Infection and Drug Resistance最新文献

{"title":"Monitoring of <i>Klebsiella pneumoniae</i> Infection and Drug Resistance in 17 Pediatric Intensive Care Units in China from 2016 to 2022.","authors":"Panpan Fan, Pan Fu, Jing Liu, Chuanqing Wang, Xiaolei Zhang, Yixue Wang, Yingying Zhang, Ting Zhu, Caiyan Zhang, Guoping Lu, Gangfeng Yan","doi":"10.2147/IDR.S475720","DOIUrl":"10.2147/IDR.S475720","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the characteristics and drug resistance patterns of Klebsiella pneumoniae (<i>K. pneumoniae</i>) infection in pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong><i>K. pneumoniae</i> strains from 17 domestic PICUs were analyzed for overall condition and drug resistance using WHO-NET software.</p><p><strong>Results: </strong>From 2016 to 2022, there was a linear increase in the detection rate of <i>K. pneumoniae</i> (P<0.05), with a total of 2591 (9.7%) strains detected. The primary sites of <i>K. pneumoniae</i> detection were the respiratory tract (71.1%), blood (8.6%), and urinary tract (7.1%). <i>K. pneumoniae</i>'s resistance to penicillin drugs exceeded 90%, and are over 50% to cephalosporins. Resistance to cefoperazone-sulbactam decreased from 51.7% to 25.7%, and ranged from 9.1% to 20.8% for ceftolozane-tazobactam. Carbapenem-resistant <i>K. pneumoniae</i> strains constituted 32.3%. Resistance to imipenem and meropenem have decreased to 33.8% and 40.2%, while increased to 35.2% for ertapenem. Levofloxacin and amikacin resistance rates have decreased to 25.7% and 9.1%, but remain high at 63.8% for moxifloxacin and 44.6% for ciprofloxacin. <i>K. pneumoniae</i> demonstrated the lowest resistance rates to polymyxin B (0.9%), tigecycline (2.2%), and polymyxin E (3.1%). No strain of <i>K. pneumoniae</i> was resistant to both polymyxin B and meropenem. However, some strains showed co-resistance to meropenem with other antibiotics, including tigecycline (2%), imipenem (16%), amikacin (27%), colistin (37%), and levofloxacin (41%).</p><p><strong>Conclusion: </strong>The rates of isolation and drug resistance of <i>K. pneumoniae</i> in PICU have significantly increased over 7 years. Careful antibiotic use, infection control strategies, and appropriate antibiotic combinations are crucial in addressing this problem.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345900","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":"Effects of Embryo Microbial Contamination on ART and Neonatal Outcomes.","authors":"Yuxia He, Yuling Mao, Yaoming Chen, Ling Tang, Haiyu Hou, Chenyun Sun, Yaqi Shang, Na-Na Tan, Lei Li","doi":"10.2147/IDR.S478594","DOIUrl":"https://doi.org/10.2147/IDR.S478594","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the incidence and microbial etiology of embryo contamination in assisted reproductive technology (ART), and its influence on embryo development, pregnancy and neonatal outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on embryo contamination at the Reproductive Centre of the Third Affiliated Hospital of Guangzhou Medical University, between 2018 and 2021.</p><p><strong>Results: </strong>In the period from 2018 to 2021, the average incidence of embryo contamination was 0.12%. Bacterial growth was observed in 39 cases, with a preponderance of <i>Escherichia coli</i> (20, 51.28%), <i>Streptococcus agalactiae</i> (7, 17.95%). The fertilization rate of contaminated embryos was 18.18% (<i>Klebsiella pneumoniae</i>) to 94.79% (<i>S. agalactiae</i>), the cleavage rate was 9.09% (<i>Enterobacter cloacae</i>) to 98.90% (<i>S. agalactiae</i>), and the available embryo rate of Day 3 was 0 (<i>Klebsiella pneumoniae, Enterobacter cloacae</i>) to 63.33% (<i>S. agalactiae</i>). Blastocyst formation rate was 3.23% (<i>Proteus mirabilis</i>) to 64.29% (<i>Streptococcus mitis</i>). <i>E. coli</i> contamination occurred mostly on Day 1, and <i>S. agalactiae</i> on Days 3 and 5. After rinsing and rescuing treatment, six healthy male babies were born.