Infection and Drug Resistance最新文献

{"title":"Development and Validation of a Nosocomial Infection Nomogram Model in the NICU: A Novel and Nurse-Led Way to Prediction in Preterm Infants.","authors":"Yanyan Shang, Ling Chen, Xindie Hu, Keqian Zhang, Qian Cheng, Xiaoyu Shui, Zhiyue Deng","doi":"10.2147/IDR.S486290","DOIUrl":"10.2147/IDR.S486290","url":null,"abstract":"<p><strong>Purpose: </strong>Nosocomial infections (NI) are a leading cause of mortality in preterm infants in the Neonatal Intensive Care Unit (NICU). The key to reducing the risk of NI is early detection and treatment in time. Nurses are close observers and primary caregivers for neonates at the bedside of the NICU, who are best positioned to capture the risk signals of NI. This study aims to develop a nurse-led prediction model for NI of preterm infants in the NICU.</p><p><strong>Patients and methods: </strong>This study was designed as a retrospective study, preterm infants of the NICU at Renmin Hospital of Wuhan University from January 2020 to December 2023 were selected and divided into the NI group and non-NI group. Clinical data were collected and then analyzed by univariate analysis, least absolute shrinkage and selection operator (LASSO) regression analysis, and multivariate logistic regression analysis. The outcome constructed a nomogram model and its predictive efficacy was evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrap method was used to repeat 1,000 times for internal validation.</p><p><strong>Results: </strong>A total of 892 preterm infants were finally included and a nurse-led predictive model established, which included six variables: skin color changes, respiratory related changes, feeding deterioration, birth weight, number of arterial and venous blood draws, and days of nasogastric tube placement. The model's AUC was 0.953, indicating good discriminatory power. The calibration plot demonstrated good calibration and the Hosmer-Lemeshow test showed high consistency. DCA indicated that the nomogram had good clinical utility. Internal validation showed the AUC of 0.952.</p><p><strong>Conclusion: </strong>This nomogram model, which is mainly based on nurses' observations, shows good predictive ability. It offered a more convenient option for neonatologists and nurses in the NICU.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"589-599"},"PeriodicalIF":2.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079721","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":"New Option for Antibiotic Susceptibility Testing in Clinical Practice: Performance Evaluation of AutoMic-i600 Automatic System Based on Broth Microdilution Method.","authors":"Chenyao Lin, Hui Zhang, Qiaoping Wu, Xuedan Qiu, Qingcao Li, Guangliang Wu","doi":"10.2147/IDR.S499486","DOIUrl":"10.2147/IDR.S499486","url":null,"abstract":"<p><strong>Background: </strong>The emergence of multidrug-resistant bacteria limits antibiotic efficacy, making accurate antimicrobial susceptibility testing (AST) essential for clinical decisions. Broth microdilution (BMD) is the gold standard but is impractical for routine application. Current automated AST systems improve efficiency but face accuracy or operational challenges, highlighting the need for reliable and user-friendly solutions.</p><p><strong>Objective: </strong>This study aims to evaluate the performance of a novel automated AST system (AutoMic-i600) based on the BMD method for AST of common clinical bacteria.</p><p><strong>Methods: </strong>A total of 229 clinical isolates (150 Gram-negative and 79 Gram-positive) were prospectively collected from microbiology laboratory between June 2023 and August 2023. We reported the comparison of the AutoMic-i600 and Vitek 2 systems for routine antibiotics, and also validated the detection performance of AutoMic-i600 for novel antibiotics, based on the BMD method.</p><p><strong>Results: </strong>The overall essential agreement (EA) and categorical agreement (CA) between AutoMic-i600 and BMD were 93.2% and 93.5% for Gram-negative bacteria and 98.5% and 97.8% for Gram-positive bacteria, respectively. The overall EA and CA between Vitek 2 and BMD were 92.6% and 93.5% for Gram-negative bacteria and 97.9% and 97.4% for Gram-positive bacteria. Importantly, for drug-resistant bacteria, AutoMic-i600 demonstrated a higher overall agreement than Vitek 2 (EA: 98.1% vs 94.8%, CA: 97.5% vs 92.0%), especially in Gram-negative bacteria (EA: 97.7% vs 93.5%, CA: 97.7% vs 89.3%). The VME rate for Gram-negative bacteria using AutoMic-i600 was significantly lower than that of Vitek 2 (1.0% vs 2.9%). Novel antibiotics detected by AutoMic-i600 exhibited EA and CA rates exceeding 90.0%.