RESUMEN
Multi-resistant bacteria such as Escherichia coli and Klebsiella pneumoniae are a growing threat worldwide. The spread of Carbapenemase-producing strains is particularly worrying. New antibiotics and combination therapies offer treatment options, but the development of resistant pathogens remains a major challenge.
Asunto(s)
Antibacterianos , Farmacorresistencia Bacteriana Múltiple , Humanos , Antibacterianos/uso terapéutico , Klebsiella pneumoniae/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiologíaRESUMEN
The presence of transmissible disease in livestock has a major impact on welfare and economics in animal and public health. A lack of data enables the spread of diseases due to misinformed decision-making on prevention and control. Low-resource settings face challenges in providing data, turning data availability into a development issue. For this study, a large dataset (n = 997) was collected on prevalence and seroprevalence estimates on viral (n = 224), bacterial (n = 83) and parasitic (n = 690) diseases in backyard chickens in low- and middle-income countries (LMICs). These estimates originate from 306 studies identified during the screening phase of a systematic literature review. An attempt was made to classify the studies according to the Food and Agriculture Organization of the United Nations'classification system for family poultry production systems. Of the studies, 98.7% (302/306) focused on a single poultry production system, while 1.3% (4/306) targeted two different production systems. Within the group of studies that covered one production system, 85.4% (258/302) were classified as âËsmall extensive scavenging or extensive scavenging,'âËsmall extensive scavenging'and/or âËextensive scavenging'. In addition, 52% (159/306) of the studies did not report information on chicken breed type. No data were found on any relevant disease for 56.9% (78/137) of LMICs, signifying a potential data gap. Of the estimates on viral and bacterial diseases, 71.0% (218/307) corresponded to diseases notifiable to the World Organisation for Animal Health, highlighting a tendency to measure disease occurrence for diseases relevant to trade. The latter might not necessarily be priority diseases for the producers, however. Furthermore, 72.3% (222/307) of the estimates originate from random samples and could be used to estimate prevalence in backyard chickens using imputation methods, thus bridging the data gap.
Les maladies transmissibles affectant les animaux d'élevage ont un impact majeur sur la santé animale et la santé publique, avec des effets sur le bien-être et sur l'économie. L'absence de données favorise la propagation des maladies puisque les mesures de prévention et de contrôle reposent sur des décisions mal informées. Les contextes faiblement dotés en ressources se heurtent à la difficulté de produire des données, ce qui fait de la disponibilité des données un enjeu de développement. Pour les besoins de la présente étude, un vaste jeu de données (n = 997) a été constitué, regroupant les taux de prévalence et de séroprévalence estimés d'un certain nombre de maladies virales (n = 224), bactériennes (n = 83) et parasitaires (n = 690) affectant les poulets de basse-cour dans les pays à revenu faible et intermédiaire. Ces estimations sont extraites des 306 études retenues lors de la phase de sélection initiale d'un examen systématique de la littérature. Une tentative de classement de ces études a été réalisée en se basant sur la classification des systèmes d'aviculture familiale élaborée par l'Organisation des Nations Unies pour l'alimentation et l'agriculture. Au total, 98,7 % (302/306) des études portaient sur un système unique de production de volailles, les 1,3 % restantes (4/306) portant sur deux systèmes de production différents. Dans le groupe des études couvrant un seul système de production, 85,4 % des élevages étudiés (258/302) relevaient des catégories " petits systèmes extensifs en liberté ou systèmes extensifs en liberté ", " petits systèmes extensifs en liberté " et/ou " systèmes extensifs en liberté ". En outre, dans 52 % des études (159/306), la race des poulets n'était pas précisée. Aucune donnée n'a pu être trouvée concernant les maladies importantes des volailles dans 56,9 % (78/137) des pays à revenu faible ou intermédiaire, ce qui indique un déficit potentiel de données. S'agissant des maladies virales et bactériennes, 71,0 % des estimations (218/307) correspondaient à des maladies à déclaration obligatoire à l'Organisation mondiale de la santé animale, ce qui souligne la tendance à signaler la survenue des maladies ayant une incidence sur les échanges internationaux. Toutefois, ce ne sont pas nécessairement ces maladies qui sont prioritaires pour les éleveurs. D'autre part, 72,3 % (222/307) des estimations provenaient d'échantillons aléatoires et pourraient donc servir à estimer la prévalence chez les poulets de basse-cour en appliquant des méthodes d'imputation, ce qui permettrait de combler les écarts.
