BMC Infectious Diseases最新文献

{"title":"Leveraging large language models on free-text symptoms from participatory surveillance enhances pertussis forecasting in the United States.","authors":"Luigi De Angelis, Samuele Tarallo, Caterina Rizzo, Autumn Gertz, Francesco Baglivo, John S Brownstein, Benjamin Rader","doi":"10.1186/s12879-026-13452-x","DOIUrl":"https://doi.org/10.1186/s12879-026-13452-x","url":null,"abstract":"<p><strong>Background: </strong>Declines in childhood vaccination in the U.S. have contributed to a resurgence of vaccine-preventable diseases, including a notable increase in pertussis cases. Traditional pertussis surveillance is limited by underdiagnosis and underreporting. Participatory surveillance systems such as Outbreaks Near Me (ONM) provide an additional population-level data stream by capturing self-reported symptoms. Although pertussis signals are difficult to detect due to low incidence and symptom overlap with other infections, ONM collects free-text descriptions that may contain pertussis-specific information. Advances in large language models (LLMs) enable the extraction of relevant signals from unstructured text to potentially improve forecasting.</p><p><strong>Methods: </strong>We analyzed U.S. pertussis case data from the CDC and ONM reports from 2022 to 2025. ONM reports were filtered for prolonged cough without alternative diagnoses and further refined using a two-step GPT-4-based pipeline that summarized participant reports and excluded cases inconsistent with pertussis to enhance case specificity. Three datasets were created: CDC-only cases, CDC and ONM filtered cases, and CDC and ONM cases post-LLM processing. Aggregated time series were split into a training set (2022-2024) and a test set (2025, first 7 months). We trained multiple forecasting models (ARIMA, XG-Boost, and linear regression) on the 2022-2024 data, first using CDC-only data to establish a baseline. The best-performing model was then applied to the two datasets, incorporating the ONM participatory data. Performance was evaluated using Mean Absolute Error (MAE).</p><p><strong>Results: </strong>CDC-reported pertussis cases totaled 862 in 2022, 2,512 in 2023, 11,276 in 2024, and 5,937 in the first seven months of 2025. Of 2,741 ONM-suspected cases, 957 remained after LLM refinement. XGBoost yielded the best baseline performance (MAE 26.65). Incorporating ONM data improved performance: MAE decreased to 25.60 with filtered ONM cases and 24.69 with LLM-processed cases.</p><p><strong>Conclusions: </strong>Integrating LLM-processing of participatory surveillance data with traditional surveillance enhances the accuracy of pertussis outbreak forecasting. This approach introduces a novel way to leverage free-text data, offering a promising pathway to augment traditional public health surveillance systems.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832872","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":"Comparative effectiveness of ivermectin versus permethrin for the treatment of scabies: an updated systematic review and meta-analysis.","authors":"David Chinaecherem Innocent, Rejoicing Chijindum Innocent, Precious Ebube Anyakorah, Promise Somtochukwu Chukwuemeka, Chiamaka Eugene, Juliet Chinaza Anuwe, Olivia Udoka Udoh, Boris Chichebem Nwachukwu, Sophia Ifechidere Obani, Ikechukwu Nosike Simplicius Dozie, Uchechukwu Madukaku Chukwuocha, Dickson Ifeanyi Okwara, Jude Eguolo Moroh, Tamunowengifiri Charles George, Allen-Adebayo Blessing, Jaiyeoba-Ojigho Jennifer Efe","doi":"10.1186/s12879-026-13451-y","DOIUrl":"https://doi.org/10.1186/s12879-026-13451-y","url":null,"abstract":"<p><strong>Background: </strong>Scabies is a highly contagious parasitic skin disease and a recognised neglected tropical disease with substantial global burden. Permethrin and ivermectin are widely used treatments, yet uncertainty remains regarding their comparative effectiveness.</p><p><strong>Aim: </strong>To systematically evaluate and compare the effectiveness of ivermectin versus permethrin for the treatment of scabies in humans.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing ivermectin with permethrin were identified through searches of PubMed, Embase, Cochrane CENTRAL, Scopus, CINAHL, and ClinicalTrials.gov. Risk of bias was assessed using the updated Cochrane Risk of Bias tool (RoB 2). A random-effects meta-analysis was performed using RevMan version 5.4.1 Only peer-reviewed RCTs involving human participants with clinically diagnosed scabies were included.</p><p><strong>Results: </strong>Seven studies involving 1,216 participants were included. Compared with permethrin, ivermectin was associated with a lower probability of clinical cure at final follow-up (RR = 0.93, 95% CI 0.86-0.99; I² = 61%) and a higher risk of treatment failure (RR = 1.52, 95% CI 1.06-2.20; I² = 0%).