Infection and Drug Resistance最新文献

{"title":"Genomic Investigation of a Bacillus subtilis Strain Sourced from Commercially Available Milk Powder in China Reveals Potential Risk Factors.","authors":"Ling Zhu, Keyu Chen, Liu Xu, Afeng Wang, Haojian Gan, Junhong Sun, Yujie Wu, Yutong Li, Yingying Guo, Yanfeng Yi, Xinhua Qiang, Jie He, Hongchang Zhou, Yibin Lin","doi":"10.2147/IDR.S544153","DOIUrl":"10.2147/IDR.S544153","url":null,"abstract":"<p><strong>Background: </strong>Milk powder is a key food source, especially for infants and vulnerable groups. However, Bacillus contamination during production, storage, or handling can cause spoilage, quality issues, or health risks. This study identified and isolated <i>Bacillus subtilis</i> from commercially available Chinese milk powder.</p><p><strong>Methods: </strong>A pure colony of <i>Bacillus subtilis</i> was isolated from an LB agar plate supplemented with milk powder and identified using mass spectrometry. The genome of this strain was sequenced using third-generation sequencing technology. Following assembly, the genome was functionally annotated and subjected to comprehensive bioinformatic analysis.</p><p><strong>Results: </strong>Genomic analysis classified the strain as <i>Bacillus subtilis</i> via MALDI-TOF and ANI (98.82% with <i>B. subtilis</i> AMR1). Its genome features a 4.26 Mbp chromosome and 97.6 kbp plasmid encoding 4,539 genes, including virulence factors (209 genes), antibiotic resistance genes (19 genes), and carbohydrate-active enzymes (253 genes). Key virulence mechanisms include immune modulation, stress adaptation, toxin production, and biofilm formation. Antibiotic resistance involves efflux pumps (eg, <i>qacJ, bmr</i>), enzymatic inactivation (eg, <i>FosBx1, aadK</i>), and target modification (eg, <i>vanG</i> cluster, <i>tet(45)</i>). Phylogenetically (LIN78), the strain clusters with foodborne <i>B. subtilis</i> isolates (eg, from Korean gochujang and soybean), diverging from <i>B. cereus</i> and environmental <i>Bacillus</i> clades. Comparative genomics revealed 53 LIN78-specific genes, encompassing defense mechanisms and mobile elements, and synteny in all homologs except <i>B. subtilis</i> ATCC 11774. Genomic islands, CRISPR arrays, and recombination-associated repeats indicate adaptive evolution.</p><p><strong>Conclusion: </strong>This study characterizes <i>Bacillus subtilis</i> LIN78, a genomically plastic strain isolated from Chinese milk powder. It exhibits adaptation to food environments via horizontal gene transfer, stress tolerance, and spoilage traits, while carrying antimicrobial resistance risks and potential biotechnological applications. The findings necessitate genomic monitoring to manage food safety, resistance spread, and leverage its dual role as both a spoilage organism and source of bioactive compounds..</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4311-4328"},"PeriodicalIF":2.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12392299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952458","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":"Impact of Multidisciplinary Collaboration on Microbiological Specimen Submission and Appropriate Use of Carbapenems: A Pre-Post Cohort Study.","authors":"Qi Zou, Yatong Zhang, Xiaoman Ai, Xiaoming Tan, Xia Wang, Ji Luo, Meng Cai","doi":"10.2147/IDR.S532011","DOIUrl":"10.2147/IDR.S532011","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed the impact of multidisciplinary collaborative management on microbiological specimen submission rates and the rational use of carbapenem antibiotics.</p><p><strong>Patients and methods: </strong>A pre- and post-intervention cohort design was employed. From February to November 2024, a multidisciplinary antimicrobial stewardship intervention was implemented for hospitalized patients receiving carbapenem antibiotics. Patients treated in January 2024 served as the control group, and those in November 2024 formed the intervention group.