Infection and Drug Resistance最新文献

{"title":"Effectiveness of Susceptibility-Guided Therapy for <i>Helicobacter pylori</i> Infection: A Retrospective Analysis by Propensity Score Matching.","authors":"Wenyue Zhou, Haoxuan Cheng, Miaomiao Li, Ruian Zhang, Zhiren Li, Guangyong Sun, Dong Zhang, Xinjuan Liu, Yanxiang Pei","doi":"10.2147/IDR.S498052","DOIUrl":"https://doi.org/10.2147/IDR.S498052","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates and compares the eradication rates of Helicobacter pylori (H. pylori) achieved through susceptibility-guided therapy (SGT) based on resistance genotyping and empirical therapy (ET).</p><p><strong>Patients and methods: </strong>A retrospective study was conducted at Beijing Chaoyang Hospital (2021-2023) on patients with H. pylori infection receiving initial eradication therapy. Resistance genotypes for clarithromycin and levofloxacin were identified using fluorescent PCR of gastric biopsy samples. Patients underwent a 14-day bismuth-containing quadruple therapy (BQT) and were evaluated via the C13 urea breath test (UBT). Based on genotyping or clinical judgment, 550 patients were assigned to SGT (n = 125) or ET (n = 425). The SGT group received personalized treatment based on genotype testing results, avoiding the use of antibiotics to which the bacteria were resistant. The ET group received the standard bismuth-containing quadruple therapy (BQT). Additionally, 29 ET patients underwent follow-up genotypic testing and eradication rates were analyzed retrospectively.</p><p><strong>Results: </strong>SGT achieved higher eradication rates than ET (ITT: 94.4% vs 86.1%, P = 0.012; PP: 95.2% vs 87.6%, P = 0.016). In levofloxacin-resistant strains, SGT showed significantly higher eradication rates in the PP analysis (95.7% vs 50.0%, P = 0.049).</p><p><strong>Conclusion: </strong>SGT exhibited remarkably superior eradication rates, notably in levofloxacin-resistant strains, proposing a compelling alternative for the treatment of H. pylori, particularly in instances of antimicrobial resistance.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1149-1159"},"PeriodicalIF":2.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541890","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":"Type II Toxin-Antitoxin Systems in <i>Escherichia coli</i>.","authors":"He Zhang, Shuan Tao, Huimin Chen, Yewei Fang, Yao Xu, A-Xiang Han, Fang Ma, Wei Liang","doi":"10.2147/IDR.S501485","DOIUrl":"https://doi.org/10.2147/IDR.S501485","url":null,"abstract":"<p><p>The toxin-antitoxin (TA) system is widespread in prokaryotes and archaea, comprising toxins and antitoxins that counterbalance each other. Based on the nature and mode of action of antitoxins, they are classified into eight groups (type I to VIII). Both the toxins and the antitoxins are proteins in type II TA systems, and the antitoxin gene is usually upstream of the toxin gene. Both genes are organized in an operon and expression of which is regulated at the transcriptional level by the antitoxin-toxin complex, which binds the operon DNA through the DNA-binding domain of the antitoxin. The TA system plays a crucial role in various cellular processes, such as programmed cell death, cell growth, persistence, and virulence. Currently, Type II TA systems have been used as a target for developing new antibacterial agents for treatment. Therefore, the focus of this review is to understand the unique response of Type II TA in <i>Escherichia coli</i> to stress and its contribution to the maintenance of resistant strains. Here, we review the Type II TA system in <i>E. coli</i> and describe their regulatory mechanisms and biological functions. Understanding how TA promotes phenotypic heterogeneity and pathogenesis mechanisms may help to develop new treatments for infections caused by pathogens rationally.