Journal of Infection and Public Health最新文献

{"title":"Impact of point-of-care PCR testing on antibiotic prescribing in pediatric outpatients with acute respiratory infections: A randomized clinical trial","authors":"Ya-Nan Li ,&nbsp;Juan Lv ,&nbsp;Jun Zhou ,&nbsp;Tian-Ming Chen ,&nbsp;Yu-Chuan Li ,&nbsp;Wei-Hua Zhang ,&nbsp;Cheng-Feng Gao ,&nbsp;Xiao-Lu Nie ,&nbsp;Xiao-Xia Peng ,&nbsp;Bing Hu ,&nbsp;Ling-Yun Guo ,&nbsp;Xue Ning ,&nbsp;Zhen-Zhen Dou ,&nbsp;Xin Guo ,&nbsp;Lin-Lin Liu ,&nbsp;Bing Liu ,&nbsp;Yue Xie ,&nbsp;Hai-Juan Xiao ,&nbsp;Jing Liu ,&nbsp;Cheng-Song Zhao ,&nbsp;Gang Liu","doi":"10.1016/j.jiph.2025.102847","DOIUrl":"10.1016/j.jiph.2025.102847","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory pathogen diagnosis has been recommended as a core element of outpatient antibiotic stewardship in the United States since 2016, and it has shown effective results. However, its implementation is mainly in developed countries, with limited research in developing countries, particularly among children.</div></div><div><h3>Methods</h3><div>We conducted a randomized, parallel-controlled clinical trial in the outpatient department of a tertiary children's hospital between July 2023 and November 2023. Participants with symptoms or signs of acute respiratory infections (ARTIs) as their chief complaint and illness duration of 7 days or less were screened for eligibility and randomized (1:1) to receive point-of-care (POC) PCR testing or routine care only. The primary outcome was the proportion of patients prescribed antibiotics on the day of enrollment. Secondary outcomes included the types of antibiotics prescribed and the time to fever resolution. Log-binomial regression models to estimate relative risks (RR) and their 95 % confidence intervals (CI) for the primary and secondary outcomes.</div></div><div><h3>Results</h3><div>We assessed 1871 patients with ARTIs for eligibility, and 1000 were finally included. Compared with the control group, the implementation of the POC PCR resulted in an 11 % reduction in antibiotic prescriptions in the intervention group (RR, 0.83; [95 %CI, 0.75–0.92]), of which antibiotics reduced 10.8 % in the “watch” group. Time to fever resolution and hospitalization rates showed no significant differences.</div></div><div><h3>Conclusions</h3><div>The POC PCR testing effectively reduced antibiotic prescriptions in pediatric patients with ARTIs, without compromising patients' clinical outcomes, enhancing the evidence that it is a promising tool for antibiotic stewardship.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102847"},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194451","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":"RPA-CRISPR/Cas12a detection based on HCMV-UL123 gene: A way with higher detection rate than clinical detection methods","authors":"Tianyang Liu ,&nbsp;Yao Wang ,&nbsp;Zihao Liao ,&nbsp;Xiaowen Li ,&nbsp;Shanshan Tang ,&nbsp;Zhongming Zhang ,&nbsp;Ming Chu ,&nbsp;Lanlan Wei","doi":"10.1016/j.jiph.2025.102845","DOIUrl":"10.1016/j.jiph.2025.102845","url":null,"abstract":"<div><h3>Objective</h3><div>Human cytomegalovirus (HCMV), a prevalent double-stranded DNA enveloped virus, poses a threat to immunocompromised individuals. The current clinical detection methods are insufficient in sensitivity, highlighting the need for more effective approaches.</div></div><div><h3>Methods</h3><div>We designed and screened RPA primers and crRNA based on the UL123 gene of HCMV. Evaluate the HCMV-RPA-CRISPR detection method using cloned plasmids and the whole-genome samples of HCMV-infected cells. Conduct RPA-CRISPR/Cas12a reactions with 48 clinical samples and compare the results with those of PCR-Fluorescent Probe Method in clinical applications and the qPCR method for detecting the UL123 gene.</div></div><div><h3>Results</h3><div>The optimized RPA-CRISPR system exhibited high sensitivity and specificity for HCMV detection. The positive rate of clinical sample detection was approximately 20.5 % (6/48) higher than that of the clinical detection method.