</p><p><strong>Results: </strong>Following the intervention, the pathogen testing rate among patients receiving carbapenem treatment increased significantly from 64.76% to 74.27% (<i>p</i> = 0.042), with the most notable improvement in the surgical ward (36.84% to 66.07%, <i>p</i> < 0.001). The blood culture qualification rate increased from 34.29% to 60.47% (<i>p</i> = 0.009), and the blood culture submission rate also increased from 2.86% to 16.02%, (<i>p</i> < 0.001). Additionally, there were improvements in the targeted therapy, rational antibiotics use, and treatment adjustments based on sensitivity results. However, no significant change was observed in the detection rate of hospital-acquired carbapenem-resistant pathogens (0.46% vs 0.35%, <i>p</i> = 0.341).</p><p><strong>Conclusion: </strong>A multidisciplinary, information-based intervention significantly improved pathogen testing and promoted more rational carbapenem use, highlighting the value of collaborative antimicrobial stewardship.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4301-4309"},"PeriodicalIF":2.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952487","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":"<i>Fusobacterium nucleatum-</i>Induced Pyopneumothorax: A Rare but Serious Clinical Entity.","authors":"Yixin Chen, Chenglin Yu, Jiannan Chai, Min Chai, Yuqi Xiao, Hongwei Loong, Dahai Xu, Lijun Wang","doi":"10.2147/IDR.S530213","DOIUrl":"10.2147/IDR.S530213","url":null,"abstract":"<p><p><i>Fusobacterium nucleatum</i> (<i>F. nucleatum</i>) is a Gram-negative, anaerobic bacterium predominantly found in the oral cavity, gastrointestinal tract, and urogenital system. It accounts for less than 1% of anaerobic bacterial infections in clinical settings and can lead to a spectrum of severe infections. This report details the case of a 55-year-old male who presented with a one-month history of productive cough, acute right-sided chest pain, dyspnea, and fever. Initial examinations showed elevated inflammatory markers and a right-sided pleural effusion on chest CT. Despite empirical therapy, the patient's condition worsened, culminating in a diagnosis of right-sided encapsulated hydropneumothorax. <i>F. nucleatum</i> was isolated from the pleural fluid culture. Treatment with meropenem and linezolid led to gradual clinical improvement, and the patient recovered without complications during follow-up. Although rare, <i>F. nucleatum</i> pleural infections can progress swiftly and are frequently misdiagnosed, posing significant diagnostic challenges. Given their potential severity, such as in cases of pyopneumothorax, immediate drainage and targeted antibiotic treatment are imperative. Clinicians should exercise heightened vigilance in diagnosing and managing this severe and often overlooked infection.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4293-4300"},"PeriodicalIF":2.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952749","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":"Ischemic Stroke as a Rare Manifestation of Neurobrucellosis: A Case Report.","authors":"Yang Zhou, Minghui Yun, Xiaocui Han, Chunlei Chen, Chao Wei, Ping Huang, Xinhuan Feng, Jing Chen, Songsong Xie","doi":"10.2147/IDR.S544038","DOIUrl":"10.2147/IDR.S544038","url":null,"abstract":"<p><strong>Background: </strong>This article presents a case report of a patient with neurobrucellosis (NB) complicated by ischemic stroke (IS).</p><p><strong>Case presentation: </strong>A male presented with new-onset left-sided limb weakness lasting three days, along with a 15-month history of intermittent fever and progressive right-sided limb weakness over eight months. A cranial MRI revealed an acute infarction in the left cerebellar vermis. Cerebrospinal fluid (CSF) analysis revealed elevated protein levels and pleocytosis. Next-generation sequencing (NGS) of the CSF detected 1469 <i>Brucella</i> species. Polymerase chain reaction (PCR) testing for the <i>Brucella</i> OMP22 gene was positive in the patient's urine, CSF, and blood samples. Following combination antimicrobial therapy with doxycycline, rifampicin, and trimethoprim-sulfamethoxazole (TMP-SMX), the patient's clinical symptoms progressively improved, and laboratory parameters normalized.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering NB in the differential diagnosis of patients presenting with unexplained symptoms in brucellosis-endemic regions. Early diagnosis and combined antibiotic therapy are critical to alleviating NB symptoms and improving clinical outcomes.