</p><p><strong>Conclusion: </strong>Permethrin demonstrates a modest advantage over ivermectin in achieving clinical cure and reducing treatment failure. Ivermectin remains a useful alternative where topical therapy is unsuitable, but optimised dosing regimens are essential.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832518","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":"Mycobacterium shinjukuense pulmonary disease in a young woman: a case report and literature review.","authors":"Siwei Gu, Chunlei Wang, Binghuai Lu, Xiaojing Cui","doi":"10.1186/s12879-026-13446-9","DOIUrl":"https://doi.org/10.1186/s12879-026-13446-9","url":null,"abstract":"<p><strong>Background: </strong>Mycobacterium shinjukuense is a rare type of non-tuberculous mycobacterium (NTM) first reported in Japan. Reported cases of Mycobacterium shinjukuense pulmonary diseases are rare where hosts exhibited apparent risk factors for NTM infection. No consensus has been made on its treatment regimen.</p><p><strong>Case presentation: </strong>We report a case of Mycobacterium shinjukuense pulmonary disease in a previously healthy young woman presented as focal bronchiectasis and nodules. The diagnosis was established with 16S rRNA sequencing on bronchoalveolar lavage fluid mycobacterium culture. The patient was successfully treated with a thrice-a-week regimen of azithromycin, isoniazid and rifampicin. Whole-exome sequencing revealed mutations in TNFRSF13B and TLR2.</p><p><strong>Conclusion: </strong>The presence of Mycobacterium shinjukuense pulmonary disease was confirmed in China. Macrolide, rifampicin and isoniazid was effective in treatment of Mycobacterium shinjukuense pulmonary disease. Genetic susceptibility to NTM should be considered in young patients without apparent risk factors.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833030","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":"Review on pertussis case definitions: a need for reliable disease surveillance.","authors":"Jana Zumstein, Ulrich Heininger","doi":"10.1186/s12879-026-13509-x","DOIUrl":"https://doi.org/10.1186/s12879-026-13509-x","url":null,"abstract":"<p><strong>Background: </strong>Existing clinical case definitions of pertussis are decades old and mainly rely on clinical signs and symptoms in infants and children. In the recent past, an age shift of pertussis towards adolescents and adults has been noted and disease presentation often is different from that in children. Therefore, in 2011 the Global Pertussis Initiative (GPI) proposed an age-stratified case definition, but its uptake has been slow. This prompted members of the GPI steering committee to critically review the case definition. In preparation for this, we performed a review to learn which case definitions have been used worldwide.</p><p><strong>Methods: </strong>We performed a narrative literature review to collect publications from January 1, 1975, to September 1, 2025, which include pertussis case definitions. This was complimented by a survey amongst GPI members to gather case definitions currently in use for pertussis surveillance in their countries.</p><p><strong>Results: </strong>The literature review identified 117 relevant publications. The two most often used case definitions were those proposed by CDC and WHO, followed by individual case definitions developed by the respective investigators for the purpose of their studies. Additionally, GPI members provided 16 country-specific surveillance case definitions. Cough and typical pertussis signs paroxysms, whooping and post-tussive vomiting are most commonly used clinical criteria. With regards to laboratory confirmation of B. pertussis infection, all case definitions require at least one criterion, most often a positive culture and/or PCR, followed by specific serology. Most case definitions do not use age-specific criteria.</p><p><strong>Discussion: </strong>Many different case definitions are in use all over the world. Most of them are focusing on the typical presentation of pertussis, i.e. disregarding less typical disease presentations and do not use age-specific criteria. This hampers a reliable and comparable disease surveillance. Therefore, a harmonized case definition that could be used globally would be highly welcome.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833003","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":"First case report of concurrent infection with Cupriavidus gilardii and Yarrowia lipolytica following esophageal stenosis resection and anastomosis in a newborn.","authors":"Mengyang Liu, Yujing Wang, Jingzhuo Guo, Shiying Sun","doi":"10.1186/s12879-026-13515-z","DOIUrl":"https://doi.org/10.1186/s12879-026-13515-z","url":null,"abstract":"<p><strong>Background: </strong>Cupriavidus gilardii and Yarrowia lipolytica are recognized as opportunistic pathogens with a low incidence of human infections. Notably, cases involving concurrent infection by these two pathogens have not been previously documented in the literature.