La presencia de enfermedades transmisibles en los animales de granja tiene importantes repercusiones en el bienestar y la economía tanto en el ámbito de la sanidad animal como en el de la salud pública. La falta de datos favorece la propagación de enfermedades debido a la toma de decisiones en materia de prevención y control basada en información mal fundada. En los entornos de bajos recursos existen dificultades para el suministro de información, lo que convierte la disponibilidad de datos en un problema de desarrollo. Para este estudio, se recopiló un amplio conjunto de datos (n = 997) sobre estimaciones de prevalencia y seroprevalencia de enfermedades víricas (n = 224), bacterianas (n = 83) y parasitarias (n = 690) en pollos de traspatio en países de ingresos medios y bajos (PIMB). Estas estimaciones provienen de 306 estudios encontrados durante la fase de selección de una revisión bibliográfica sistemática. Se intentó clasificar los estudios según la clasificación de sistemas de producción avícola familiar de la Organización de las Naciones Unidas para la Alimentación y la Agricultura. El 98,7 % de los estudios (302/306) se centraron en un único sistema de producción avícola, mientras que el 1,3 % (4/306) se centraron en dos sistemas de producción diferentes. Dentro del grupo de estudios que abarcaban un solo sistema de producción, el 85,4 % (258/302) se clasificaron como sistema "extensivo de escarbado pequeño o extensivo de escarbado", "extensivo de escarbado pequeño" o "extensivo de escarbado". Además, en el 52 % (159/306) de los estudios no se proporcionó información sobre el tipo de raza de los pollos. No se encontraron datos sobre ninguna enfermedad pertinente para el 56,9 % (78/137) de los PIMB, lo que indica una posible carencia de datos. De las estimaciones sobre enfermedades víricas y bacterianas, el 71,0 % (218/307) correspondían a enfermedades de declaración obligatoria a la Organización Mundial de Sanidad Animal, lo que evidencia una tendencia a medir la aparición de enfermedades pertinentes para el comercio. Sin embargo, estas podrían no ser necesariamente enfermedades prioritarias para los productores. Por otro lado, el 72,3 % (222/307) de las estimaciones proceden de muestras aleatorias y podrían utilizarse para estimar la prevalencia en los pollos de traspatio utilizando métodos de imputación, lo que permitiría subsanar la carencia de datos.
Asunto(s)
Pollos , Países en Desarrollo , Enfermedades de las Aves de Corral , Animales , Enfermedades de las Aves de Corral/epidemiología , Prevalencia , Estudios Seroepidemiológicos , Crianza de Animales Domésticos , Infecciones Bacterianas/veterinaria , Infecciones Bacterianas/epidemiología , Enfermedades Parasitarias en Animales/epidemiología , Virosis/epidemiología , Virosis/veterinariaRESUMEN
BACKGROUND: Understanding the aetiological organisms causing maternal infections is crucial to inform antibiotic treatment guidelines, but such data are scarce from Sub-Saharan Africa (SSA). We performed this systematic review and meta-analysis to address this gap. METHODS: Microbiologically confirmed maternal infection data were collected from PubMed, Embase, and African Journals online databases. The search strategy combined terms related to bacterial infection, pregnancy, postnatal period, observational studies, SSA. Exclusion criteria included colonization, asymptomatic infection, and screening studies. Pooled proportions for bacterial isolates and antimicrobial resistance (AMR) were calculated. Quality and completeness of reporting were assessed using the Newcastle-Ottawa and STROBE checklists. FINDINGS: We included 14 papers comprising data from 2,575 women from four sources (blood, urine, surgical wound and endocervical). Mixed-growth was commonly reported at 17% (95% CI: 12%-23%), E. coli from 11%(CI:10%-12%), S. aureus from 5%(CI: 5%-6%), Klebsiella spp. at 5%(CI: 4%- 5%) and Streptococcus spp. at 2%(CI: 1%-2%). We observed intra-sample and inter-sample heterogeneity between 88-92% in all meta-analyses. AMR rates were between 19% -77%, the highest with first-line beta-lactam antibiotics. Convenience sampling, and limited reporting of laboratory techniques were areas of concern. INTERPRETATION: We provide a comprehensive summary of microbial aetiology of maternal infections in SSA and demonstrate the paucity of data available for this region. We flag the need to review the current local and international empirical treatment guidelines for maternal bacterial infections in SSA because there is high prevalence of AMR among common causative bacteria. FUNDING: This research was supported by the NIHR-Professorship/NIHR300808 and the Wellcome-Strategic-award /206545/Z/17/Z. TRIAL REGISTRATION: Prospero ID CRD42021238515.