</p><p><strong>Conclusion: </strong><i>E. coli</i> and <i>S. agalactiae</i> were the most common bacterial embryo contaminants. Most microbial contamination can significantly decrease the fertilization rate. Embryo transfer after rinsing and continuing culture had no negative effect on neonatal outcomes, but there was an increased risk of early abortion due to <i>E. coli</i> contamination.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11430217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345877","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":"Bacterial Epidemiology and Antimicrobial Resistance Profiles of Bloodstream Infections Caused by Negative Bacteria in Children's: A Multicenter Study in China (2016-2022).","authors":"Hongmei Xu, Ningning Wu, Hui Yu, Chuanqing Wang, Jikui Deng, Hongmei Wang, Chunzhen Hua, Yinghu Chen, Xuejun Chen, Ting Zhang, Hong Zhang, Yiping Chen, Shifu Wang, Qing Cao, Huiling Deng, Sancheng Cao, Jianhua Hao, Wei Gao, Chunmei Jing","doi":"10.2147/IDR.S473227","DOIUrl":"https://doi.org/10.2147/IDR.S473227","url":null,"abstract":"<p><strong>Objective: </strong>Aim to investigate the pathogens distribution and drug resistance of gram-negative bacteria causing bloodstream infection (BSIs) in Infectious Disease Surveillance of Pediatric from 2016 to 2022. The prevalence of four important drug resistance phenotypes was studied: difficult-to-treat resistance, fluoroquinolone resistance, carbapenem resistance, and extended-spectrum cephalosporin resistance, and to provide reference basis for preventing and treating BSIs diseases in children.</p><p><strong>Methods: </strong>Strain identification and antimicrobial susceptibility tests were independently performed at each hospital. Data were analyzed using Whonet 5.6 and GraphPad Prism 8 software. The Mann-Whitney <i>U</i>-test was used to examine and compare temporal changes.</p><p><strong>Results: </strong>A total of 39977 BSIs strains were isolated, with 27.1% of the negative bacteria causing BSIs (10824 strains). The highest bacteria detected were <i>E. coli</i> and <i>S. maltophilia in</i> the neonatal and pediatric groups. The detection rate of carbapenem-resistant-<i>K. pneumo</i>niae (CRKPN) in neonate group was 31.4%, significantly increased compared with pediatric group, whose detection rate was 24.7%. The rates of resistance to levofloxacin and trimethoprim/sulfamethoxazole were significantly lower in neonatal groups than pediatric groups in BSIs caused by <i>K. pneumoniae</i>. To imipenem and meropenem were 3.6% and 3.9% among neonatal isolates, which was lower than 4.7% and 5.8 among pediatric BSIs caused by <i>E. coli</i>. Isolated from neonatal BSIs caused by <i>A. baumannii</i> showed lower resistance ratios to all the agents tested than those from pediatric. However, only the prevalence of piperacillin/tazobactam resistance was statistically lower than that in pediatric BSIs caused by <i>P. aeruginosa</i>. The average detection rates of carbapenem resistance, extended-spectrum cephalosporin resistance, and fluoroquinolone resistance for <i>K. pneumoniae</i> and <i>E. coli</i> were 28.1%,41.4%,11.6% and 4.0%,24.3%,31.1%, respectively.</p><p><strong>Conclusion: </strong>The detection rate of gram-negative pathogens showed an increasing trend among the bloodstream infection. The detection rate of CRKPN assumed a downward trend in 2018. There are differences types of pathogens between the neonatal group and the pediatric group, The detection rate of CRKPN in the neonate group was significantly higher than pediatric group. The first average detection rates for carbapenem resistance, extended-spectrum cephalosporin resistance, and fluoroquinolone resistance were obtained for <i>A. baumannii, K. pneumoniae</i>, and <i>Escherichia coli</i>, respectively. Those data showed a high level of antimicrobial resistance, which has posed an urgent threat to Children's health, suggested that effective monitoring of antimicrobial resistance and antimicrobial stewardship among children in China are required.