</p><p><strong>Conclusion: </strong>Based on these findings, we recommend that the AutoMic-i600 system could be a new option for routine AST testing in a clinical setting. Particularly for drug-resistant bacteria and novel antibiotics, detection with AutoMic-i600 may be more reliable, which could further contribute to the prevention and treatment of drug-resistant bacteria.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"543-556"},"PeriodicalIF":2.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122869","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":"The Utility of Synovial Fluid Interleukin-10 in Diagnosing Chronic Periprosthetic Joint Infection: A Prospective Cohort Study.","authors":"Yinshuang Zou, Yaji Yang, Jianye Yang, Yanhao Zhang, Chen Zhao, Leilei Qin, Ning Hu","doi":"10.2147/IDR.S490962","DOIUrl":"10.2147/IDR.S490962","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing chronic periprosthetic joint infection (PJI) is challenging. Synovial fluid interleukin-10 (SF IL-10), an anti-inflammatory cytokine produced by leukocytes, plays a pivotal role in inflammation and infection regulation. However, limited research has explored the diagnostic potential of SF IL-10 in chronic PJI patients.</p><p><strong>Objective: </strong>The study aimed to investigate the relationship between SF IL-10 and incidence of chronic PIJ, and to evaluate its diagnostic reliability.</p><p><strong>Design and methods: </strong>We analyzed data from 137 patients who underwent revision surgery for aseptic loosening or chronic PJI between 2017 and 2019 in our hospital. PJI diagnoses followed the 2013 International Consensus Meeting criteria. We measured serum ESR, serum CRP, SF PMN%, SF WBC and SF IL-10 levels, using logistic regression and receiver operating characteristic (ROC) curves to evaluate associations and diagnostic accuracy.</p><p><strong>Results: </strong>Demographic data showed no significant differences. However, SF IL-10 levels differed significantly between groups. Logistic regression indicated a strong association between SF IL-10 and chronic PJI (OR = 1.11, 95% CI 1.05~1.17, p < 0.001). At a cut-off of 10.305 pg/mL, SF IL-10 had an area under the ROC curve (AUC) of 0.891, with 92.16% sensitivity and 77.91% specificity. Adding SF IL-10 to traditional models improved risk prediction for chronic PJI (net reclassification improvement [NRI]: 0.167 [0.023 ~ 0.312]; integrated discrimination improvement [IDI]: 0.160 [0.096 ~ 0.224]).</p><p><strong>Conclusion: </strong>Higher SF IL-10 levels were significantly associated with chronic PJI in revision surgery patients, and incorporating SF IL-10 into the traditional risk model enhanced its predictive value for chronic PJI in these patients.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"533-542"},"PeriodicalIF":2.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079723","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":"Application of Targeted Next-Generation Sequencing in Bronchoalveolar Lavage Fluid for the Detection of Pathogens in Pulmonary Infections.","authors":"Xianning Dai, Kai Xu, Yu Tong, Jing Li, Liya Dai, Jianyou Shi, Haibin Xie, Xi Chen","doi":"10.2147/IDR.S499265","DOIUrl":"10.2147/IDR.S499265","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the utility of targeted next-generation sequencing (tNGS) in bronchoalveolar lavage fluid (BALF) for hospitalized patients with pulmonary infections.</p><p><strong>Methods: </strong>A cohort of 358 patients who received diagnosis and treatment for respiratory infections in the department of Respiratory Medicine at Wenzhou People's hospital from January 2023 to April 2024 were selected for this study. The BALF of the patients was analyzed using tNGS, and the diagnostic efficacy of tNGS was subsequently compared with that of conventional testing methods (CTs) for pathogen detection.</p><p><strong>Results: </strong>Through the analysis of tNGS from the cohort, the pathogen detection rate in BALF using tNGS was significantly higher than that of CTs (90.22% VS 57.26%, <i>P</i>=0.001). Among them, <i>Tropheryma Whipplei</i> (6.15%), <i>Bordetella pertussis</i> (2.51%), <i>Non-tuberculous mycobacteria</i> (1.96%), <i>Mycobacteria tuberculosis</i> (1.40%), <i>Chlamydia pneumoniae</i> (1.96%), <i>Chlamydia psittaci</i> (0.56%), <i>Legionella pneumophila</i> (0.28%) were detected using tNGS alone, and the CTs results of these microorganisms were all negative. Among the various types of mixed infections observed, concurrent presence of bacteria and viruses was the most common, accounting for 37.15%. The detection rates of tNGS and CTs have statistical significance (66.87% VS 35.12%, <i>P</i>=0.001). Furthermore, a total of 61 cases of antimicrobial resistance genes were detected, including 34 cases of 23S rRNA A2063G, 6 cases of KPC, 5 cases of OXA, 2 cases of CTX-M, 3 cases of IMP, 1 case of NDM and 13 cases of mecA. Using the clinical diagnosis as references, the positive coincidence rate of the tNGS was significantly higher compared to that of the CTs (<i>P</i>=0.012).