Asunto(s)
Antibacterianos , Infecciones Bacterianas , Farmacorresistencia Bacteriana , Complicaciones Infecciosas del Embarazo , Humanos , África del Sur del Sahara/epidemiología , Femenino , Embarazo , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificaciónRESUMEN
BACKGROUND: Continuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there's limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda. METHODS: We analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018-2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period. RESULTS: Out of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63-84% for sulfonamides, fluoroquinolones macrolides (46-76%), phenicols (48-71%), penicillins (42-97%), ß-lactamase inhibitors (20-92%), aminoglycosides (17-53%), cephalosporins (8.3-90%), carbapenems (5.3-26%), and glycopeptides (0-20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29-78% p < 0.001), ciprofloxacin (17-43%, p = 0.004), ceftriaxone (8-72%, p = 0.003), imipenem (6-26%, p = 0.004), and meropenem (7-18%, p = 0.03). CONCLUSION: The study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO's Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for "Watch" or "Reserve."
Asunto(s)
Antibacterianos , Farmacorresistencia Bacteriana , Humanos , Uganda/epidemiología , Antibacterianos/farmacología , Pruebas de Sensibilidad Microbiana , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/tratamiento farmacológico , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificación , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificaciónRESUMEN
BACKGROUND: The mortality risk of co-infections/secondary infections (CoI/ScI) is under-reported in patients with non-critical COVID-19, leading to the under-management of CoI/ScI and publication bias in the medical literature. We aimed to investigate the association between CoI/ScI and mortality in patients hospitalised with mild-to-severe COVID-19. METHODS: We conducted a retrospective cohort study at a COVID-19 treatment hospital in Vietnam and collected all eligible medical records, with CoI/ScI status as the exposure (non-CoI/ScI and CoI/ScI, with the latter including nature of pathogen [bacterial, fungal, or bacterial + fungal] and multidrug-resistance pathogen [no MDRp or ≥ 1 MDRp]). The outcome was all-cause mortality, defined as in-hospital death by all causes or being discharged under critical illness. We used time-dependent analysis to report rates of mortality with 95% confidence intervals (95% CI, Poisson regression) and hazard ratios (HR) with 95% CI (Cox proportional hazards regression with Holm's method for multiplicity control). RESULTS: We followed 1466 patients (median age 61, 56.4% being female) for a median of 9 days. We recorded 387 (26.4%) deaths (95/144 [66.0%] in the CoI/ScI group and 292/1322 [22.1%] in the non-CoI/ScI group). Adjusted mortality rates (per 100 person-days) of the CoI/ScI (6.4, 95% CI 5.3 to 7.8), including bacterial (8.0, 95% CI 7.2 to 8.9), no MDRp (5.9, 95% CI 4.8 to 7.4), and ≥ 1 MDRp (9.0, 95% CI 8.2 to 10.0) groups were higher than that of the non-CoI/ScI group (2.0, 95% CI 1.8 to 2.2). These corresponded to higher risks of mortality in the overall CoI/ScI (HR 3.27, 95% CI 2.58 to 4.13, adjusted p < 0.001), bacterial CoI/ScI (HR 3.79, 95% CI 2.97 to 4.83, adjusted p < 0.001), no MDRp CoI/ScI (HR 3.13, 95% CI 2.42 to 4.05, adjusted p < 0.001), and ≥ 1 MDRp CoI/ScI group (HR 3.89, 95% CI 2.44 to 6.21, adjusted p < 0.001). We could not attain reliable estimates for fungal and bacterial + fungal CoI/ScI. CONCLUSION: Compared with the non-CoI/ScI group, patients with CoI/ScI had a significantly higher risk of all-cause mortality, regardless of resistance status. More evidence is needed to confirm the mortality risks in patients with fungal or bacterial + fungal CoI/ScI.