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4329-4335"},"PeriodicalIF":2.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992438","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":"Dual Regulatory Roles of Pannexin 1 in the Pathogenesis and Recovery of Sepsis-Induced Acute Lung Injury.","authors":"Qiancheng Xu, Yan Qian, Yingya Cao, Weihua Lu, Jianguo Li","doi":"10.2147/IDR.S532405","DOIUrl":"10.2147/IDR.S532405","url":null,"abstract":"<p><p>Sepsis-associated acute lung injury (ALI) is a leading cause of death in sepsis patients, characterized by complex pathogenesis involving inflammatory responses, immune dysregulation, cell death, and coagulation system activation. Despite advancements in critical care, specific drugs or therapies for ALI remain unavailable. Pannexin 1 (Panx1), a widely expressed membrane channel protein, has emerged as a pivotal regulator in the onset and progression of sepsis-induced ALI. During the early stages, Panx1 amplifies inflammatory responses by promoting immune cell activation, chemotaxis, cytokine release, and coagulation. Simultaneously, it contributes to epithelial and endothelial cell damage through apoptosis, pyroptosis, and ferroptosis. Conversely, in the recovery phase, Panx1 plays a reparative role, facilitating inflammation resolution, epithelial cell proliferation, and tissue regeneration. This review highlights Panx1's dual role, presenting it as a promising therapeutic target. Preclinical models have demonstrated a key therapeutic advantage: the potential for stage-specific interventions. This strategy involves pharmacological inhibition to mitigate early-stage damage and potential activation to promote later-stage repair. However, a critical knowledge gap remains in defining the precise therapeutic window for such interventions and translating these findings into clinical practice. By elucidating Panx1's complex mechanisms, we aim to provide a theoretical basis for novel therapeutic strategies, addressing a critical unmet need in sepsis-induced ALI management and improving patient outcomes.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4277-4292"},"PeriodicalIF":2.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952767","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":"Comparative Genomic Analysis of Tigecycline Resistance Development in Clinical <i>Acinetobacter baumannii</i> Isolates.","authors":"Xiaoxia Li, Junnian Liu, Xinyu Zhang, Juan Li, Luhan Xuan, Sue Yuan, Jianglin Li, Yu Sun, Xuefei Du","doi":"10.2147/IDR.S539267","DOIUrl":"10.2147/IDR.S539267","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study investigated the mechanisms underlying the reduced tigecycline sensitivity of &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; strains isolated from infected patients during antimicrobial therapy. The goal is to provide clinical insights into the development of tigecycline resistance in &lt;i&gt;A. baumannii&lt;/i&gt;, with a focus on multidrug-resistant strains commonly associated with hospital-acquired infections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted dynamic tracking of multidrug-resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; (MDR-AB) infections in three patients to monitor changes in tigecycline sensitivity during antimicrobial therapy. From each patient, tigecycline-sensitive and -resistant &lt;i&gt;A. baumannii&lt;/i&gt; strains were collected and paired into groups. A total of six strains were subjected to molecular typing and phylogenetic analysis to assess the genetic homology between the tigecycline-sensitive and -resistant strains within each group. Whole-genome sequencing and comparative genomic analysis were performed to identify single nucleotide polymorphisms and small insertions/deletions between paired strains, aiming to pinpoint mutated genes. Gene knockout experiments were conducted to validate the role of the identified genes in modulating tigecycline sensitivity and contributing to the development of tigecycline resistance in &lt;i&gt;A. baumannii&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Molecular typing and phylogenetic analysis confirmed that the tigecycline-resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; strains isolated from each patient evolved from the initially infecting tigecycline-sensitive strains. All three patients had received tigecycline therapy before the emergence of tigecycline resistance. Notably, in one patient, resistance developed 21 days after discontinuing tigecycline treatment. Comparative genomic analysis of the paired strains revealed point mutations in the conserved domain of the trimeric autotransporter adhesin in all three groups. Additionally, a frameshift mutation in the &lt;i&gt;acrR&lt;/i&gt; gene was identified in two of the three groups. To investigate the role of &lt;i&gt;acrR&lt;/i&gt; in the development of tigecycline resistance, an &lt;i&gt;acrR&lt;/i&gt; knockout strain was constructed. The results indicated that the &lt;i&gt;acrR&lt;/i&gt; gene did not significantly impact tigecycline resistance or biofilm formation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The use of tigecycline promotes the development of tigecycline resistance in &lt;i&gt;Acinetobacter baumannii&lt;/i&gt;, and resistance may continue to evolve even after discontinuing tigecycline treatment. Mutations in the &lt;i&gt;ata, adeS&lt;/i&gt;, and &lt;i&gt;acrR&lt;/i&gt; genes may contribute to the development of tigecycline resistance in &lt;i&gt;A. baumannii&lt;/i&gt;. Although gene knockout experiments in this study showed that &lt;i&gt;acrR&lt;/i&gt; did not directly impact tigecycline resistance or biofilm formation, clinical isolates are influenced by a complex, multifactorial environment. Therefore, the role of &lt;i&gt;acrR&lt;/i&gt; warrants further inv","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4263-4276"},"PeriodicalIF":2.9,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Prognosis of Patients with Severe Pneumonia with Neurological Dysfunction: A Regional Multicenter Retrospective Study in Mainland China.","authors":"Yue Zhu, Yangyang Jia, Cheng Zhang, Hangyang Li, Peili Ding, Lingtong Huang, Guobin Wang, Hongliu Cai, Wenqiao Yu","doi":"10.2147/IDR.S537406","DOIUrl":"10.2147/IDR.S537406","url":null,"abstract":"<p><strong>Purpose: </strong>Pneumonia is common in ICU patients with neurological dysfunction, but differences in pulmonary pathogen distribution in this population remain unclear. This study aimed to compare pathogen profiles, clinical features, and outcomes between ICU patients with and without neurological dysfunction.</p><p><strong>Methods: </strong>This regional multicenter retrospective study included adult patients with severe pneumonia admitted to intensive care units (ICUs) in 11 hospitals across Zhejiang and Henan Provinces in mainland China between December 2018 and November 2023. All patients required invasive mechanical ventilation and underwent bronchoalveolar lavage fluid metagenomic next-generation sequencing (mNGS). Patients were classified into neurological dysfunction (ND) and without neurological dysfunction (WND) groups. Clinical characteristics, microbiological findings, and outcomes were compared. Propensity score matching (PSM) and Cox regression were used to assess prognosis.</p><p><strong>Results: </strong>Among 1737 patients, 636 (41.8%) were in the ND group. After PSM, the ND group showed a higher 28-day ICU mortality rate and shorter time to death compared to the WND group. However, ND was not identified as an independent risk factor for 28-day mortality in Cox analysis. The prevalence of <i>Acinetobacter baumannii, Klebsiella pneumoniae, Burkholderia, Serratia marcescens, Elizabethkingia, Clostridium</i> spp. and <i>Ureaplasma</i> was higher in ND patients. Significant differences in the prevalence of <i>Haemophilus influenzae, Fusarium oxysporum, Fusobacterium nucleatum, Porphyromonas gingivalis, Mycobacterium abscessus, Escherichia coli</i>, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) were also observed.</p><p><strong>Conclusion: </strong>ICU patients with neurological dysfunction exhibited distinct pulmonary pathogen profiles and worse outcomes. These findings may inform empirical antimicrobial strategies. Further prospective studies are warranted to validate these results.