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345876","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":"Antimicrobial Susceptibility Profile of Methicillin-Resistant <i>Staphylococcus Aureus</i> Isolated from Clinical Samples at Bac Ninh Provincial General Hospital, Vietnam.","authors":"Nguyen Van An, Hai Thi Nguyen, Van Nguyen Le, Ha Thi Thu Van, Nguyen Minh Hai, Vu Huy Luong, Vinh Thi Ha Nguyen, Hoa Quynh Pham, Hung Van Le, Dinh Viet Hung, Hoang Trung Kien, Minh Nhat Le, Nguyen Hoang Viet, Luong Cong Thuc, Ta Ba Thang, Tran Viet Tien, Le Huy Hoang, Nguyen Thuy Tram, Tuan Dinh Le, Nguyen Tien Son, Hai Ha Long Le","doi":"10.2147/IDR.S477031","DOIUrl":"https://doi.org/10.2147/IDR.S477031","url":null,"abstract":"<p><strong>Purpose: </strong><i>Staphylococcus aureus</i>, including methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) strain, can become resistant to all classes of clinically available antibiotics and causes skin infections and severe infections in the lungs, heart, and bloodstream. The study aimed to evaluate antimicrobial susceptibility patterns and MRSA exhibiting multidrug resistance obtained through a microbiological culture of clinical specimens at Bac Ninh Provincial General Hospital in Bac Ninh Province, Vietnam.</p><p><strong>Methods: </strong>We employed a cross-sectional analysis at Bac Ninh Provincial General Hospital in Vietnam. 15,232 clinical samples from inpatients were examined. <i>S. aureus</i> isolates were identified using established protocols and tested for MRSA and antibiotic susceptibility. Data was analyzed using R software, with statistical calculations to assess associations between variables.</p><p><strong>Results: </strong><i>Staphylococcus aureus</i> was isolated from 417 samples (2.7%), with 77.2% being MRSA and 22.8% methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA). Significant sources of MRSA were wounds (64.6%) and the surgical unit (50%) according to sample types and hospital wards, respectively. <i>S. aureus</i> showed high resistance rates, the highest being azithromycin (83.2%), and was fully susceptible to vancomycin. Among 294 multidrug-resistant (MDR) strains, the prevalence was 82.0% in MRSA and 18.0% in MSSA.</p><p><strong>Conclusion: </strong>The study highlights widespread antimicrobial resistance among MRSA isolates from a provincial hospital in Vietnam, emphasizing the urgent need for antibiotic surveillance, formulation of antibiotic policies, and preventive measures to tackle the increasing prevalence of multidrug-resistant MRSA.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345875","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":"Nosocomial, Healthcare-Associated, and Community-Acquired Acinetobacter baumannii in China: Clinical Characteristics, Antimicrobial Resistance Patterns and Risk Factors Associated with Carbapenem Resistance","authors":"Yuqing Li, Jiachen Zhang, Yingjuan Gu, Ling Wang, Jing Hu","doi":"10.2147/idr.s469244","DOIUrl":"https://doi.org/10.2147/idr.s469244","url":null,"abstract":"<strong>Background:</strong> <em>Acinetobacter baumannii (A. baumannii</em>) is an widespread pathogen and carbapenem-resistant strains are great threat to hospitalized patients. This study is aimed to investigate the clinical characteristics, antimicrobial resistance patterns, and risk factors associated with carbapenem resistance in nosocomial, healthcare-associated (HCA), and community-acquired (CA) <em>A. baumannii</em> infections.<br/><strong>Methods:</strong> This study retrospectively reviewed cases in a tertiary hospital in southern China between January 1, 2019, and December 31, 2021. Univariate and multivariate logistic regression analyses were performed to identified the risk factors of carbapenem resistance in nosocomial, HCA and CA <em>A. baumannii</em> infections.