</div></div><div><h3>Conclusion</h3><div>Currently, the sensitivity and early detection of HCMV in clinical settings are still limited. The UL123 gene of HCMV is characterized by high transcription in the early stage and high conservation. The RPA-CRISPR/Cas12a technology exhibits high sensitivity in detecting the HCMV UL123 gene, and it is expected to provide a more effective method for the early specific detection of HCMV infection.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102845"},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195013","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":"Suppressing lipid biosynthesis in Mycobacterium tuberculosis through polyketide synthase 13 thioesterase inhibition: Insights from computational analysis","authors":"Maha M. Alawi ,&nbsp;Hattan S. Gattan ,&nbsp;Azzah S. Alharbi ,&nbsp;Mohammed H. Alruhaili ,&nbsp;Ibrahim A. Al-Zahrani ,&nbsp;Saad B.AL Masaud ,&nbsp;Vivek Dhar Dwivedi ,&nbsp;Esam I. Azhar","doi":"10.1016/j.jiph.2025.102835","DOIUrl":"10.1016/j.jiph.2025.102835","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a global health challenge, particularly with the emergence of multidrug-resistant and extensively drug-resistant strains. Mycolic acid biosynthesis is essential for the integrity of Mtb's cell wall, offering promising therapeutic intervention targets. The thioesterase domain of polyketide synthase 13, Pks13-TE, is at the heart of this pathway and, therefore, an attractive drug target.</div></div><div><h3>Methods</h3><div>1228 natural compound libraries were computationally screened to identify the most potentially active Pks13-TE inhibitors. In silico virtual screening was done on top candidates using MTiOpenScreen based on binding affinity. The molecular dynamics simulation was applied to analyze the structural properties in terms of stability, compactness, and flexibility of the post-validation of the docking result. The MMGBSA method was used to calculate the binding-free energy. Further conformational landscape analysis was applied using FEL.</div></div><div><h3>Results</h3><div>Three such promising compounds were identified: ZINC000008214766, ZINC000006845076, and ZINC000253498755. The compound ZINC000008214766 showed the most favorable binding interactions by making multiple hydrogen bonds and van der Waals contacts with Pks13-TE active site residues. MD simulations have revealed that it is consistently stable with minimal fluctuations and compact conformation. The MM/GBSA analysis confirmed its superior binding energetics compared to other candidates. The FEL analysis highlighted narrow and deep minima for ZINC000008214766, indicating strong conformational stability. Properties of ZINC000006845076 and ZINC000253498755 followed moderate binding but low stability.</div></div><div><h3>Conclusions</h3><div>The study underlines the possibility of ZINC000008214766 acting as a potential lead compound in inhibiting Pks13-TE and presents a new therapeutic strategy against TB. These results also highlight the use of a computational workflow in drug discovery and give cause for belief that natural compounds can win the battle against resistant TB. Further in vitro and in vivo studies are warranted to validate these findings.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102835"},"PeriodicalIF":4.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194938","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":"Microbiological and clinical epidemiology of cryptococcosis in non-HIV Korean patients: 4-year collection","authors":"Bosung Park ,&nbsp;Eunsang Suh ,&nbsp;Yeseul Choi ,&nbsp;Tae Yeul Kim ,&nbsp;Eun Jeong Won ,&nbsp;Hee Jae Huh ,&nbsp;Heungsup Sung ,&nbsp;Mi-Na Kim","doi":"10.1016/j.jiph.2025.102842","DOIUrl":"10.1016/j.jiph.2025.102842","url":null,"abstract":"<div><h3>Background</h3><div>Cryptococcosis causes a high burden of disease worldwide; however, it has been relatively rare in Korea, where data on its prevalence and clinical characteristics remain limited. This study aimed to characterize the microbiological features of clinical cryptococcal isolates and to investigate the clinical profiles of HIV-negative patients with cryptococcosis in South Korea.