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1.
S. Siméon V. Le Moing S. Tubiana X. Duval D. Fournier J.-P. Lavigne M.-L. Erpelding C.-A. Gustave S. Desage C. Chirouze F. Vandenesch P. Tattevin 《Clinical microbiology and infection》2019,21(4):481-488
Objectives
Time to blood culture positivity (TTP), a routinely available parameter in automated blood culture systems, may be a proxy for infectious burden in patients with bloodstream infections. We aimed to study the association between TTP and infective endocarditis (IE), or death, in patients with Staphylococcus aureus bacteraemia.Methods
VIRSTA is a multicentre prospective cohort study that included all adult patients with S. aureus bacteraemia in eight university hospitals in France (2009–2011). We analysed data from four centres which collected data on TTP. Regression models were used to study the association between TTP and definite IE (Duke-Li criteria), and 30 day-mortality.Results
We included 587 patients with S. aureus bacteraemia: mean age was 65.3 ± 16.3 years, 420 out of 587 patients (71.6%) were male, 121 out of 587 (20.6%) died, and 42 out of 587 (7.2%) had definite IE. Median TTP of first positive blood culture was 13.7 h (interquartile range 9.9–18). On multivariate analysis, 30-day mortality was associated with TTP ≤13.7 h (74/295 (25.1%) vs. 47/292 (16.1%), p 0.02), as well as old age, McCabe score, methicillin resistance, stroke, pneumonia, and C-reactive protein. TTP was also independently associated with IE, but with a U-shape curve: IE was more common in the first (TTP <10 h, 17/148, 11.5%), and the last (TTP ≥18 h, 8/146, 5.5%) quartiles of TTP, p 0.002.Conclusions
TTP provides reliable information in patients with S. aureus bacteraemia, on the risk of IE, and prognosis, with short TTP being an independent predictor of death. These data, readily available at no cost, may be used to identify patients who require specific attention. 相似文献2.
Ling-Shan Syue Hung-Jen Tang Yuan-Pin Hung Po-Lin Chen Chia-Wen Li Ming-Chi Li Pei-Fang Tsai Ching-Chuan Liu Nan-Yao Lee Wen-Chien Ko 《Journal of microbiology, immunology, and infection》2019,52(2):225-232
Background
Dengue is an important mosquito-borne tropical viral disease and dual infection, though rare, has been regarded as a risk factor for severe disease and mortality. However, few studies focused on bloodstream infections (BSIs) and empirical antibiotic therapy rarely addressed.Methods
Dengue patients with concurrent or subsequent BSIs between July 1 and December 31, 2015 were included. Clinical information, laboratory data, and drug susceptibility data were collected.Results
Totally 80 patients, with an in-hospital mortality rate of 32.5%, were included and categorized into three groups. 32 patients in Group I (BSI onset within 48 h after admission), 32 in Group II (between 48 h and one week), and 16 in Group III (more than one week). Patients in Group I were older (mean age: 75.6 vs. 72.6 or 69.6 years; P = 0.01) and had a higher Charlson comorbidity index (3.1 vs. 1.8 or 1.9; P = 0.02) than those in Group II or III. Streptococcus species (28.9%, 11/38) and Escherichia coli (23.7%, 9/38) were major pathogens in Group I. Enterobacteriaceae (38.2%, 13/34) isolates predominated in Group II. Fatal patients more often received inappropriate empirical antibiotic than the survivors (61.5% vs. 35.2%; P = 0.03). According to susceptibility data, pathogens in Group I and II shared similar susceptibility profiles, and levofloxacin, cefepime, or piperacillin/tazobactam, can be empirically prescribed for those hospitalized within one week.Conclusions
BSI pathogens vary among dengue patients. For adults with dengue and suspected BSI hospitalized within one week, empirical antimicrobial agents are recommended. 相似文献3.
4.
X. Zeng H. Gu Y. Cheng K.-R. Jia D. Liu Y. Yuan Z.-F. Chen L.-S. Peng Q.-M. Zou Y. Shi 《Clinical microbiology and infection》2019,21(4):516.e1-516.e4
Objectives
Acinetobacter baumannii can cause severe nosocomial and community-acquired pneumonia. To study the pathogenesis of A. baumannii and to develop new treatments, appropriate mouse models are needed. Most reported mouse models of pulmonary A. baumannii infection are non-lethal or require mouse immunosuppression to enhance infection. These models are not suitable for studying host immune responses or evaluating immunotherapies.Methods
The virulence of 30 clinical isolates was assessed in mice. The most virulent isolate, SJZ24, was selected to develop a pneumonia model in immunocompetent mice. The cytokine mRNA expression in the lung was assessed with real-time PCR. The cell infiltration in bronchoalveolar lavage fluid (BALF) after SJZ24 infection was determined by flow cytometry. Vaccine efficacy was assessed using this model.Results
Intratracheal inoculation of SJZ24 (5 × 107 CFU) resulted in death in 100% of the mice (5/5). SJZ24-infected mice showed high bacterial burdens in blood and organs as well as severe lung-tissue damage. Infection with SJZ24 induced increased inflammatory cytokine expression in the lung and increased neutrophil infiltration in BALF. Immunization with inactivated whole cells of SJZ24 showed 100% protection (5/5) against A. baumanni infection in this model.Conclusions
We established a lethal pneumonia model in immunocompetent mice with hypervirulent A. baumannii isolate SJZ24. This model can be used to study the immune response to A. baumannii infection and to evaluate vaccine efficacy. 相似文献5.