</p><p><strong>Case presentation: </strong>We present a case of a 1-month-old male neonate who developed concurrent infection with C. gilardii and Y. lipolytica following surgical resection and anastomosis for congenital esophageal stenosis. The patient developed a postoperative pulmonary infection and subsequent microbiological culture of thoracic drainage fluid confirmed the presence of both C. gilardii and Y. lipolytica. Based on the results of antimicrobial susceptibility testing (AST), the neonate was treated with a combined antimicrobial regimen comprising cefoperazone/sulbactam and fluconazole, and resulting in full clinical and microbiological recovery.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this is the first reported case of a human co-infected with C. gilardii and Y. lipolytica. The clinical course of this case underscores the indispensable role of microbiological laboratory diagnostics in facilitating accurate diagnosis and informing targeted therapeutic strategies. Timely identification and confirmation of pathogen, combined with in vitro AST, can provide active guidance for anti-infective therapy. For immunocompromised patients, high-risk factors predisposing to nosocomial infections such as intubation should be eliminated as soon as possible. Such systematic approaches are essential to avert significant therapeutic delays, prevent clinical deterioration, and avoid futile treatments attributable to unidentified or misidentified pathogens.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832907","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":"C-reactive protein as a predictor of mortality in tuberculosis: systematic review and meta-analysis.","authors":"Jessica Edelyne, Muhammad Prasetio Wardoyo, Luthfiyah Zanida Putri, Salsabila Hulwani, Assica Permata Amalya Hakiman, R Muhammad Kevin Baswara, Yogik Onky Silvana Wijaya, Erlina Burhan","doi":"10.1186/s12879-026-13462-9","DOIUrl":"https://doi.org/10.1186/s12879-026-13462-9","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a leading cause of global mortality, underscoring the need for accessible prognostic tools. C-reactive protein (CRP) is a widely available acute-phase biomarker that may predict outcomes in TB. This systematic review and meta-analysis assessed the prognostic value of baseline CRP in predicting mortality among adults with TB.</p><p><strong>Methods: </strong>Eligible studies included cohort studies, observational studies, and control arms of randomized controlled trials involving adults (≥ 18 years) with microbiologically confirmed TB. The exposure of interest was baseline CRP level, and the primary outcome was mortality, reported as adjusted hazard ratios (aHRs) or odds ratios (aORs). Data extraction followed the CHARMS-PF checklist. Risk of bias was assessed using the QUIPS, while certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>From 1,277 records, nine studies met the inclusion criteria (three retrospective cohorts, three prospective cohorts, and three case-control studies) conducted in Japan, China, South Korea, Chinese Taipei, and South Africa. Five studies reported significant associations between elevated baseline CRP and increased mortality. In pooled analyses, three studies reporting aORs showed a modest but statistically significant association between higher baseline CRP and mortality (aOR 1.07, 95% CI 1.03-1.11; I²=0%). In contrast, pooled aHRs from four studies (aHR 1.02, 95% CI 0.99-1.05; I²=60%) and pooled cHRs from two studies (cHR 1.75, 95% CI 0.58-5.29; I²=91%) were not statistically significant.</p><p><strong>Conclusions: </strong>Baseline CRP showed a modest association with mortality in pooled aOR analyses, but not in pooled hazard ratio analyses. Nevertheless, its low cost and wide availability suggest potential utility as part of multimodal prognostic models, especially in high-risk populations and resource-limited settings. High-quality prospective studies with standardized CRP protocols are needed to clarify its prognostic role.</p><p><strong>Registration: </strong>PROSPERO (CRD420251101984).</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832645","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":"Symptomatic candiduria in neonates, infants, and pediatric patients admitted to ICUs: Epidemiology, risk factors, clinical symptoms, and outcomes of empirical antifungal therapy.","authors":"Marjan Motamedi, Niloofar Shaabani, Ahmad Jabrodini, Mojtaba Shafiekhani, Somayeh Yazdanpanah, Esmaeil Eghtedarnejad, Neda Amirzadeh","doi":"10.1186/s12879-026-13493-2","DOIUrl":"https://doi.org/10.1186/s12879-026-13493-2","url":null,"abstract":"<p><p>Candiduria, defined as the presence of Candida spp. in urine, is more common among hospitalized patients, particularly those admitted to intensive care units (ICUs). This study aimed to determine the epidemiology, associated risk factors, clinical