</div></div><div><h3>Methods</h3><div>Clinical isolates of <em>Cryptococcus</em> species were collected from two university hospitals in South Korea (about 5000 beds, in total) over a 4-year period. Species identification, multilocus sequence typing, and antifungal susceptibility testing were performed. Clinical features of cryptococcosis and prognostic factors for 30-day mortality were analyzed by univariate and multivariate logistic regression analysis.</div></div><div><h3>Results</h3><div>A total of 40 nonduplicate isolates from 39 patients during the study period and sequencing confirmed 38 isolates of <em>C. neoformans</em> and 2 isolates of <em>C. deuterogatii</em>. MLST analysis of <em>C. neoformans</em> identified 35 isolates as ST5, along with single isolates of ST2, ST15, and a newly discovered sequence type, ST707. The percentages of non-wild type to amphotericin B, 5-fluorocytosine, fluconazole, itraconazole, voriconazole, and posaconazole were 10.0 %, 4.0 %, 8.0 %, 6.0 %, 2.0 %, and 8.0 %, respectively. However, the two isolates of <em>C. deuterogatii</em> exhibited a wild type phenotype for all the aforementioned antifungal agents. Overall, the cumulative 30-day mortality rate was 41.0 % (16/39). Univariate analysis showed that total parenteral nutrition, severe sepsis, intensive care unit admission, vasopressor use, acute renal failure, and underlying chronic kidney disease (CKD) were risk factors for 30-day mortality, and azole therapy was the protective factor. Finally, CKD was the independent risk factor for 30-day mortality by multivariate analysis. No significant differences were observed in patient survival across sequence type of isolates.</div></div><div><h3>Conclusions</h3><div>This study showed that ST5 was the predominant genotype of <em>C. neoformans</em> in South Korea and CKD significantly increased the risk of 30-day mortality of cryptococcosis.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102842"},"PeriodicalIF":4.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204722","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":"The potential role of probiotics and their bioactive compounds in the management of pulmonary tuberculosis","authors":"Hamed Memariani ,&nbsp;Mojtaba Memariani ,&nbsp;Seyed Ebrahim Eskandari ,&nbsp;Abdolmajid Ghasemian ,&nbsp;Ali Nour Neamatollahi","doi":"10.1016/j.jiph.2025.102840","DOIUrl":"10.1016/j.jiph.2025.102840","url":null,"abstract":"<div><div>The significance of gut microbiota in human health is well recognized, yet its effects on pulmonary infectious diseases like tuberculosis (TB) are not thoroughly comprehended. While anti-TB drugs and preventive strategies are indispensable, the incorporation of adjunct therapies, including probiotics and their bioactive compounds, could provide potential biotherapeutic benefits. This review strives to collate the recent experimental and clinical investigations into the manipulation of the gut microbiome through probiotics, exploring their potential to sustain eubiosis, enhance recovery from TB, and mitigate the adverse effects of anti-TB therapies. The multi-pronged mechanisms by which probiotics act against <em>M. tuberculosis</em> include their immunomodulatory properties, the promotion of autophagy, direct inhibition of the pathogen growth via bacteriocin production, the reduction of adverse effects from anti-TB drugs, and a diminished risk of comorbidities. Future research should prioritize high-quality randomized controlled trials that integrate omics with personalized microbiome-based therapeutic approaches to combat TB.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102840"},"PeriodicalIF":4.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204795","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":"Mpox outbreak response: Regulatory and public health perspectives from India and the world","authors":"Ritu Tiwari ,&nbsp;Poornima Gulati ,&nbsp;Rajeev Singh Raghuvanshi","doi":"10.1016/j.jiph.2025.102839","DOIUrl":"10.1016/j.jiph.2025.102839","url":null,"abstract":"<div><h3>Background</h3><div>Mpox, formerly known as Monkeypox, has re-emerged as a significant global health concern, marked by its unexpected geographic spread and evolving clinical profile. Initially endemic to Central and West Africa, recent outbreaks have underscored its potential for sustained human-to-human transmission, posing challenges to public health systems worldwide.