spectrum and positive outcome of culture in urine and stones were significantly different. The incidence of postoperative SIRS was highest in patients with UC+SC+ but with different bacteria strains. Prolonged pre-surgical antibiotic treatment apparently induced higher drug resistance for bacteria inside the stone.<br/><br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculous Ulcerative Skin Lesion of the Penis: A Case Report","authors":"Meilan Xu, Fuxiang Fang, Krishna Hamal, Shenhou Tang, Donghua Liu","doi":"10.2147/idr.s472573","DOIUrl":"https://doi.org/10.2147/idr.s472573","url":null,"abstract":"<strong>Abstract:</strong> Genitourinary tuberculosis (GUTB), especially penile tuberculosis (PTB), is a disease often overlooked by urological specialists, especially in Europe, where the pathology is less frequent. In this report, we described a case of penile tuberculosis (PTB) characterized by ulcers on the penis. After the patient was administered three months of anti-tuberculosis treatment (isoniazid 0.3 g/qd, rifampicin 0.6 g/qw, and ethambutol 0.75 g/qd), the ulcer disappeared. The patient was followed up for seven months and showed no recurrence.<br/><br/><strong>Keywords:</strong> Mycobacterium tuberculosis, penile ulcers, dermatopathology, a case report<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequacy of the Dosing and Infusion Time of Ceftazidime/Avibactam for the Treatment of Gram-Negative Bacterial Infections: A PK/PD Simulation Study","authors":"Yun Han, Jianping Zhu, Jieqiong Liu, Ying Zheng, Gang Liang, Yi Yang, Lingyan Yu, Zhenwei Yu, Gang Han","doi":"10.2147/idr.s469313","DOIUrl":"https://doi.org/10.2147/idr.s469313","url":null,"abstract":"<strong>Introduction:</strong> Recent studies suggested the potential benefits of extended infusion times to optimize the treatment efficacy of ceftazidime/avibactam, which indicated that the current pharmacokinetic/pharmacodynamic (PK/PD) target may not be sufficient, especially for severe infections. The purpose of this study is to assess the adequacy of dosing strategies and infusion durations of ceftazidime/avibactam when applying higher PK/PD targets.<br/><strong>Methods:</strong> This study utilized published PK parameters to conduct Monte Carlo simulations. Different dosages including the recommended regimen based on renal function were simulated and evaluated by the probability of target attainment (PTA) and cumulative fraction of response (CFR). Different PK/PD targets were set for ceftazidime and avibactam. MIC distributions from various sources were used to calculate the CFR.<br/><strong>Results:</strong> Multiple PK/PD targets have been set in this study, All recommended dosage could easily achieve the target of 50%<em>f</em>T ≥ MIC (ceftazidime) and 50%<em>f</em>T ≥ C_{T=1.0 mg/L} (avibactam). However, for severe infection patients with normal renal function and augmented renal clearance at the recommended dosage (2000 mg/500 mg, every 8 hours), the infusion duration needs to be extended to 3 hours and 4 hours to achieve the targets of 100%<em>f</em>T ≥ MIC and 100%<em>f</em>T ≥ C_{T=1.0 mg/L}. Only continuous infusion at higher dosages achieved 100%<em>f</em>T ≥ 4×MIC and 100%<em>f</em>T ≥ C_{T=4.0 mg/L} targets to all currently recommended regimens. According to the varying MIC distributions, higher concentrations are needed for <em>Pseudomonas aeruginosa</em>, with the attainment rates vary across different regions.<br/><strong>Conclusion:</strong> The current recommended dosing regimen of ceftazidime/avibactam is insufficient for severe infection patients, and continuous infusion is suggested.<br/><br/><strong>Keywords:</strong> ceftazidime, avibactam, pharmacokinetic/pharmacodynamic, probability of target attainment<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}