<br/><strong>Results:</strong> A total of 391 patients with <em>A. baumannii</em> infection were included. Of these patients, 96 (24.6%) had nosocomial infections, 215 (55.0%) had HCA infections, and 80 (20.5%) had CA infections. The overall 30-day mortality rates of nosocomial and HCA infection patients was significantly higher than that of CA infection (P&lt; 0.05). The incidence of antimicrobial resistance was also higher in nosocomial and HCA bacteremia than that in CA bacteremia (P&lt; 0.05). Logistic regression analysis identified age ≥ 60 years, urethral catheterization, and exposure to two or more antibiotics as the independent risk factors for carbapenem-resistant <em>A. baumannii</em> (CRAB) infection in the nosocomial infection group and exposure to two or more antibiotics and endotracheal intubation in the HCA infection group. However, malignant tumors and hematological diseases were identified as protective factors against CRAB infection in the HCA group.<br/><strong>Conclusion:</strong> These data suggest that HCA <em>A. baumannii</em> infection is quite different from CA infection, with antimicrobial resistance and 30-day mortality rates similar to those of nosocomial infections. Additionally, the risk factors for CRAB development in the CA, HCA, and nosocomial groups were not the same, which may provides the help for controlling practices and instruction empirical clinical medication.<br/><br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247807","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":"Analysis of Clinical Isolation Characteristics of Nontuberculous Mycobacteria and Drug Sensitivity of Rapidly Growing Mycobacteria in the General Hospital of Guangzhou, China","authors":"Xiaoyi Liu, Zhiwei Lin, Yiwen Li, Zhiwei Zhong, Aiwu Wu, Yueting Jiang","doi":"10.2147/idr.s465468","DOIUrl":"https://doi.org/10.2147/idr.s465468","url":null,"abstract":"<strong>Purpose:</strong> The clinical distribution characteristics of nontuberculous mycobacteria (NTM) in general hospital were explored to guide the clinical diagnosis and treatment of NTM infection.<br/><strong>Methods:</strong> Samples with positive mycobacterium culture in the First Affiliated Hospital of Guangzhou Medical University were collected and identified through PCR. Phenotypic drug sensitivity experiments were conducted on 44 <em>Mycobacteroides abscessus</em> isolated from clinical departments with broth microdilution method, and <em>rrl, rrs</em> and <em>erm (41)</em> genes associated with drug resistance were detected.<br/><strong>Results:</strong> From September 2020 to July 2023, 314 mycobacterium-positive isolates were separated from patients in the First Affiliated Hospital of Guangzhou Medical University, with 147 (46.8%) NTM isolates were included in our study. The samples were respiratory tract specimens mainly, with 64% bronchoalveolar lavage fluid. Of 144 cases identified, samples were from 133 patients (60 males and 73 females; gender ratio of 0.82:1). NTM was mainly isolated from the people aged 40 and above, especially females (<em>χ²</em> = 10.688, <em>P</em> = 0.014). <em>M. abscessus</em> (61, 42.36%), <em>M. intracellulare</em> (35, 24.31%) were the two most NTMs in this hospital. Clinical strains of <em>M. abscessus</em> exhibited high resistance to antibiotics, except for cefoxitin (31.8%), linezolid (25.0%), amikacin (0%), and clarithromycin (18.2%). Among 8 strains of <em>M. abscessus</em> with clarithromycin acquired resistance, just 4 strains (50.0%) showed mutations (A2270G, A2271G) in <em>rrl</em> gene, but a new mutation (C2750T) was detected in 1 strain. Among 14 strains of <em>M. abscessus</em> with clarithromycin-induced resistance, 13 (93.0%) strains had T28 <em>erm (41)</em> gene and 1 (7.0%) strain had C28 <em>erm (41)</em> gene.<br/><strong>Conclusion:</strong> <em>M. avium–intracellulare</em> complex was gradually becoming predominant strain in Guangzhou area. The resistant situation of <em>M. abscessus</em> in general hospital had shown severe. Potential mutation in <em>rrl</em> gene associated with clarithromycin acquired resistance of <em>M. abscessus</em> were found, but drug-resistant mechanism remained unclear.