</div></div><div><h3>Objective</h3><div>This paper aims to examine the global epidemiology and impact of Mpox, while also highlighting the responses from regulatory bodies and public health organizations worldwide. Additionally, it seeks to evaluate India's strategic approaches to addressing this issue, identify existing research gaps, and propose future directions to enhance global health preparedness.</div></div><div><h3>Methods</h3><div>A comprehensive review of peer-reviewed literature, WHO reports, and national policy documents was conducted to synthesize current knowledge on Mpox transmission, global and regional responses, and regulatory compliance along with shifting geopolitical landscape and India’s potential for expanded global health leadership.</div></div><div><h3>Results</h3><div>The global response to Mpox has highlighted disparities in surveillance capacity, regulatory readiness, and access to diagnostics and vaccines. While international mechanisms such as the International Health Regulations (IHR 2005) facilitated coordinated responses, implementation varied across regions. India’s response has demonstrated adaptability through surveillance enhancements, diagnostic scale-up, and alignment with WHO guidelines, although challenges remain in areas such as vaccine availability and risk communication.</div></div><div><h3>Conclusion</h3><div>Mpox inspires a call for stronger global health governance and resilient national systems. By addressing research gaps in transmission, vaccine development, and regulations, while embracing a One Health approach and promoting regulatory harmonization and equitable resource distribution, we can pave the way for a future that prevents outbreaks and ensures the health security of our global community.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102839"},"PeriodicalIF":4.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231075","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":"Alterations in the intestinal fungal microbiome of patients with severe fever with thrombocytopenia syndrome","authors":"Meng-Yu Liu ,&nbsp;Sheng-Fu He ,&nbsp;Yu-Yao Li ,&nbsp;Jiao-Jiao Shen ,&nbsp;Jia-Jia Li ,&nbsp;Ya-Sheng Li ,&nbsp;Yan-Yan Liu ,&nbsp;Ting Wu ,&nbsp;Jia-Bin Li ,&nbsp;Li-Fen Hu","doi":"10.1016/j.jiph.2025.102837","DOIUrl":"10.1016/j.jiph.2025.102837","url":null,"abstract":"<div><h3>Background</h3><div><em>Aspergillus</em> coinfection in patients with severe fever with thrombocytopenia syndrome (SFTS), is a serious clinical challenge associated with increased mortality. Understanding the factors contributing to this co-infection is crucial for improving patient outcomes. This study aimed to reveal the role of the intestinal mycobiome in SFTS severity and the risk of <em>Aspergillus</em> coinfection, with the goal of identifying potential therapeutic targets.</div></div><div><h3>Methods</h3><div>Fecal samples were collected from 80 patients both during their hospitalization and post-discharge. Internal transcribed spacer (ITS) amplicon sequencing and fungal profiling of intestine were performed. R statistical software (version 3.5.1) was used for data processing and analysis.</div></div><div><h3>Results</h3><div>The intestinal mycobiomes of SFTS patients showed strong alterations characterized by increased <em>Aspergillus</em> species, and a highly heterogeneous mycobiome configuration compared to healthy controls. The <em>Aspergillus</em> had a positive correlation with coinfection of invasive pulmonary aspergillosis (IPA) and disease severity of SFTS (<em>p</em> &lt; 0.001), whereas <em>Saccharomycetales</em> and <em>Candida</em> were more abundant in SFTS patients without IPA (<em>p</em> &lt; 0.001). In SFTS patients with IPA, <em>A. subversicolor</em>, <em>A. flavus</em> and <em>A. penicillioides</em> were the three most common fungal species. Longitudinal dynamic detection revealed that patients who experienced significant fluctuations in their intestinal mycobiome tended to have more severe illness. After recovering, the gut mycobiome of patients can recover and stabilize within a month.