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4215-4226"},"PeriodicalIF":2.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952696","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 Antimicrobial Resistance Analysis of Blood Culture Isolates at a Chinese National Cardiovascular Regional Medical Center: A 7-Year Retrospective Study.","authors":"Qian Wang, Fan Wu, Tao Li","doi":"10.2147/IDR.S545293","DOIUrl":"10.2147/IDR.S545293","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to characterize the epidemiological patterns and antimicrobial resistance profiles of bloodstream infections (BSIs) in a cardiovascular specialty hospital and to identify region-specific pathogen distributions, resistance risks, and clinical implications for optimizing empirical therapy and infection control strategies.</p><p><strong>Patients and methods: </strong>A retrospective analysis (2018-2024) evaluated 1,055 non-duplicate BSI isolates from 37,576 blood cultures at the Fuwai Central China Cardiovascular Hospital. Researchers investigated both bacterial classification and associated drug resistance through comprehensive analysis.</p><p><strong>Results: </strong>The study revealed that a total of 1,055 bacterial strains were isolated from blood cultures, with Gram-negative bacteria accounting for 31.5% (332 strains), Gram-positive bacteria for 62.7% (662 strains), and fungi for 5.8% (61 strains). The most frequently isolated pathogens were <i>Staphylococcus epidermidis</i> (13.7%), <i>Staphylococcus hom</i>inis (8.0%), <i>Klebsiella pneumoniae</i> (7.4%), <i>Escherichia coli</i> (7.1%), and <i>Staphylococcus haemolyticus</i> (6.7%). These pathogens were predominantly isolated from intensive care units (ICUs), with the Coronary Heart Disease ICU (24.7%), General ICU (18.0%), and Adult Cardiac Surgery ICU (8.1%) representing the top three departments for bacterial detection. Among <i>Staphylococcus</i> isolates, methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) and methicillin-resistant coagulase-negative <i>Staphylococci</i> (MRCNS) were identified at rates of 51.6% and 88.7%, respectively. The carbapenem resistance rates of <i>K. pneumoniae</i> and <i>E. coli</i> were 28.8% and 4.0%, respectively. Non-fermenting Gram-negative bacilli, such as <i>Acinetobacter baumannii</i>, showed alarming resistance rates to carbapenems (60.0%) and other β-lactams (≥52%), while <i>Burkholderia cepacia</i> and <i>Stenotrophomonas maltophilia</i> remained highly susceptible to first-line agents.</p><p><strong>Conclusion: </strong>Blood culture isolates in our hospital demonstrated a predominance of Gram-positive organisms, with high detection rates of MRSA, MRCNS, and carbapenem-resistant Gram-negative bacilli. Continuous antimicrobial resistance surveillance of bloodstream isolates should be maintained in clinical practice to provide evidence-based data for rational antibiotic use and mitigate the emergence of resistant pathogens.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4249-4262"},"PeriodicalIF":2.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952698","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 First Reported Case of Infant Soft Tissues Infection Caused by <i>Legionella Maceachernii</i>: A Case Report and Literature Review.","authors":"Wenxue Zhang, Mengyuan Wang, Lei Xu, Shifu Wang","doi":"10.2147/IDR.S541464","DOIUrl":"10.2147/IDR.S541464","url":null,"abstract":"<p><p><i>Legionella spp</i>. predominantly <i>Legionella pneumophila</i>, are recognized respiratory pathogens, while soft tissue infections caused by non-pneumophila species remain exceptionally rare. We present the first documented case of <i>L. maceachernii</i> soft tissue infection in an infant worldwide. The patient presented with fever accompanied by occipital, anterior thoracic, and wrist masses. Diagnosis was confirmed through metagenomic next-generation sequencing (mNGS) of tissue samples with histopathological correlation. Initial empiric therapy with vancomycin and cefotaxime yielded no clinical improvement. Subsequent mNGS analysis of cerebrospinal