</p><p><strong>Conclusion: </strong>Compared to CTs, the application of tNGS enables the identification of a greater diversity of organisms and exhibits superior accuracy, effectively identifying pathogens that are undetectable by CTs, especially fastidious and atypical organisms. Consequently, it holds immense potential in pathogen diagnosis and offers valuable clinical guidance for patients with pulmonary infections.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"511-522"},"PeriodicalIF":2.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079650","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":"Appendiceal Perforation and Abdominal Wall Infection Caused by Invasive Mucormycosis in a Child with Acute Leukemia.","authors":"Chuanxin Li, Yonghan Luo, Yanchun Wang, Qiang Bai","doi":"10.2147/IDR.S504206","DOIUrl":"10.2147/IDR.S504206","url":null,"abstract":"<p><p>Gastrointestinal mucormycosis is one of the most difficult forms of the disease to diagnose due to its lack of specific clinical features. It is extremely rare to observe gastrointestinal mucormycosis in pediatric acute leukemia patients undergoing chemotherapy. In this report, we describe a case of a child with acute leukemia who developed invasive mucormycosis, leading to appendiceal perforation and abdominal wall infection. Initially, surgical intervention was delayed due to concerns over exacerbating bone marrow suppression, which ultimately resulted in the progression of the intra-abdominal infection. However, after thorough debridement of the abdominal wall infection and treatment with liposomal amphotericin B, the patient gradually recovered. This case highlights the importance of early and complete debridement of abdominal wall infections and intra-abdominal abscesses to prevent the further spread of mucormycosis, shorten the course of the disease, and improve outcomes.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"495-498"},"PeriodicalIF":2.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079649","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":"Azithromycin in the Management of Upper Respiratory Tract Infections (URTIs): Indian Real-Life Experience.","authors":"Mathew Dominic, Rakesh Srivastava, Kshitij Shah, Sudhir M Naik, Khageswar Rout, Bidhan Ray, Dinesh Patil, Darshan Rana, Onkar C Swami","doi":"10.2147/IDR.S488479","DOIUrl":"10.2147/IDR.S488479","url":null,"abstract":"<p><strong>Objective: </strong>Upper Respiratory Tract Infections (URTIs) pose a significant public health challenge worldwide. Azithromycin has been approved for its management due to broad-spectrum antibacterial properties and favorable pharmacokinetics. This study aims to evaluate the effectiveness and safety of Azithromycin in treatment of URTIs in a real-world setting.</p><p><strong>Methods: </strong>This multicenter, retrospective, observational study was conducted across 184 Ear, Nose, and Throat (ENT) clinics in India. Medical records of adults (≥18 years) who received Azithromycin 500 mg for 5 days to treat URTIs and provided consent were retrieved. Sore throat, fever, and interference with daily activities were assessed alongside clinical signs (pharyngeal erythema, tonsillar erythema, and exudates/plugs on tonsils). Clinical global impression of change was evaluated using a 7-point rating scale. Statistical analyses included paired <i>t</i>-tests for mean score changes and the McNemar-Bowker test to evaluate symptom improvement from baseline to day 5.</p><p><strong>Results: </strong>Data from 884 patients were analyzed. With 5 days of Azithromycin therapy, significant reduction in proportion of patients reporting URTI symptoms and signs was noted. Proportion of patients reporting sore throat was reduced from 95.8% to 10.4%; work absenteeism dropped from 47.9% to 1%; and fever subsided in 97.4% of patients. Clinical signs also improved notably, with moderate-to-severe pharyngeal erythema (90.9% of patients at baseline to 13.6% at day 5), tonsillar erythema (84% of patients at baseline to 9.6%), and tonsillar exudates (58.3% patients at baseline to 4.4%). Also, 97.2% of patients showed considerable improvement in their Clinical Global Impression score with Azithromycin. Adverse events were reported by 2.37% of patients.