</div></div><div><h3>Conclusion</h3><div>The research highlighted enrichment of intestinal <em>Aspergillus</em> was conducive to IPA and disease severity in SFTS patients. Monitoring the gut mycobiome could potentially be used as a biomarker to assess disease severity of SFTS.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102837"},"PeriodicalIF":4.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231076","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":"Assessment of clinical effectiveness and safety of ceftazidime-avibactam in ‐treating multi-drug-resistant infections – A retrospective analysis at a tertiary care hospital in Saudi Arabia","authors":"Eman Merghani Ali ,&nbsp;Hanan A. Bakri ,&nbsp;Otilia J.F. Banji ,&nbsp;Amani Khardali ,&nbsp;Moaddey Alfarhan ,&nbsp;Hilal A. Thaibah ,&nbsp;Dalin A. Hassan ,&nbsp;Mohamed Eltaib Elmobark ,&nbsp;Anugeetha Thacheril Mohanan ,&nbsp;Mousa Mohammed Hassan Tawhari ,&nbsp;Zamzam O. Mashraqi ,&nbsp;Ahmed Hassan Suhaqi ,&nbsp;Majed Abdu Soliman Akam ,&nbsp;Rafat Fahad Mohammed Hawbani","doi":"10.1016/j.jiph.2025.102841","DOIUrl":"10.1016/j.jiph.2025.102841","url":null,"abstract":"<div><h3>Background</h3><div>The present study investigated the, effectiveness, safety and appropriateness of prescribing Ceftazidime-Avibactam (CAZ-AVI) to facilitate optimal clinical use and improve patient outcomes.</div></div><div><h3>Methods</h3><div>The retrospective study included 77 patients who received CAZ-AVI between June 2022 and October 2023. Data was extracted from the hospital's electronic records, and a questionnaire was used to gather information on care setting, medication history, therapies, dosage, treatment duration, adverse effects, culture site, microbiological response and appropriateness of CAZ-AVI prescriptions. <em>Chi</em>-squared analysis was performed, with p ≤ 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Males comprised 53.2 % of the study population. A substantial number of patients were in the ICU, with 84.4 % requiring mechanical ventilation. Carbapenem-resistant <em>Klebsiella pneumoniae</em> was the primary pathogen in 87 % of patients. A significant association was observed between the genotype and clinical improvement (χ² = 9.78, P = 0.024), with the Oxa-48 +NDM genotype (44.2 %) being the most prevalent. Clinical improvement was significantly associated with the duration of therapy (<em>P</em> = 0.001), with improvement seen in 46.8 % of patients after treatment for 8–14 days. Adding a second antibiotic to CAZ-AVI did not significantly improve clinical outcomes statistically (P = 0.054), with aztreonam being the frequently co-administered agent (36.4 %). However, its use did not result in superior efficacy or outcomes compared to other second-line antibiotics (P = 0.18). Microbiological assays showed no growth of organisms in 70.1 % of patients after seven days and no recurrence in 77.9 % of patients within 15–30 days of treatment. Adverse effects were absent in most patients, and Infectious Diseases specialists appropriately filled out 97.4 % of the prescription order forms.</div></div><div><h3>Conclusions</h3><div>CAZ-AVI use was associated with clinical improvement in carbapenem-resistant <em>Klebsiella pneumonia</em> infections. The low incidence of adverse effects and frequent prescriptions filled by ID specialists support the appropriateness of its use.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102841"},"PeriodicalIF":4.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212403","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":"Higher prevalence of hypervirulent Klebsiella pneumoniae isolates with high-risk multidrug resistance in Asia","authors":"Lin Gan ,&nbsp;Pan Mao ,&nbsp;Ziyan Tian ,&nbsp;Xin Li ,&nbsp;Zihui Yu ,&nbsp;Bing Du ,&nbsp;Guanhua Xue ,&nbsp;Chao Yan ,&nbsp;Jinghua Cui ,&nbsp;Hanqing Zhao ,&nbsp;Yanling Feng ,&nbsp;Junxia Feng ,&nbsp;Zheng Fan ,&nbsp;Tongtong Fu ,&nbsp;Ziying Xu ,&nbsp;Yang Yang ,&nbsp;Lijuan Huang ,&nbsp;Shuo Zhao ,&nbsp;Jing Yuan","doi":"10.1016/j.jiph.2025.102834","DOIUrl":"10.1016/j.jiph.2025.102834","url":null,"abstract":"<div><h3>Background</h3><div>The emergence of hypervirulent and antibiotic-resistant <em>Klebsiella pneumoniae</em> isolates poses a significant global public health threat, necessitating stringent prevention and control strategies on an international scale. However, current research efforts are often geographically restricted and lack integration of large-scale data analyses, limiting the understanding of the global prevalence and molecular epidemiology of <em>K. pneumoniae</em>. Furthermore, studies on hypervirulent <em>K. pneumoniae</em> (hvKp) have predominantly emphasized virulence traits, with limited exploration of their associations with molecular subtypes, such as sequence types (STs) and capsule types.