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1083-1096"},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541953","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":"Distribution and Antibiotic Resistance Analysis of 13,048 Clinically Common Isolates.","authors":"Jing Zhao, Peng Yue, Zhi-Jie Li, Ting Xu, Guo-Zheng Xing, Yan Shao, Hong-Yuan Yu","doi":"10.2147/IDR.S510193","DOIUrl":"https://doi.org/10.2147/IDR.S510193","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the distribution and antibiotic resistance profiles of common bacteria isolated from clinical specimens at a hospital's microbiology laboratory between 2020 and 2022.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on microbial culture results from clinical specimens collected over three years, including sample types, departmental distribution, pathogen species, and resistance profiles.</p><p><strong>Results: </strong>A total of 13,048 unique pathogenic strains were isolated, predominantly from respiratory and urine specimens. Secretion specimens exhibited the highest positive detection rate (73.6%), while blood specimens showed a lower rate (9.7%). The five most frequently isolated pathogens were: <i>Klebsiella pneumoniae</i> (<i>K. pneumoniae</i>) (19.6%), <i>Pseudomonas aeruginosa</i> (<i>P. aeruginosa</i>) (14.7%), <i>Escherichia coli</i> (<i>E. coli</i>) (9.2%), <i>Acinetobacter baumannii</i> (<i>A. baumannii</i>) (8.0%), and <i>Candida albicans</i> (<i>C. albicans</i>) (7.0%). Gram-negative bacteria constituted 53.7% of all isolates (7009/13,048). A total of 7590 multidrug-resistant organisms (MDRO) were identified, corresponding to a detection rate of 21.3% (7590/35,613). The detection rates of carbapenem-resistant Enterobacteriaceae (CRE) increased annually: 7.2% (2020), 8.6% (2021), and 14.4% (2022).</p><p><strong>Conclusion: </strong>The annual detection rate of CRE increased during the study period, while the rate of <i>methicillin-resistant Staphylococcus aureus</i> (MRSA) declined. Timely and effective interventions targeting pathogenic bacteria are essential for controlling and mitigating nosocomial infection risks.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1071-1081"},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541936","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":"Follow-up of Surgical and Nonsurgical Patients With Pulmonary Aspergillosis: A Real-World Study.","authors":"Zhifeng Chen, Yulin Shang, Binaya Wasti, Yanru Ou, Subo Gong, Xudong Xiang, Ruoyun Ouyang","doi":"10.2147/IDR.S496765","DOIUrl":"10.2147/IDR.S496765","url":null,"abstract":"<p><strong>Objective: </strong>In the real clinical world, both surgery and medication are used to treat pulmonary aspergillosis (PA), but the prognosis of different treatments is unclear. The purpose of this study was to investigate the diagnosis and treatment, follow-up results and prognostic factors of PA patients in the real world, so as to deepen our understanding of PA and improve the prognosis of PA patients.</p><p><strong>Materials and methods: </strong>Eligible patients with pathologically diagnosed PA (n = 125) were retrospectively enrolled and followed up. Further comparisons and subgroup analyses were performed between patients receiving surgical and nonsurgical treatments. Univariate and multivariate logistic regression analyses were used to investigate the factors associated with treatment failure.</p><p><strong>Results: </strong>A total of 125 patients with PA were included in the study. Of these, 49 (39.2%) received surgical treatment (25 of whom also received postoperative antifungal therapy), while 76 (60.8%) received antifungal therapy alone. The median age was 59 years (46.5-67 years). Compared with the nonsurgical group, the surgical group had lower inflammatory cell counts and less inflammatory response, and higher hemoglobin and albumin levels. Multivariate logistic regression analysis showed that white blood cell (WBC) levels >9.5×10⁹/L and C-reactive protein (CRP) levels >8 mg/L were independent predictors linked to treatment failure.