fluid and lesional tissue identified <i>L. maceachernii</i> infection, prompting targeted antimicrobial therapy with levofloxacin and rifampicin that resulted in clinical resolution. A review of historical cases reveals that <i>Legionella</i> soft tissue infections typically occur in immunocompromised hosts or those receiving immunosuppressive therapies, and this association prompted an investigation into possible congenital immunodeficiency in our patient. Whole exome sequencing coupled with Sanger sequencing validation identified a pathogenic mutation in the <i>IL2RG</i> gene, confirming X-linked severe combined immunodeficiency (X-SCID) in the infant and carrier status in the mother. This case highlights three paradigm-shifting concepts in pediatric infectious disease management, including 1) <i>L. maceachernii</i> should be included in the differential diagnosis of pediatric soft tissue infections refractory to standard therapy, 2) underlying immunodeficiency must be systematically evaluated in pediatric patients with atypical <i>Legionella</i> infections, and 3) the diagnostic utility of mNGS in identifying fastidious pathogens and underscore the importance of genomic investigations in elucidating immunological comorbidities.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4241-4248"},"PeriodicalIF":2.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952604","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":"Factors Influencing COVID-19 Viral Clearance: Implications for Vaccination and Antiviral Therapy.","authors":"Jia Zeng, Heping Xu, Shuai Luo, Xiaotian Zhou, Xishi Li, Yuwen Zeng, Yihan Wang, Haotian Jiang, Changfeng Lin, Chengfang Zheng, Jianwen Ruan, Weiling Yu, Jinjian Yao, Jiannong Zhao","doi":"10.2147/IDR.S515224","DOIUrl":"10.2147/IDR.S515224","url":null,"abstract":"<p><strong>Background: </strong>Understanding the factors influencing viral clearance in hospitalized COVID-19 patients, including vaccination status and antiviral therapy, is critical for optimizing clinical management.</p><p><strong>Methods: </strong>1,424 hospitalized COVID-19 patients retrospectively included from four tertiary hospitals in Hainan Province between March and December 2022. Viral clearance was defined as the interval from hospital admission to the first of two consecutive RT-PCR tests with Ct values ≥35. Clinical data, vaccination history, and antiviral treatment were collected. A generalized linear mixed model and Robust regression were used to assess viral clearance dynamics and their predictors.</p><p><strong>Results: </strong>Delayed viral clearance was independently associated with advanced age (<i>p</i> < 0.001), male sex (<i>p</i> = 0.006), hypertension (<i>p</i> < 0.001), coronary heart disease (<i>p</i> = 0.004), ICU admission (<i>p</i> < 0.001), and mechanical ventilation (<i>p</i> < 0.001).Patients receiving ≥2 inactivated vaccine doses had significantly higher baseline Ct values (median 29.75 vs 28.75, <i>p</i> = 0.014), shorter time to viral negativity (6.3 vs 7.4 days, p < 0.001), and reduced hospital stay (11.2 vs 12.7 days, <i>p</i> < 0.001). Among these, patients vaccinated ≥360 days prior had shortest negative conversion time (5.6 days) and shortest hospitalization (10.3 days).Antiviral therapy with Nirmatrelvir-ritonavir (N/R) accelerated viral clearance more effectively than Azvudine (2.29 vs 1.82 Ct/day, <i>p</i> = 0.045) and no antiviral treatment (1.88 Ct/day, <i>p</i> = 0.041), Although NAT-treated patients achieved viral negativity more rapidly (6.2 days, p = 0.013), N/R demonstrated superior clearance rate. Hospital stays were shorter with N/R than Azvudine (12.1 vs 13.5 days, <i>p</i> = 0.015).</p><p><strong>Conclusion: </strong>Viral clearance dynamics in hospitalized COVID-19 patients are influenced by age, comorbidities, vaccination, and antiviral treatment. Administration of ≥2 inactivated vaccine doses-especially ≥360 days apart-and early N/R therapy may accelerate viral clearance and reduce hospital stay.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4227-4240"},"PeriodicalIF":2.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952715","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}