</div></div><div><h3>Methods</h3><div>To address these gaps, a total of 55,684<em>K. pneumoniae</em> isolates collected across global regions, were applied in this study to investigate virulence factors, antimicrobial resistance profiles, molecular typing characteristics and the intrinsic connections between these features.</div></div><div><h3>Results</h3><div>Through the application of big data analytics, we generated a comprehensive global distribution map of <em>K. pneumoniae</em>, revealing a higher prevalence of hvKp isolates with high-risk multidrug resistance in Asia. Notably, sequence types ST23, ST65, and ST86 exhibited the highest proportions of hvKp isolates. Regional differences in the virulence potential of specific sequence types were associated with the presence of aerobactin, a key siderophore. Additionally, capsular type KL64 was identified as potentially correlated with hypervirulence.</div></div><div><h3>Conclusions</h3><div>This large-scale genomic surveillance offers critical insights into the global distribution and molecular epidemiology of <em>K. pneumoniae</em>, providing an evidence base for risk mapping and the formulation of tailored control strategies to mitigate the threat posed by this pathogen.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102834"},"PeriodicalIF":4.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204721","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":"Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia","authors":"Yi-Tsung Lin ,&nbsp;Shih-Neng Lin ,&nbsp;Chien Chuang ,&nbsp;Szu-Yu Liu ,&nbsp;Yu-Chien Ho ,&nbsp;Chih-Han Juan ,&nbsp;Hsiang-Ling Ho ,&nbsp;Sheng-Hua Chou","doi":"10.1016/j.jiph.2025.102836","DOIUrl":"10.1016/j.jiph.2025.102836","url":null,"abstract":"<div><h3>Background</h3><div>Ceftazidime-avibactam (CZA) is the preferred treatment for infections caused by carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP). This study aimed to investigate the prognostic factors of 28-day mortality and 14-day clinical failure in patients treated with CZA for CZA-susceptible CRKP bacteremia.</div></div><div><h3>Methods</h3><div>Patients with CZA-susceptible CRKP bacteremia who received CZA for a minimum of 5 days at our hospital from February 2020 to September 2023 were enrolled. The resistance mechanisms of the CRKP isolates were determined. Cox regression analysis was used to analyze the factors associated with 28-day mortality, and logistic regression was used to study 14-day clinical failure.</div></div><div><h3>Results</h3><div>A total of 135 adults who received CZA for CRKP bacteremia were identified. Among the CRKP isolates, 85 (63.0 %) were KPC-2 producers and 17 (12.6 %) were OXA-48 producers. Monotherapy with CZA was identified in 98 cases (72.5 %). The 28-day mortality rate was 28.1 %, and the 14-day clinical failure rate was 41.5 %. In multivariate analysis, 28-day mortality was positively associated with older age, malignancy, and INCREMENT score ≥8. Charlson comorbidity index and the SOFA score were independent predictors of 14-day clinical failure. Among patients with SOFA score &gt;6, malignancy was an independent risk factor for 28-day mortality, and early initiation of CZA therapy within 4 days was a protective factor against 28-day mortality.</div></div><div><h3>Conclusion</h3><div>Older age, malignancy, and INCREMENT score ≥8 are predictors for mortality in CZA-susceptible CRKP bacteremia treated with CZA. Early treatment with CZA is associated with survival in patients with high disease severity.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 9","pages":"Article 102836"},"PeriodicalIF":4.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195457","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}