</p><p><strong>Conclusion: </strong>PA patients with severe inflammation and poor general health are usually treated with antifungal drugs only. Risk factors including elevated WBC levels and high CRP levels can help identify PA patients who may have a less favorable response to treatment at an early stage. It should be noted that increasing the dose and duration of antifungal therapy may improve patient prognosis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1059-1070"},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500842","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":"Genomic Characterization and Antimicrobial Resistance of ESBL-Producing, <i>Escherichia coli</i> Isolates in Suzhou, China.","authors":"Cailin Wang, Hong Zhang, Rongfen Zhao, Clement Kin-Ming Tsui, Shuwen Deng","doi":"10.2147/IDR.S488794","DOIUrl":"10.2147/IDR.S488794","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of third-generation cephalosporin-resistant and extended-spectrum beta-lactamases (ESBL) producing <i>Escherichia coli</i> poses a significant global public health concern due to their resistance to multiple antibiotics; however, their prevalence and epidemiological patterns in China are not very well investigated.</p><p><strong>Objective: </strong>This study aimed to investigate the molecular epidemiology, and antimicrobial susceptibility of ESBL-producing <i>E. coli</i> among clinical isolates in China.</p><p><strong>Methods: </strong>Phenotypic ESBL-producing <i>E. coli</i> isolates were collected from in-patients at a non-tertiary hospital in Suzhou from 2018.06.01 -2019.11.30. All isolates were identified and analyzed by conventional microbiological methods, and antimicrobial susceptibility testing was determined. Genes associated with resistance to <i>β</i>-lactamases, fluoroquinolone, aminoglycosides, sulfonamides, sequence types (STs), and genetic relationship were characterized through whole-genome sequencing (WGS) data.</p><p><strong>Results: </strong>Eighty-six isolates were collected and sequenced, and genomic analysis identified twenty-five different sequence types (STs). The most prevalent STs were ST131 (n=22, 25.6%), ST1193 (n=16, 18.6%), ST38 (n=9, 10.5%) and ST167 (n=6, 7.0%). <i>bla</i>CTX-M genotypes were the most dominant, comprising a variety of subtypes (eg, <i>bla</i>CTX-M-14, <i>bla</i>CTX-M-15, <i>bla</i>CTX-M-27, <i>bla</i>CTX-M-55) and <i>bla</i>TEM-type among ESBL-producing <i>E. coli</i> in our study. All cases of co-carriage of <i>β</i>-lactamase genes showed a strong link to amoxicillin/sulbactam resistance, while the co-carriage of <i>bla</i>CTX-M-15/TEM-1B or <i>bla</i>CTX-M-15/OXA-1 were strongly linked to resistance against cefepime, ceftazidime, and aztreonam. In addition, genes associated with resistance to fluoroquinolone, aminoglycosides, and sulfonamides were also detected.</p><p><strong>Conclusion: </strong>Our findings highlighted the prevalence of globally circulating ESBL-producing <i>E. coli</i> clones, such as ST131 and ST1193, in Suzhou, China. These clones and sublineages are also resistant to quinolones. No predominant <i>bla</i>CTX-M subtypes were detected, while the coexistence of different ESBL types was strongly linked to resistance to amoxicillin/sulbactam, cefepime, ceftazidime, and aztreonam, suggesting the widespread circulation of diverse <i>bla</i>CTX-M genes within the Suzhou community. In clinical cases of ESBL resistance, carbapenem therapy is recommended as most (>90%) isolates were susceptible.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1049-1057"},"PeriodicalIF":2.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491914","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":"Staphylococcal Drug Resistance: Mechanisms, Therapies, and Nanoparticle Interventions.","authors":"Kunyu Shao, Yuxun Yang, Xuankai Gong, Ke Chen, Zixiang Liao, Suvash Chandra Ojha","doi":"10.2147/IDR.S510024","DOIUrl":"10.2147/IDR.S510024","url":null,"abstract":"<p><p>The increasing incidence of antibiotic resistance in <i>Staphylococcus aureus</i> (<i>S. aureus</i>) poses a substantial threat to global public health. In recent decades, the evolution of bacteria and the misuse of antibiotics have led to a progressive development in drug resistance of <i>S. aureus</i>, resulting in a worldwide rise in