Asunto(s)
COVID-19 , Coinfección , SARS-CoV-2 , Humanos , Vietnam/epidemiología , COVID-19/mortalidad , COVID-19/epidemiología , COVID-19/complicaciones , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Coinfección/mortalidad , Coinfección/epidemiología , Coinfección/microbiología , Anciano , Adulto , Infecciones Bacterianas/mortalidad , Infecciones Bacterianas/epidemiología , Micosis/epidemiología , Micosis/mortalidad , Micosis/microbiología , Hospitalización/estadística & datos numéricos , Mortalidad HospitalariaRESUMEN
Background: Antibiotic resistance (ABR) is a global challenge, and its control depends on robust evidence primarily derived from surveillance systems. Methods: We utilised a national surveillance data set to demonstrate how such evidence can be systematically generated. In doing so, we characterised the ABR profiles of priority clinical pathogens, identified associated factors, and drew inferences on antibiotic usage in Uganda. Results: Of the 12 262 samples collected between 2019-21, we analysed 9033 with complete metadata. ABR was steadily increasing at a rate of 0.5% per year, with a surge in 2021 and the highest and lowest levels of penicillin and carbapenems detected in the northern (odds ratio (OR) = 2.26; P < 0.001) and the northeast (OR = 0.28; P < 0.001) regions of Uganda respectively. ABR was commonly observed with Escherichia coli (OR = 1.18; P < 0.001) and Klebsiella pneumoniae (OR = 1.25; P < 0.001) among older and male patients (61-70 years old) (OR = 1.88; P = 0.005). Multi-drug resistance (MDR) and ABR were disproportionately higher among bloodstream infections than respiratory tract infections and urinary tract infections, often caused by Acinetobacter baumannii. Co-occurrence of ABR suggests that cephalosporins such as ceftriaxone are in high use all over Uganda. Conclusions: ABR is indeed a silent pandemic, and our results suggest it is increasing at 0.5% per year, with a notable surge in 2021 likely due to coronavirus disease 2019 (COVID-19). Of concern, ABR and MDR are mainly associated with bloodstream and surgical wound infections, with a gender and age dimension. However, it is encouraging that carbapenem resistance remains relatively low. Such evidence is critical for contextualising the implementation and evaluation of national action plans.
Asunto(s)
Antibacterianos , Humanos , Uganda/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Preescolar , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Niño , Lactante , Adolescente , Adulto Joven , Recién Nacido , COVID-19/epidemiología , Farmacorresistencia Bacteriana , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana MúltipleRESUMEN
The COVID-19 pandemic has altered respiratory infection patterns in pediatric populations. The emergence of the SARS-CoV-2 Omicron variant and relaxation of public health measures have increased the likelihood of coinfections. Previous studies show conflicting results regarding the impact of viral and bacterial coinfections with SARS-CoV-2 on severity of pediatric disease. This study investigated the prevalence and clinical impact of coinfections among children hospitalized with COVID-19 during the Omicron wave. A retrospective analysis was conducted on 574 hospitalized patients aged under 18 years in Russia, from January 2022 to March 2023. Samples from patients were tested for SARS-CoV-2 and other respiratory pathogens using qRT-PCR, bacterial culture tests and mass spectrometry, and ELISA. Approximately one-third of COVID-19 cases had coinfections, with viral and bacterial coinfections occurring at similar rates. Adenovirus and Staphylococcus aureus were the most common viral and bacterial coinfections, respectively. Viral coinfections were associated with higher fevers and increased bronchitis, while bacterial coinfections correlated with longer duration of illness and higher pneumonia rates. Non-SARS-CoV-2 respiratory viruses were linked to more severe lower respiratory tract complications than SARS-CoV-2 monoinfection. These findings suggest that during the Omicron wave, seasonal respiratory viruses may have posed a greater threat to children's health than SARS-CoV-2.
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Infecciones Bacterianas , COVID-19 , Coinfección , Hospitalización , SARS-CoV-2 , Humanos , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/virología , COVID-19/epidemiología , COVID-19/complicaciones , COVID-19/microbiología , Adolescente , Niño , Preescolar , Femenino , Masculino , Lactante , Federación de Rusia/epidemiología , Estudios Retrospectivos , Prevalencia , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Recién NacidoRESUMEN
SUMMARYHealthcare-associated infections (HAIs) represent a burden for public health with a high prevalence and high death rates associated with them. Pathogens with a high potential for antimicrobial resistance, such as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and Clostridioides difficile, are responsible for most HAIs. Despite the implementation of infection prevention and control intervention, globally, HAIs prevalence is stable and they are mainly due to endogenous pathogens. It is undeniable that complementary to infection prevention and control measures, prophylactic approaches by active or passive immunization are needed. Specific groups at-risk (elderly people, chronic condition as immunocompromised) and also healthcare workers are key targets. Medical procedures and specific interventions are known to be at risk of HAIs, in addition to hospital environmental exposure. Vaccines or monoclonal antibodies can be seen as attractive preventive approaches for HAIs. In this review, we present an overview of the vaccines and monoclonal antibodies in clinical development for prevention of the major bacterial HAIs pathogens. Based on the current state of knowledge, we look at the challenges and future perspectives to improve prevention by these means.