</p><p><strong>Conclusion: </strong>Azithromycin demonstrates a significant improvement in clinical manifestations of URTIs, with a low incidence of adverse events.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"523-531"},"PeriodicalIF":2.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079720","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":"Molecular and Transmission Characteristics of <i>Mycobacterium Tuberculosis</i> Strains Among College Students in Beijing, China.","authors":"Xiaolong Cao, Xinyue Li, Zexuan Song, Ping He, Ruiqing Zhang, Chong Teng, Qian Sun, Xue Wang, Bing Zhao, Zhiguo Zhang, Yanlin Zhao","doi":"10.2147/IDR.S503797","DOIUrl":"10.2147/IDR.S503797","url":null,"abstract":"<p><strong>Background: </strong>College students are a crucial link in curbing the epidemic. The aim of this study is to analyze the genetic diversity and drug resistance of <i>Mycobacterium tuberculosis</i> strains in college students with tuberculosis in Beijing, revealing the lineage structure and transmission patterns specific to this group.</p><p><strong>Methods: </strong>This study used the hospital's electronic management system to screen for tuberculosis among college students in Changping District, Beijing, from January 2004 to December 2023. Socio-demographic and clinical data were collected, and whole-genome sequencing was performed on culture-positive isolates. Isolates with a genetic distance of less than 12 SNPs were grouped into the same genomic cluster. The TB Profiler software predicted drug resistance mutations, and categorical data were analyzed using Chi-square or Fisher's exact tests.</p><p><strong>Results: </strong>Among the 1436 college students with tuberculosis, a total of 153 isolates successfully underwent whole-genome sequencing. The results showed that about one-third (49/153) of the isolates carried one or more drug resistance genes, with more than half (26/49) associated with first-line anti-tuberculosis drugs. However, encouragingly, the incidence of drug-resistant tuberculosis showed a significant downward trend, with statistical significance (<i>p</i><0.05). Lineage 2 (86.3%, 132/153) was the predominant genotype, with the Beijing genotype (90.1%, 120/153) being the most common, while the isolation of Lineage 3 in a student from Xinjiang. Sixteen college student isolates clustered, and all of which were Beijing genotype. Transmission within the same campus showed characteristics of short clustering time.</p><p><strong>Conclusion: </strong>The drug resistance rate among college students is relatively high, however it shows a declining trend. School tuberculosis infections could stem not only from within-campus transmission but also necessitate consideration of spatial and cross-regional spread possibilities.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"499-509"},"PeriodicalIF":2.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079722","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":"Advances in the Diagnosis of Latent Tuberculosis Infection.","authors":"Haiying Zhang, Weiwei Guan, Jikun Zhou","doi":"10.2147/IDR.S504632","DOIUrl":"10.2147/IDR.S504632","url":null,"abstract":"<p><p>Latent tuberculosis infection (LTBI) is a critical stage of tuberculosis infection in which Mycobacterium tuberculosis (MTB) is dormant and does not cause active disease. Traditionally, the most commonly used clinical methods for diagnosing LTBI have been the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA). Recently, however, novel skin tests, molecular biology techniques, and cytokine biomarkers have been developed. This review summarizes the latest research on the diagnosis of LTBI, highlighting new tools and methods to improve detection and differentiation from active tuberculosis(ATB).</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"483-493"},"PeriodicalIF":2.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065440","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":"Epidemiology, Clinical Characteristics and Treatment Outcomes of <i>Acinetobacter baumannii</i> Infection at a Regional Hospital in Thailand.","authors":"Parichart Sakulkonkij, Jackrapong Bruminhent","doi":"10.2147/IDR.S494712","DOIUrl":"https://doi.org/10.2147/IDR.S494712","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective cohort study evaluated the treatment outcome of <i>Acinetobacter baumannii</i> infection.