<br/><br/><strong>Keywords:</strong> nontuberculous mycobacterium, drug resistance, clarithromycin, <em>Mycobacteroides abscessus</em><br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247808","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":"Mortality and Risk Factors of Death in Patients with AmpC β-Lactamase Producing Enterobacterales Bloodstream Infection: A Cohort Study","authors":"Ana Sheila Duarte Nunes Silva, Natalia Chilinque Zambão da Silva, Fernanda Moreth do Valle, Jaqueline Abel da Rocha, Shelley Ehrlich, Ianick Souto Martins","doi":"10.2147/idr.s473789","DOIUrl":"https://doi.org/10.2147/idr.s473789","url":null,"abstract":"<strong>Aim:</strong> ESCPM bacteria include <em>Enterobacter</em> spp, <em>Serratia, Citrobacter</em> spp, <em>Providencia</em> spp, and <em>Morganella</em> spp. These Gram-negative bacilli harbor chromosomally encoded AmpC-type β-lactamases that cause resistance to β-lactam antibiotics, such as penicillins, β-lactam/β-lactamase inhibitors, and first-, second-, and third-generation cephalosporins. Bloodstream infections caused by ESCPM group bacteria (BSI-ESCPM) are difficult to treat.<br/><strong>Purpose:</strong> To describe 30-day mortality and analyze potential risk factors for death in patients with BSI-ESCPM.<br/><strong>Patients and Methods:</strong> A cohort study of patients aged ≥ 18 years with BSI-ESCPM was conducted at a University Hospital in Brazil, from January 2013 and December 2018. Potential risk factors for death within 30 days of bloodstream infection BSI diagnosis were analyzed using multivariable logistic regression.<br/><strong>Results:</strong> Among 138 patients with BSI-ESCPM, 63.0% were males, with a median age of 61 years. Of 155 BSI-ESCPM episodes, 61.3% were hospital-acquired. Primary BSI-ESCPM associated with short-term central venous catheter (37.4%) and BSI-ESCPM secondary to respiratory infection (19.4%) occurred mainly. Mostly, <em>Enterobacte</em>r spp. (49.7%) and <em>Serratia</em> spp. (29.0%) were isolated. Multidrug-resistance occurred in 27.7% of BSI-ESCPM episodes, involving <em>Enterobacter</em> spp. (16.1%) and <em>Serratia</em> spp. (7.7%) mainly. The mortality was 24.5%. Developing septic shock within 72 h of BSI-ESCPM diagnosis (OR: 70.26; 95% CI: 16.69– 295.77; <em>P</em>&lt; 0.01) was risk factor for death. Conversely, combined antibiotic therapy (OR: 0.23; 95% CI: 0.05– 0.94; <em>P</em>:0.04), BSI-ESCPM secondary to urinary infection (OR: 0.11; 95% CI: 0.01– 0.99; <em>P</em>:0.05), and <em>Enterobacter</em> spp. BSI (OR: 0.16; 95% CI: 0.05– 0.56; <em>P</em> 0&lt; 0.01) was protective factor against death. Tendency of association between inadequate antibiotic therapy and death (OR: 2.19; 95% CI: 0.51– 9.42; <em>P</em>:0.29) was observed.<br/><strong>Conclusion:</strong> BSI-ESCPM is severe and has serious outcomes such as sepsis-associated deaths. Combined antibiotic therapy was a protective factor against death in patients with BSI-ESCPM. There is a suggestive association between inadequate antibiotic therapy and mortality. The ESCPM group bacteria that are considered to be at moderate to high risk of clinically significant AmpC production were not associated with death.<br/><br/><strong>Keywords:</strong> bloodstream infection, <em>Enterobacterales</em>, AmpC β-lactamase, mortality, risk factors of death<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247810","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":"Hematocrit and Albumin Levels at Admission Predict in-Hospital Mortality in Pediatric COVID-19 Omicron Variant Patients","authors":"Yun Zhu, Lingyan Li, Wenxiao Wang, Xiaodan Liu, Meng Xue Zhang, Xiumin Chen, Xiaofeng Hou, Weimei Wang, Tuo Min, Jinmei Liu, Lecui Liu, Chengjun Liu, Zhong Jiang, Yanping Wang, Dayun Chang, Hua Pan","doi":"10.2147/idr.s479580","DOIUrl":"https://doi.org/10.2147/idr.s479580","url":null,"abstract":"<strong>Introduction:</strong> The Omicron variant is the present predominant COVID-19 strain worldwide. Accurate mortality prediction can facilitate risk stratification and targeted therapies. The study aimed to evaluate the feasibility of the difference in hematocrit and albumin (HCT-ALB) levels, alone or combined with the pediatric Sequential Organ Failure Assessment (pSOFA) score and lactate level, to predict the in-hospital mortality of COVID-19 Omicron variant-infected pediatric patients.