symptoms, ultrasound findings, and outcomes of empirical antifungal therapy in neonates, infants, and pediatric patients with symptomatic candiduria admitted to neonatal ICU (NICU) and pediatric ICU (PICU) in southern Iran. In this retrospective cross-sectional study, medical records of neonates, infants, and pediatric patients with candiduria admitted to the NICU and PICU of two tertiary-care hospitals in Shiraz, Iran, between March 2012 and March 2022 were reviewed. Data were extracted from the hospital information system. Among 19,900 ICU admissions (3,471 neonates; 4,810 infants; and 11,619 pediatric patients), 400 patients (2.01%) were diagnosed with candiduria. The prevalence was 2.18% (n = 76) in neonates, 1.58% (n = 76) in infants, and 2.13% (n = 248) in pediatric patients. Prematurity was the most common risk factor among neonates (29, 38.15%), whereas urinary catheterization was predominant in infants (41, 53.94%) and history of bacterial urinary tract infection in pediatric patients (165, 66.53%). Hydronephrosis (176, 44%) was the most frequent ultrasound finding. Most patients had an ICU stay of 1-5 days (335, 83.75%), and candiduria was typically diagnosed within the first three days of ICU admission. Fluconazole was the primary empirical antifungal agent, while amphotericin B was administered in selected cases. All patients achieved complete clinical and microbiological resolution following treatment. Our findings indicate that history of bacterial urinary tract infection, urinary catheterization, antibiotic exposure, poor feeding, and hydronephrosis are important predisposing factors for candiduria in critically ill neonates, infants, and pediatric patients. Fluconazole appears to be an effective first-line empirical therapy in this population.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833009","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":"Prevalence of anti-HBc and anti-HBs among blood donors in Guangzhou: implications for HBV screening strategies in China.","authors":"Zhengang Shan, Min Wang, Ru Xu, Fenfang Liao, Qiao Liao, Jieting Huang, Bochao Liu, Huishan Zhong, Yongshui Fu, Huaqin Liang, Xia Rong","doi":"10.1186/s12879-026-13487-0","DOIUrl":"https://doi.org/10.1186/s12879-026-13487-0","url":null,"abstract":"<p><strong>Background & aims: </strong>In China, blood donations are routinely screened for both HBsAg and HBV DNA to prevent transfusion-transmitted hepatitis B virus (HBV) infection. However, the benefit of implementing universal anti-HBc screening to intercept occult HBV infection remains debated, primarily due to concerns over donor loss and cost-effectiveness. This study aimed to assess the prevalence of anti-HBc among blood donors in Guangzhou and to evaluate whether the current HBV screening strategy in China requires further optimization.</p><p><strong>Methods: </strong>In this study, we enrolled 25,056 voluntary blood donors who tested negative for both HBsAg and HBV DNA. All samples were first screened for anti-HBc using ELISA. A subset of positive samples was then retested with an electrochemiluminescence (ECL) assay. Subsequently, quantitative anti-HBs testing was performed on samples that were positive by both assays, and those that were anti-HBs-negative underwent HBV RNA testing.</p><p><strong>Results: </strong>The initial anti-HBc-positive rate was 27.1% (6795/25,056), which exhibited a strong age-dependent increase but showed no association with gender. Of the 1343 samples that underwent retesting, 82.1% (1102/1343) were confirmed positive. Among the double-positive samples, 91.2% (990/1085) were also anti-HBs positive, and 53.5% (580/1085) presented with anti-HBs levels ≥ 200 IU/L. No statistically significant difference in anti-HBs levels was observed between genders or across age groups. Furthermore, HBV RNA was not detected in any of the 95 anti-HBs-negative samples tested.</p><p><strong>Conclusion: </strong>The high prevalence of anti-HBc, coupled with a substantial proportion of donors having protective levels of anti-HBs, suggests that the incremental benefit of universal anti-HBc screening in Guangzhou's current donor population may be limited. While implementing such assays is not considered feasible at present, future declines in prevalence of HBV infection may warrant a re-evaluation and optimization of the screening strategy.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832983","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":"Audit of antibiotic prescribing practices for pediatric pneumonia in the outpatient department: focus on amoxicillin and azithromycin.","authors":"Waqar Ahmed, Iqrar Ali, Sheeraz Ahmed, Samina Naz, Bela Bashir, Zarrish Shabbir, Muhammad Kashif Khaskheli, Heera Nand, Habibullah Maitlo, Fatimah Unar, Fareeda Bhanbhro","doi":"10.1186/s12879-026-13372-w","DOIUrl":"https://doi.org/10.1186/s12879-026-13372-w","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic overuse in childhood pneumonia contributes significantly to antimicrobial resistance, particularly in low- and middle-income countries (LMICs). This clinical audit evaluated outpatient antibiotic prescribing practices, implemented targeted educational interventions, and assessed improvements in the appropriateness of prescribing.