</p><p><strong>Methods: </strong>In this retrospective cohort study, 476 patients with <i>Acinetobacter baumannii</i> (<i>A. baumannii</i>) infection who were admitted to the internal medicine ward at Lampang Hospital, Lampang, Thailand, from 1 January 2020 to 31 December 2020 were enrolled. Medical records were reviewed.</p><p><strong>Results: </strong>A total of 476 patients with <i>A. baumannii</i> infection were enrolled. Of these, 204 (43%) survived, while 272 (57%) died. Extensively drug-resistant (XDR) <i>A. baumannii</i> with hospital-acquired pneumonia was the most common presentation. Risk factors for acquiring multidrug-resistant (MDR) pathogens included previous hospitalization or antibiotic use and the presence of an indwelling urinary catheter, which was common in both survived and deceased groups. The survival group was significantly more likely to have received appropriate antibiotic therapy compared to the deceased group (71% vs 51%; <i>p</i><0.001), particularly with colistin monotherapy (34% vs 18%; <i>p</i><0.001). Additionally, multivariate analysis showed that predictors of unfavorable outcomes, such as multiorgan failure, hypoalbuminemia, hematologic malignancy, and healthcare-associated pneumonia. The survival group had a significantly longer hospital stay compared to the deceased group (15 days vs 7 days; <i>p</i><0.001) and also showed an increased microbiological cure rate (49% vs 26%; <i>p</i><0.001).</p><p><strong>Conclusion: </strong>XDR <i>A. baumannii</i> leads to serious nosocomial infections. Understanding the risk factors for XDR <i>A. baumannii</i> infections could enhance colistin prescription prior to the antimicrobial susceptibility testing results.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"473-482"},"PeriodicalIF":2.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065443","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":"Five-Year Prospective Follow-Up of Patients with Hepatitis C Virus Infection Treated with Direct-Acting Antiviral Agents.","authors":"Yaping Zhang, Huan Xia, Luchang Fan, Lu Jiang, Bin Yang, Fengmei Wang","doi":"10.2147/IDR.S487414","DOIUrl":"10.2147/IDR.S487414","url":null,"abstract":"<p><strong>Purpose: </strong>The research intended to present prospective data on the long-term prognosis of individuals with hepatitis C virus (HCV) infection who received direct-acting antiviral agent (DAA) treatment.</p><p><strong>Patients and methods: </strong>Patients who received DAA treatment at Tianjin Third Central Hospital and Tianjin Second People's Hospital were prospectively enrolled and subsequently underwent a longitudinal follow-up. This research monitored occurrences of virological relapse, hepatocellular carcinoma (HCC), mortality, and liver disease progression. The annualized incidence rates (AIRs), cumulative incidence rates of adverse events and risk factors were investigated. Changes in liver stiffness measurement (LSM), aspartate aminotransferase-to-platelet ratio index (APRI) score, fibrosis-4 (FIB-4) index, as well as the albumin-bilirubin (ALBI) scores were also documented.</p><p><strong>Results: </strong>A total of 862 individuals were followed up for 4.86 (P₂₅, P₇₅; 4.48, 5.48) years. The proportion of all participants with undetectable HCV-RNA exceeded 98% at all follow-up time points. Patients experienced virological relapse, HCC, death and disease progression with a cumulative AIRs of 1.03% (95% confidence interval [CI] 0.6-1.5), 1.76% (95% CI 1.2-2.3), 1.51% (95% CI 1.0-2.0), and 5.81% (95% CI 4.8-6.8), respectively. Cirrhotic patients were at a heightened risk of virological relapse (adjusted hazard ratio [aHR] 3.20, 95% CI 1.59-9.75; p = 0.016), HCC (aHR 6.57, 95% CI 2.66-16.28; p < 0.0001), and unfavorable prognosis (aHR 6.93, 95% CI 2.56-18.74; p < 0.0001). Additionally, patients with diabetes faced an elevated risk of HCC (aHR 2.33, 95% CI 1.05-5.15; p = 0.038) and poor prognosis (aHR 2.72, 95% CI 1.13-6.55; p = 0.026). Furthermore, liver stiffness measurement (LSM) exhibited a significant decrease compared to baseline. Additionally, patients in the cirrhosis group showed reductions in APRI score, FIB-4 index and ALBI score to different degrees.</p><p><strong>Conclusion: </strong>Cirrhotic patients exhibited increased susceptibility to virological relapse, HCC, unfavorable prognosis, and liver disease progression following DAA treatment. Consequently, it is imperative to implement a rigorous monitoring protocol for all cirrhotic patients after DAA treatment.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"455-471"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059034","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}