<br/><strong>Methods:</strong> A multicenter retrospective cohort study was performed for children with COVID-19 Omicron variant infection between December 2021 and January 2022. The demographics, clinical characteristics, hospital admission laboratory test results, and treatments were recorded. The in-hospital mortality was documented. The associations between HCT-ALB levels and mortality, and between HCT-ALB+pSOFA+lactate and mortality were analyzed.<br/><strong>Results:</strong> A total of 119 children were included. The median age was 1.6 (interquartile range: 0.5– 6.2) years old. There were 70 boys and 49 girls. The mortality rate was 14.3% (17/119). The univariate and multivariate Cox regression analysis revealed that HCT-ALB was associated to in-hospital mortality (hazard ratio: 1.500, 95% confidence interval: 1.235– 1.822, <em>p</em>&lt; 0.001). The receiver operating characteristic curve analysis revealed that HCT-ALB can be used to accurately predict in-hospital mortality at a cut-off value of − 0.7 (area under the curve: 0.888, sensitivity: 0.882, specificity: 0.225, Youden index: 0.657, <em>p</em>&lt; 0.001). These patients were assigned into three groups based on the HCT-ALB level, pSOFA score, and lactate level (low-, medium-, and high-risk groups). The Kaplan-Meier analysis revealed that the mortality increased in the high-risk group, when compared to the medium-risk group (<em>p</em>&lt; 0.01). The latter group had a higher mortality, when compared to the low-risk group (<em>p</em>&lt; 0.01).<br/><strong>Conclusion:</strong> The HCT-ALB level can be applied to predict the in-hospital mortality of children infected with the COVID-19 Omicron variant. Its combination with other variables can improve prediction performance.<br/><br/><strong>Keywords:</strong> COVID-19, omicron variant, hematocrit, albumin, mortality<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247847","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":"Functional Study of desKR: a Lineage-Specific Two-Component System Positively Regulating Staphylococcus aureus Biofilm Formation","authors":"Xinyan Ma, Ziyan Wu, Junpeng Li, Yang Yang","doi":"10.2147/idr.s485049","DOIUrl":"https://doi.org/10.2147/idr.s485049","url":null,"abstract":"<strong>Purpose:</strong> Biofilms significantly contribute to the persistence and antibiotic resistance of <em>Staphylococcus aureus</em> infections. However, the regulatory mechanisms governing biofilm formation of <em>S. aureus</em> remain not fully elucidated. This study aimed to investigate the function of the <em>S. aureus</em> lineage-specific two-component system, <em>desKR</em>, in biofilm regulation and pathogenicity.<br/><strong>Methods:</strong> Bioinformatic analysis was conducted to assess the prevalence of <em>desKR</em> across various <em>S. aureus</em> lineages and to examine its structural features. The impact of <em>desKR</em> on <em>S. aureus</em> pathogenicity was evaluated using in vivo mouse models, including skin abscess, bloodstream infection, and nasal colonization models. Crystal violet staining and confocal laser scanning microscopy were utilized to examine the impact of <em>desKR</em> on <em>S. aureus</em> biofilm formation. Mechanistic insights into <em>desKR</em>-mediated biofilm regulation were investigated by quantifying polysaccharide intercellular adhesin (PIA) production, extracellular DNA (eDNA) release, autolysis assays, and RT-qPCR.