methicillin-resistant <i>S. aureus</i> (MRSA) infection rates. Understanding the molecular mechanisms underlying staphylococcal drug resistance, the treatments for staphylococcal infections, and the efficacy of nanomaterials in addressing multi-drug resistance is crucial. This review explores the resistance mechanisms, which include limiting drug uptake, target modification, drug inactivation through the production of degrading enzymes, and active efflux of drugs. It also examines the current therapeutic strategies, such as antibiotic combination therapy, phage therapy, monoclonal antibody therapy, and nanoparticle therapy, with a particular emphasis on the role of silver-based nanomaterials. Nanoparticles possess the ability to overcome multi-drug resistance, offering a novel avenue for the management of drug-resistant bacteria. The nanomaterials have demonstrated potent antibacterial activity against <i>S. aureus</i> through various mechanisms, including cell membrane disruption, generation of reactive oxygen species (ROS), and inhibition of essential cellular processes. It also highlights the need for further research to optimize nanoparticle design, enhance their antibacterial potency, and ensure their biocompatibility and biodegradability. The review ultimately concludes by emphasizing the importance of a multifaceted approach to treatment, including the development of new antibiotics, investment in stewardship programs to prevent antibiotic misuse, and the exploration of natural compounds and bacteriocins as potential antimicrobial agents.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1007-1033"},"PeriodicalIF":2.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483032","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":"Emerging Mobile Colistin Resistance Gene <i>Mcr-1</i> and <i>Mcr-10</i> in <i>Enterobacteriaceae</i> Isolates From Urban Sewage in China.","authors":"Yujing Zhang, Jiajie Chen, Xinyu Yang, Yangshiyu Wu, Zhenyu Wang, Yawen Xu, Le Zhou, Jing Wang, Xinan Jiao, Lin Sun","doi":"10.2147/IDR.S502067","DOIUrl":"10.2147/IDR.S502067","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the epidemiology and dissemination of <i>mcr</i>-positive <i>Enterobacteriaceae</i> in urban sewage in Yangzhou, China.</p><p><strong>Methods: </strong>A total of 366 sewage samples were collected from the Yangzhou Wastewater Treatment Plant in Jiangsu Province. Colistin-resistant <i>Enterobacteriaceae</i> was identified through PCR targeting <i>mcr-1</i> to <i>mcr-10</i> genes. The isolates underwent antimicrobial susceptibility testing, and whole-genome sequencing was performed to analyze their genomic features. Additionally, conjugation experiments were conducted to assess the transferability of <i>mcr</i>-positive plasmids.</p><p><strong>Results: </strong>Three <i>mcr</i>-positive <i>Enterobacteriaceae</i> isolates were identified, representing an isolation rate of 0.82%. These included one <i>mcr-1</i>-positive <i>Escherichia coli</i> (ST167) and two <i>mcr-10</i>-positive <i>Klebsiella pneumoniae</i> complex strains with novel sequence types ST6801 and ST6825. The <i>mcr-1</i> gene was located on an IncI2 plasmid (pYZ22WS208_3) and successfully transferred to recipient strains. In contrast, the <i>mcr-10</i> gene was carried on IncF plasmids (pYZ22WS067_1 and pYZ22WS223_1) but was not transferable in this study. Phylogenetic analysis revealed that the <i>mcr-1</i>-positive <i>E. coli</i> strain clustered within Clade II, alongside strains from various countries and sources. Phylogenomic analysis of <i>mcr-10</i>-positive isolates showed their sporadic distribution across 13 countries, with associations to diverse hosts and environments, indicating potential for widespread transmission.</p><p><strong>Conclusion: </strong>This study demonstrates the presence of <i>mcr-1</i> and <i>mcr-10</i>-positive <i>Enterobacteriaceae</i> in wastewater, emphasizing the importance of wastewater surveillance for tracking antibiotic resistance. The horizontal transfer of <i>mcr-1</i> and potential spread of <i>mcr-10</i> across various hosts underscore the need for ongoing monitoring and preventive measures.