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Anticuerpos Monoclonales , Infecciones Bacterianas , Vacunas Bacterianas , Infección Hospitalaria , Humanos , Infección Hospitalaria/prevención & control , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/epidemiología , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales/inmunología , Vacunas Bacterianas/inmunologíaRESUMEN
BACKGROUND: Spontaneous bacterial peritonitis (SBP) represents a critical and potentially lethal condition that typically develops in individuals with liver cirrhosis. This meta-analysis aimed to assess diabetes mellitus (DM) as a risk factor for SBP in liver cirrhotic patients. METHODS: Following PRISMA guidelines, fifteen studies were included, for a total of 76 815 patients. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). We represented the results as risk ratios (RR) with the corresponding 95% confidence intervals (CI) using RevMan software. Additionally, we pooled the hazard ratios (HR) for developing SBP in patients with DM from the included studies. RESULTS: The meta-analysis shows a significantly increased risk of SBP in cirrhotic patients with DM (HR: 1.26; 95% CI [1.05-1.51], P=.01; HR: 1.70; 95% CI [1.32-2.18], P<.001). CONCLUSIONS: The study signifies that DM is an independent risk factor for SBP, emphasizing the need for targeted preventive measures in this specific population.
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Infecciones Bacterianas , Cirrosis Hepática , Peritonitis , Humanos , Peritonitis/microbiología , Peritonitis/epidemiología , Peritonitis/etiología , Cirrosis Hepática/complicaciones , Factores de Riesgo , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/complicaciones , Diabetes Mellitus/epidemiología , Complicaciones de la Diabetes/epidemiologíaRESUMEN
Influenza-like illness (ILI) patients co-detected with respiratory pathogens exhibit poorer health outcomes than those with single infections. To address the paucity of knowledge concerning the incidence of concurrent respiratory pathogens, their relationships, and the clinical differences between patients detected with single and multiple pathogens, we performed an in-depth characterization of the oropharyngeal samples of primary care patients collected in Genoa (Northwest Italy), during winter seasons 2018/19-2019/20.The apriori algorithm was employed to evaluate the incidence of viral, bacterial, and viral-bacterial pairs during the study period. The grade of correlation between pathogens was investigated using the Phi coefficient. Factors associated with viral, bacterial or viral-bacterial co-detection were assessed using logistic regression.The most frequently identified pathogens included influenza A, rhinovirus, Haemophilus influenzae and Streptococcus pneumoniae. The highest correlations were found between bacterial-bacterial and viral-bacterial pairs, such as Haemophilus influenzae-Streptococcus pneumoniae, adenovirus-Haemophilus influenzae, adenovirus-Streptococcus pneumoniae, RSV-A-Bordetella pertussis, and influenza B Victoria-Bordetella parapertussis. Viruses were detected together at significantly lower rates. Notably, rhinovirus, influenza, and RSV exhibited significant negative correlations with each other. Co-detection was more prevalent in children aged < 4, and cough was shown to be a reliable indicator of viral co-detection.Given the evolving epidemiological landscape following the COVID-19 pandemic, future research utilizing the methodology described here, while considering the circulation of SARS-CoV-2, could further enrich the understanding of concurrent respiratory pathogens.