<br/><strong>Results:</strong> The prevalence of <em>desKR</em> varied among different <em>S. aureus</em> lineages, with notably low carriage rates in ST398 and ST59 lineages. Deletion of <em>desKR</em> in NCTC8325 strain resulted in decreased susceptibility to β-lactam and glycopeptide antibiotics. Although <em>desKR</em> did not significantly affect acute pathogenicity, the Δ<em>desKR</em> mutant exhibited significantly reduced nasal colonization and biofilm-forming ability. Overexpression of <em>desKR</em> in naturally <em>desKR</em>-lacking strains (ST398 and ST59) enhanced biofilm formation, suggesting a lineage-independent effect. Phenotypic assays further revealed that the Δ<em>desKR</em> mutant showed reduced PIA production, decreased eDNA release, and lower autolysis rates. RT-qPCR indicated significant downregulation of <em>icaA, icaD, icaB</em>, and <em>icaC</em> genes, along with upregulation of <em>icaR</em>, whereas autolysis-related genes remained unchanged.<br/><strong>Conclusion:</strong> The <em>desKR</em> two-component system positively regulates <em>S. aureus</em> biofilm formation in a lineage-independent manner, primarily by modulating PIA synthesis via the <em>ica</em> operon. These findings provide new insights into the molecular mechanisms of biofilm formation in <em>S. aureus</em> and highlight <em>desKR</em> as a potential target for therapeutic strategies aimed at combating biofilm-associated infections.<br/><br/><strong>Keywords:</strong> <em>Staphylococcus aureus</em>, two-component system, <em>desKR</em>, biofilm<br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247849","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":"Target Attainment and Population Pharmacokinetics of Nirmatrelvir/Ritonavir in Critically Ill Adult Patients","authors":"Na Chen, Xuben Yu, Lu Li, Ping Yang, Rong Dong, Yizhen Huang, Xiao Ling, Qiaoqiao Shentu, Wenqiao Yu, Saiping Jiang","doi":"10.2147/idr.s471918","DOIUrl":"https://doi.org/10.2147/idr.s471918","url":null,"abstract":"<strong>Background:</strong> The population pharmacokinetics of nirmatrelvir/ritonavir (NIR/RIT) has not yet been described for critically ill adult patient.<br/><strong>Purpose:</strong> This was a prospective observational population pharmacokinetic study of nirmatrelvir/ritonavir (NIR/RIT) in critically ill adult patients and identify optimal dosing regimens.<br/><strong>Patients and Methods:</strong> The prescription of NIR/RIT is determined by the attending physician and ranges from 150mg/100mg to 300mg/100mg twice a day. Two to three serial blood samples were collected for each patient after the second doses. We developed and validated PK model for plasma NIR and plasma RIT. Monte Carlo dosing simulations were performed to assess target attainment.<br/><strong>Results:</strong> We analyzed 89 plasma samples from 31 adult patients. The data were best described by a one-compartment model. Among the covariates tested on pharmacokinetic parameters, creatinine clearance (CrCL) and area under curve (AUC) of RIT had a significant effect on apparent clearance (CL/F) of NIR. Mean (SD) parameters estimates for the absorption rate constant (Ka), apparent distribution (V/F) and CL/F were 0.42 (0.10) h^{− 1}. 36.5 (8.5) L, 3.6 (0.26) L/h, respectively. Dosing simulations showed that the target in vitro 90% effective concentration (EC₉₀) was more likely to be achieved twice a day than once a day at the same daily dose of NIR. High CrCL, low AUC of RIT were associated with a reduced likelihood of NIR reaching the target EC₉₀.<br/><strong>Conclusion:</strong> Based on our dosing simulations, the initial dosage of NIR/RIT was 300mg/100mg twice a day in critically ill patients with CrCL&gt; 45 mL/min; When CrCL in critically ill patients is between 15 and 45 mL/min, NIR/RIT is 150mg/100mg twice a day. The maintenance dose is adjusted according to CrCL and AUC of RIT, with the dosages varying between 75mg/100mg and 300mg/100mg.<br/><br/>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247848","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}