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"1035-1048"},"PeriodicalIF":2.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482992","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":"Dynamic Serotype Distribution and Antimicrobial Resistance of <i>Salmonella</i> Isolates from 2019 to 2023 in Guizhou, China.","authors":"Jingtong Wu, Lv You, Yanmin Liu, Li Long, Ming Wang, Xiaoyu Wei, Junhua Wang, Shijun Li","doi":"10.2147/IDR.S492042","DOIUrl":"10.2147/IDR.S492042","url":null,"abstract":"<p><strong>Introduction: </strong><i>Salmonella</i>, a leading cause of human infectious diarrhea diseases, foodborne illness, and zoonotic infections, poses a significant health burden.</p><p><strong>Methods: </strong>A retrospective screening was performed to elucidate the serotype distribution and antimicrobial resistance of 933 human <i>Salmonella</i> isolates from nine cities (prefectures) in Guizhou province of southwestern China between 2019 and 2023 through slide agglutination and antimicrobial resistance testing.</p><p><strong>Results: </strong>Fifty-four different serotypes were identified in this study, with <i>S</i>. Typhimurium (44.4%) and <i>S</i>. Enteritidis (20.7%) being the predominant serotypes, followed by <i>S</i>. London (3.1%), <i>S</i>. Derby (2.8%), and <i>S</i>. Rissen (2.0%). A total of 39 serotypes were reported for the first time in Guizhou province, and 121 isolates (13.0%) could not be classified. The diversity of <i>Salmonella</i> serotypes in Guizhou has increased from 8 in 2019 to 39 in 2023. In addition, the detection rate of <i>S</i>. Enteritidis showed a decreasing trend over time, while the detection rate of <i>S</i>. Typhimurium demonstrated an annual increase since 2020. For 933 isolates, a significant majority (94.0%) exhibited resistance to at least one class of antimicrobial agents. The highest resistance observed was to ampicillin (86.4%), followed by resistance to tetracycline (76.3%) and streptomycin (72.8%). Notably, we discovered that the resistance rate to colistin was 4.7%, with 93.2% of these isolates being <i>S</i>. Enteritidis. Meanwhile, 78.5% of isolates were demonstrated multidrug resistance (MDR), with the MDR rates for <i>S</i>. Rissen and <i>S</i>. Typhimurium exceeding 90%. Additionally, 5.7% of <i>Salmonella</i> isolates were extensively drug-resistant (XDR), with <i>S</i>. Typhimurium and <i>S</i>. Enteritidis exhibiting XDR rates of 5.1% and 4.1%, respectively. The rate of MDR and XDR in <i>Salmonella</i> peaked in 2019 and then gradually declined from 2020 to 2022, rising again in 2023.</p><p><strong>Conclusion: </strong>Our research revealed an increasing diversity in <i>Salmonella</i> serotypes within Guizhou province, alongside significant challenges posed by MDR and a rising XDR rate. Therefore, it is essential to continuously improve the surveillance of <i>Salmonella</i>, keep track of changes in serotype distribution and dynamic shifts, and strengthen the persistent monitoring of antimicrobial agents.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"993-1006"},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482981","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-Based Evaluation of Ceftazidime-Avibactam Dosing Regimens in Critically and Non-Critically Ill Patients With Carbapenem-Resistant <i>Klebsiella pneumoniae</i>.","authors":"Yiying Chen, Bo Chen, Yingbin Huang, Xueyong Li, Junnan Wu, Rongqi Lin, Ming Chen, Maobai Liu, Hongqiang Qiu, Yu Cheng","doi":"10.2147/IDR.S495279","DOIUrl":"10.2147/IDR.S495279","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to describe the population pharmacokinetics (PopPK) of ceftazidime-avibactam (CAZ-AVI) in adult patients, and to develop optimal dosing regimens for both non-critically ill and critically ill patients by combining different pharmacokinetic/pharmacodynamic (PK/PD) targets.