</p><p><strong>Methods: </strong>A two-cycle clinical audit was conducted at the Children Hospital, Sukkur (SICHN), Pakistan. Children under 15 years diagnosed with pneumonia by treating clinicians in the outpatient department were included during pre-audit (n = 132) and post-audit (n = 153) phases. The audit focused on patients who received antibiotics, evaluating appropriateness in terms of choice, dose, and duration according to WHO AWaRe and IMNCI guidance. Educational sessions and real-time feedback were provided between audit cycles. Data on demographics, clinical features, antibiotic prescriptions, and follow-up were analyzed.</p><p><strong>Results: </strong>Overall antibiotic prescribing remained high (116/132 [87.9%] pre-audit vs. 135/153 [88.2%] post-audit). However, prescribing quality improved substantially. Amoxicillin use increased from 26/132 (19.7%) to 119/153 (77.8%), with appropriate prescribing rising from 1/26 (3.8%) to 96/119 (80.7%). Azithromycin use decreased from 66/132 (50.0%) to 5/153 (3.3%), with appropriate use improving from 20/66 (30.3%) to 4/5 (80.0%). Documentation practices improved, although objective diagnostic criteria were inconsistently recorded. Follow-up rates remained low (~ 15%), but most returning patients showed clinical improvement.</p><p><strong>Conclusion: </strong>Structured audit and feedback significantly improved the appropriateness of antibiotic prescribing for children diagnosed with pneumonia in outpatient settings. While overall prescribing rates remained unchanged, a marked shift toward guideline-recommended antibiotic use highlights the effectiveness of stewardship-focused interventions in resource-limited, real-world clinical environments.</p><p><strong>Clinical trial registration: </strong>This study was a clinical audit and not an interventional clinical trial.</p><p><strong>Clinical trial number: </strong>not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833098","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":"Age and comorbidity in COVID-19 mortality: a retrospective cohort study using multivariable regression and interaction analyses.","authors":"Nuha Al-Aghbari, Arif Maldar, Mubashir Angolkar","doi":"10.1186/s12879-026-13497-y","DOIUrl":"https://doi.org/10.1186/s12879-026-13497-y","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) has significantly increased mortality worldwide, with advanced age and comorbidity burden has been identified as a major risk factors. However, the combined effect of age and comorbidity burden on COVID-19 mortality remains unclear. This study aimed to assess the independent and interactive effects of age and comorbidity burden on in-hospital mortality from COVID-19.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted among 642 laboratory-confirmed COVID-19 patients admitted to a tertiary care hospital in Belagavi, Karnataka, India, between October 2020 and September 2021. Bivariate analysis, multivariable logistic regression, and interaction analysis were performed to examine associations with mortality.</p><p><strong>Results: </strong>Patients aged ≥ 50 years had significantly higher odds of mortality compared to those aged < 50 years (AOR = 2.01, 95% CI: 1.27-3.16, p = 0.002). Dyspnea (AOR = 2.88, 95% CI: 1.85-4.48, p < 0.001) and kidney disease (AOR = 6.56, 95% CI: 2.39-18.02, p < 0.001) were significant predictors of mortality. Blood glucose (per 10 mg/dL increase; AOR = 1.03, 95% CI: 1.01-1.05, p < 0.001) and pulse rate (per bpm increase; AOR = 1.02, 95% CI: 1.01-1.03, p < 0.001) were also significantly associated with mortality. Multimorbidity was not independently associated with mortality in the main model (AOR = 1.63, 95% CI: 0.67-4.00, p = 0.278). In the interaction model, no statistically significant interaction between age and multimorbidity was observed. However, predicted probabilities suggested a higher mortality risk among older patients with multimorbidity compared to other groups.</p><p><strong>Conclusion: </strong>Advanced age, dyspnea, kidney disease, elevated blood glucose, and pulse rate are significant predictors of COVID-19 mortality. While multimorbidity may contribute to mortality risk, no strong evidence of interaction between age and comorbidity burden was observed. These findings highlight the importance of comprehensive risk stratification using multiple clinical factors in hospitalized COVID-19 patients.</p><p><strong>Clinical trial: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833110","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}