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Coinfección , Infecciones del Sistema Respiratorio , Humanos , Coinfección/epidemiología , Coinfección/virología , Coinfección/microbiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Italia/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/diagnóstico , Adolescente , Anciano , Preescolar , Niño , Adulto Joven , Lactante , Gripe Humana/epidemiología , Gripe Humana/virología , Estaciones del Año , Bacterias/aislamiento & purificación , Bacterias/clasificación , Bacterias/genética , Orofaringe/microbiología , Orofaringe/virología , Virus/aislamiento & purificación , Virus/clasificación , Virus/genética , Anciano de 80 o más Años , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/diagnóstico , Recién NacidoRESUMEN
Objective: To study the distribution and drug resistance characteristics of pathogenic bacteria in the elderly population of China by collecting and analyzing the standardized case data on the pathogens of infections in elderly patients, and to facilitate the establishment of a standardized layered surveillance system for pathogenic bacteria in China. Methods: We collected the case data of elderly patients (≥65 years old) from 62 sentinel hospitals across the country in 2021. Then, we statistically analyzed the data by patient age, their geographical region, the distribution of pathogenic bacteria, and the drug resistance characteristics of main pathogens. Results: A total of 3468 cases from across the country were included in the study. The top three sources of patients were the intensive care unit (13.2%), the department of respiratory medicine (11.2%), and the department of general surgery (8.4%). The top three types of specimens were urine (25.5%), sputum (20.6%), and blood (18.7%). A total of 3468 strains of pathogens were isolated, among which, 78.9% were gram-negative bacteria and 21.1% were gram-positive bacteria. The top five types of bacteria were Escherichia coli (20.9%), Klebsiella pneumoniae (18.3%), Pseudomonas aeruginosa (11.2%), Staphylococcus aureus (9.0%), and Acinetobacter baumannii (7.0%). The isolation rates of common important drug-resistant bacteria were 38.0% for methicillin-resistant Staphylococcus aureus (MRSA), 68.7% for carbapenem-resistant Acinetobacter baumannii (CRAB), and 38.2% for carbapenem-resistant Pseudomonas aeruginosa (CRPA), 20.1% for carbapenem-resistant Klebsiella pneumoniae (CRKP), 5.2% for carbapenem-resistant Escherichia coli (CRECO), and 2.1% for vancomycin-resistant Enterococcus (VRE). There were differences in the isolation rates of CRAB and CRKP in clinical care in the elderly population in seven geographical regions of China (P<0.05). Klebsiella pneumoniae is the most important pathogen in the elderly population ≥85 years old, and the isolation rates of CRKP showed significant differences in different age groups (P<0.05). Conclusion: There are significant differences in the drug resistance of pathogenic bacteria in the elderly populations of different regions and age groups in China. Therefore, monitoring the distribution and drug resistance of pathogenic bacteria in the elderly population and formulating targeted treatment plans according to the characteristics of the specific regions and age groups are of great significance to the improvement in the treatment outcomes and prognosis of the elderly population.
Asunto(s)
Antibacterianos , Klebsiella pneumoniae , Humanos , Anciano , China/epidemiología , Antibacterianos/farmacología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Anciano de 80 o más Años , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Farmacorresistencia Bacteriana , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Farmacorresistencia Bacteriana Múltiple , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificación , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/epidemiología , Pruebas de Sensibilidad Microbiana , Masculino , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificación , Femenino , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
BACKGROUND: Fever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection. METHODS: This was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones. RESULTS: 442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001). CONCLUSIONS: Although the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious.
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Infecciones Bacterianas , COVID-19 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , COVID-19/diagnóstico , Lactante , Estudios Retrospectivos , Masculino , Femenino , Recién Nacido , Italia/epidemiología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/diagnóstico , Índice de Severidad de la Enfermedad , SARS-CoV-2 , FiebreAsunto(s)
Brotes de Enfermedades , Enfermedades de los Caballos , Enfermedades Parasitarias en Animales , Vigilancia de Guardia , Caballos , Animales , Enfermedades de los Caballos/epidemiología , Vigilancia de Guardia/veterinaria , Reino Unido/epidemiología , Brotes de Enfermedades/veterinaria , Enfermedades Parasitarias en Animales/epidemiología , Femenino , Virosis/veterinaria , Virosis/epidemiología , Masculino , Infecciones Bacterianas/veterinaria , Infecciones Bacterianas/epidemiología , EmbarazoRESUMEN
Acute undifferentiated febrile illness (AUFI) is often undiagnosed in Thailand, resulting in delayed or ineffective treatment. We compared the demographic, exposure history, and clinical characteristics of AUFI patients with laboratory evidence of bacterial and nonbacterial pathogens. Patients aged 2-80 years presenting to 12 hospitals in Nakhon Phanom and Tak provinces were enrolled from April 2017 through May 2020. Interviews were conducted and blood, urine, and sputum were collected for culture as well as rapid diagnostic and molecular testing. A total of 1,263 patients tested positive for one or more bacterial, viral, or parasitic pathogens and were included in the analysis. Multivariable logistic regression was performed to compare factors associated with bacterial infections versus nonbacterial infections. Bacterial infections were more commonly identified in participants from Nakhon Phanom than Tak. Bacterial infections were independently associated with several factors including age ≥50 years (adjusted odds ratio [95% CI]): (4.18 [2.85-6.14]), contact with farm animals (1.82 [1.29-2.57]), antibiotic use within 72 hours of hospital presentation (2.37 [1.50-3.74]), jaundice (2.31 [1.15-4.63]), existing comorbidities (2.77 [1.93-3.96]), contact with febrile individuals (0.42 [0.31-0.57]), muscle pain (0.44 [0.31-0.64]), and rash (0.45 [0.29-0.70]). Bacterial infections were also associated with longer hospitalization (2.75 [2.08-3.64]) and lower odds of recovery at the time of discharge (0.14 [0.07-0.31]). Consideration of patient characteristics and signs/symptoms may help to inform targeted laboratory testing for suspected infectious etiologies. Understanding factors associated with bacterial and non-bacterial causes of AUFI may aid diagnosis and judicious use of antibiotics in resource-limited settings.