</p><p><strong>Patients and methods: </strong>A prospective, single-center study involving patients who were infected with CRKP and received CAZ-AVI therapy was conducted. Nonlinear mixed-effect modeling was used to develop a PopPK model. The optimal dosing regimen was assessed using Monte Carlo simulation.</p><p><strong>Results: </strong>The PopPK analysis of CAZ-AVI included 91 steady-state concentrations from 45 adult patients. The data were modeled using a one-compartment model. The typical population values of CAZ and AVI clearances were 2.96 L/h and 3.09 L/h, and the volumes of distribution were 17.76 L and 18.25 L, respectively. Our study showed that creatinine clearance (CrCL) calculated using the Cockcroft-Gault equation significantly affected the pharmacokinetics of CAZ-AVI. The Monte Carlo simulation optimized the dosing regimen for both non-critically ill and critically ill patients with varying renal functions, providing detailed supplements to the instructions.</p><p><strong>Conclusion: </strong>Our study established a PopPK model for CAZ-AVI and proposed a reference for dosing regimen adjustment based on the severity of the disease and renal functional status.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"941-955"},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483012","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":"Risk Factors for Development and Mortality of Carbapenem-Resistant <i>Pseudomonas aeruginosa</i> Bloodstream Infection in a Chinese Teaching Hospital: A Seven-Year Retrospective Study.","authors":"Luyan Dong, Yingbin Huang, Shengcen Zhang, Binbin Xu, Bin Li, Yingping Cao","doi":"10.2147/IDR.S495240","DOIUrl":"10.2147/IDR.S495240","url":null,"abstract":"<p><strong>Objective: </strong><i>Pseudomonas aeruginosa</i> (<i>P. aeruginosa</i>) is a gram-negative opportunistic pathogen, which can cause acute and chronic infections, often resulting in high mortality. The aim of this study was to investigate the risk factors for the development and mortality of patients with carbapenem-resistant <i>P. aeruginosa</i> bloodstream infection (CRPA BSI).</p><p><strong>Methods: </strong>A total of 112 patients with CRPA BSI and 112 patients with carbapenem-sensitive <i>P. aeruginosa</i> (CSPA) BSI were included from a Chinese teaching hospital from January 2017 to December 2023 in this retrospective cohort study. The detection rate, antimicrobial susceptibility of <i>P. aeruginosa</i> and clinical characteristics of these patients were investigated. Multivariable logistic regression analysis was used to identify risk factors for the development and outcomes of CRPA BSI.</p><p><strong>Results: </strong>In the past 7 years, 7480 blood samples of <i>P. aeruginosa</i> were cultured in the hospital. The detection rates of CRPA, multidrug resistant <i>P. aeruginosa</i> (MDRPA), and difficult-to-treat resistant <i>P. aeruginosa</i> (DTRPA) BSI increased annually (26% to 47%, 10% to 36% and 5% to 15%, respectively). CRPA showed high resistance to conventional antibiotics. Chronic lung disease (OR 3.953, 95% CI 1.131-13.812), transplantation (OR 2.837, 95% CI 1.036-7.770), multi-organ failure (OR 4.815, 95% CI 1.949-11.894), pre-infection within CRPA (OR 9.239, 95% CI 3.441-24.803), and exposure to carbapenems within 90 days (OR 2.734, 95% CI 1.052 -7.106) were independent risk factors for the development of CRPA bacteremia. Sepsis or septic shock (OR 8.774, 95% CI 3.140-24.515, <i>p</i> = 0.001) were independent risk factors of mortality.</p><p><strong>Conclusion: </strong>Chronic lung disease, transplantation, multi-organ failure, prior CRPA infection, and prior carbapenems exposure are independent risk factors for the development of CRPA bacteremia. Sepsis or septic shock increases 28-day mortality. To investigate the molecular mechanisms of carbapenem-resistance of <i>P. aeruginosa</i>, standardize antibiotic usage, and assess risk factors for the development and mortality of CRPA BSI are beneficial to control infection and reduce death.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"979-991"},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482963","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}