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Infecciones Bacterianas , Fiebre , Humanos , Tailandia/epidemiología , Masculino , Persona de Mediana Edad , Femenino , Adulto , Adolescente , Anciano , Niño , Preescolar , Adulto Joven , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/complicaciones , Anciano de 80 o más Años , Fiebre/epidemiología , Fiebre/etiología , Factores de Riesgo , Enfermedad AgudaRESUMEN
BACKGROUND AND OBJECTIVES: Viral bronchiolitis is a common pediatric illness. Treatment is supportive; however, some children have concurrent serious bacterial infections (cSBIs) requiring antibiotics. Identifying children with cSBI is challenging and may lead to unnecessary treatment. Improved understanding of the prevalence of and risk factors for cSBI are needed to guide treatment. We sought to determine the prevalence of cSBI and identify factors associated with cSBI in children hospitalized with bronchiolitis. METHODS: We performed a retrospective cohort study of children <2 years old hospitalized with bronchiolitis at a free-standing children's hospital from 2012 to 2019 identified by International Classification of Diseases codes. cSBI was defined as bacteremia, urinary tract infection, meningitis, or pneumonia. Risk factors for cSBI were identified using logistic regression. RESULTS: We identified 7871 admissions for bronchiolitis. At least 1 cSBI occurred in 4.2% of these admissions; with 3.5% meeting our bacterial pneumonia definition, 0.4% bacteremia, 0.3% urinary tract infection, and 0.02% meningitis. cSBI were more likely to occur in children with invasive mechanical ventilation (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78-3.63), a C-reactive protein ≥4 mg/dL (OR 2.20, 95% CI 1.47-3.32), a concurrent complex chronic condition (OR 1.67, 95% CI 1.22-2.25) or admission to the PICU (OR 1.46, 95% CI 1.02-2.07). CONCLUSIONS: cSBI is uncommon among children hospitalized with bronchiolitis, with pneumonia being the most common cSBI. Invasive mechanical ventilation, elevated C-reactive protein, presence of complex chronic conditions, and PICU admission were associated with an increased risk of cSBI.
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Bronquiolitis , Humanos , Lactante , Femenino , Masculino , Estudios Retrospectivos , Bronquiolitis/epidemiología , Bronquiolitis/complicaciones , Factores de Riesgo , Prevalencia , Infecciones Bacterianas/epidemiología , Hospitalización/estadística & datos numéricos , Niño Hospitalizado/estadística & datos numéricos , Infecciones Urinarias/epidemiología , Hospitales PediátricosRESUMEN
Introduction: Pathogens causing diabetic foot infections (DFIs) vary by region globally; however, knowledge of the causative organism is essential for effective empirical treatment. We aimed to determine the incidence and antibiotic susceptibility of DFI pathogens worldwide, focusing on Asia and China. Methods: Through a comprehensive literature search, we identified published studies on organisms isolated from DFI wounds from January 2000 to December 2020. Results: Based on our inclusion criteria, we analyzed 245 studies that cumulatively reported 38,744 patients and 41,427 isolated microorganisms. DFI pathogens varied according to time and region. Over time, the incidence of Gram-positive and Gram-negative aerobic bacteria have decreased and increased, respectively. America and Asia have the highest (62.74%) and lowest (44.82%) incidence of Gram-negative bacteria, respectively. Africa has the highest incidence (26.90%) of methicillin-resistant Staphylococcus aureus. Asia has the highest incidence (49.36%) of Gram-negative aerobic bacteria with species infection rates as follows: Escherichia coli, 10.77%; Enterobacter spp., 3.95%; and Pseudomonas aeruginosa, 11.08%, with higher local rates in China and Southeast Asia. Linezolid, vancomycin, and teicoplanin were the most active agents against Gram-positive aerobes, while imipenem and cefoperazone-sulbactam were the most active agents against Gram-negative aerobes. Discussion: This systematic review showed that over 20 years, the pathogens causing DFIs varied considerably over time and region. This data may inform local clinical guidelines on empirical antibiotic therapy for DFI in China and globally. Regular large-scale epidemiological studies are necessary to identify trends in DFI pathogenic bacteria. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023447645.
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Antibacterianos , Pie Diabético , Humanos , Pie Diabético/microbiología , Pie Diabético/epidemiología , China/epidemiología , Antibacterianos/uso terapéutico , Incidencia , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/tratamiento farmacológicoRESUMEN
Bacterial zoonoses are established causes of severe febrile illness in East Africa. Within a fever etiology study, we applied a high-throughput 16S rRNA metagenomic assay validated for detecting bacterial zoonotic pathogens. We enrolled febrile patients admitted to 2 referral hospitals in Moshi, Tanzania, during September 2007-April 2009. Among 788 participants, median age was 20 (interquartile range 2-38) years. We performed PCR amplification of V1-V2 variable region 16S rRNA on cell pellet DNA, then metagenomic deep-sequencing and pathogenic taxonomic identification. We detected bacterial zoonotic pathogens in 10 (1.3%) samples: 3 with Rickettsia typhi, 1 R. conorii, 2 Bartonella quintana, 2 pathogenic Leptospira spp., and 1 Coxiella burnetii. One other sample had reads matching a Neoerhlichia spp. previously identified in a patient from South Africa. Our findings indicate that targeted 16S metagenomics can identify bacterial zoonotic pathogens causing severe febrile illness in humans, including potential novel agents.
Asunto(s)
Fiebre , Metagenómica , ARN Ribosómico 16S , Humanos , Tanzanía/epidemiología , Adulto , Preescolar , Adolescente , Metagenómica/métodos , Fiebre/microbiología , Masculino , Femenino , Animales , Niño , ARN Ribosómico 16S/genética , Adulto Joven , Bacterias/genética , Bacterias/clasificación , Bacterias/aislamiento & purificación , Zoonosis Bacterianas/microbiología , Zoonosis Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/diagnóstico , Zoonosis/microbiología , Zoonosis/epidemiologíaRESUMEN
Background: Spontaneous preterm delivery is defined as the beginning of the birth process before the 37th week of pregnancy. The presence of microorganisms in the fetal membranes is accompanied by an increase in the production of prostaglandin, one of the important factors associated with the prevalence of preterm birth. The invasion of microorganisms leads to the production of protease, coagulase, and elastase, which directly stimulate the onset of childbirth. We investigated the role of genital infections in women with preterm birth. Methods: The present case-control study was conducted in the west of Iran on 100 women with spontaneous preterm delivery (following 24 weeks of gestation and before 36 weeks and 6 days) as the case group and 100 women with normal delivery as controls. A questionnaire was applied to collect the data. Polymerase chain reaction and pathological examination of the placenta were performed. Results: The average age in women with normal delivery (30.92 ± 5.10) in women with spontaneous preterm delivery (30.27 ± 4.93). The prevalence of Chlamydia trachomatis, Neisseria gonorrhea, Listeria monocytogenes, and Mycoplasma genitalium infections was zero in both groups. The highest prevalence of Gardnerella vaginalis was 19 (19%) in the case group and Ureaplasma parvum 15 (15%) in the control group. Also, Placental inflammation was zero in controls and 7(7%) in the patient group. There was a significant relationship between Gardnerella vaginalis bacteria and spontaneous preterm delivery. Conclusion: The results of our study showed that except for Gardnerella vaginalis bacteria, there is no significant relationship between the above bacterial infections and spontaneous preterm birth. Moreover, despite the significant reduction in the prevalence of many sexually transmitted infections in this research, it is still suggested to increase the awareness of people, including pregnant women, about the ways it can be transmitted by gynecologists and health and treatment centers.