Tsung-Yu Huang Chien-Hui Hung Wei-Hsiu Hsu Kuo-Ti Peng Ming-Szu Hung Li-Ju Lai Hui-Ju Chuang Wan-Ling Tai Yu-Pei Ku Ting-Shu Wu 《Journal of microbiology, immunology, and infection》2019,52(2):312-319
Background
Genitourinary tuberculosis (GUTB) is rare but fatal if not diagnosed early. The purpose of this study was to investigate the outcomes of GUTB in Taiwan.Methods
We retrospectively reviewed medical records of 57 patients who were diagnosed as GUTB from January 2002 to December 2016, over a 15-year period. Demographic data and clinical manifestations were recorded for analysis.Results
There were 37 males and 20 females with a median age of 71 years. Kidney (24.6%) was the most involved organ. Fever (56.1%) was the major presentation. Sixteen (28.1%) patients presented unfavorable outcome. Compared with the favorable outcome group, the unfavorable outcome group had more malignancy (p = 0.013), fever (p = 0.020), anemia (p = 0007), thrombocytopenia (p = 0.003), and hypoalbuminemia (p = 0.015). In a multivariate analysis, fever (odds ratio: 42.716, 95% confidence interval: 1.032–1767.569; p = 0.048) was identified as prognostic factors for unfavorable outcome.Conclusion
GUTB is often in advanced stages with a high mortality in Taiwan. Establishing a diagnosis is difficult and requires thorough investigation. Fever is associated with unfavorable outcome. 相似文献6.
K. Wagner F. Imkamp V.P. Pires P.M. Keller 《Clinical microbiology and infection》2019,25(3):383.e5-383.e7
Objectives
Rapid detection of macrolide resistance–associated mutations in Mycoplasma pneumoniae is crucial for effective antimicrobial treatment. We evaluated the Lightmix Mycoplasma macrolide assay for the detection of point mutations at nucleotide positions 2063 and 2064 in the 23S ribosomal RNA (rRNA) gene of M. pneumoniae that confer macrolide resistance.Methods
Samples from 3438 patients with a respiratory tract infection were analysed by M. pneumoniae real-time PCR, and 208 (6%) of them were tested positive. In this retrospective study, 163 M. pneumoniae real-time PCR–positive samples were analysed by the Lightmix assay, and results were compared to targeted 23S rRNA sequencing.Results
Macrolide-resistant M. pneumoniae were found in 15 (9%) of 163 retrospectively analysed samples. The Lightmix assay showed a sensitivity of 100% (95% confidence interval, 78.2–100) and a specificity of 100% (95% confidence interval, 97.5–100) as the detected M. pneumoniae genotype (148 wild type and 15 non–wild type) was confirmed by 23S rRNA sequencing in all samples.Conclusions
The Lightmix assay is an easy-to-use and accurate molecular test that allows rapid determination of macrolide resistance in M. pneumoniae. 相似文献7.
Thean Yen Tan Melissa Ong Yvonne Cheng Lily Siew Yong Ng 《Journal of microbiology, immunology, and infection》2019,52(1):30-34
Introduction
This retrospective study investigated the clinical etiology of community-acquired bacteremic Klebsiella pneumoniae infections, and characterized laboratory and genetic markers which may be associated with primary liver abscess (PLA).Methods
Community-onset K. pneumoniae bacteremic episodes from 2010 to 2011 were identified from the laboratory information system. Isolates were retrieved for susceptibility testing, hypermucoviscosity testing, PCR-based serotyping (K1, K2 and K5) and PCR detection of virulence genes (rmpA, alls, kfu and aerobactin). Clinical data collected from electronic medical records included primary and secondary diagnoses, co-existing morbidities, antibiotic therapy, and in-patient mortality.Results
129 bacteremic episodes were identified. The most common primary infections were pneumonia (n = 24, 18.6%), primary liver abscess (n = 21, 16.3%) and urinary tract infections (n = 21, 16.3%). Hypermucoviscosity was present in 55 isolates (42.6%). The most commonly detected virulence genes were aerobactin (n = 63, 48.8%) and rmpA (n = 59, 45.7%). Isolates causing liver abscess were significantly associated with a positive string test, rmpA, aerobactin gene, and capsular serotype K1 (all p < 0.01), but not with capsular serotype K2, K5, kfu, or allS genes. The absence of a positive string test, rmpA, or aerobactin genes had a 97.3%–100% negative predictive value for PLA. The positive predictive values of the string test, rmpA, aerobactin genes, and serotype K1 for PLA ranged from 31.7% to 35.6%.Conclusion
In our study population, pneumonia and PLA were the most common sources of community-acquired bacteremia. Hypermucoviscosity, rmpA, aerobactin, and serotype K1 could be useful laboratory markers to alert clinicians to arrange abdominal imaging to detect liver abscess. 相似文献8.
Ying-Chun Cho Nan-Chang Chiu Fu-Yuan Huang Daniel Tsung-Ning Huang Lung Chang Ching-Ying Huang Yen-Hsin Kung Kuo-Sheng Lee Hsin Chi 《Journal of microbiology, immunology, and infection》2019,52(1):75-80
Background
Concerns about non-typeable Haemophilus influenzae (NTHi) in otitis media (OM) have grown after the introduction of pneumococcal conjugate vaccine (PCV). We aim to better understand the clinical role of NTHi in pediatric OM.Methods
Middle ear fluid samples from children <18 years with OM were obtained from 2010 to 2015. For culture-positive episodes (Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis, and Streptococcus pyogenes), patients' demographic and clinical information were reviewed and analyzed.Results
A total of 783 episodes were included with 31.8% of isolates as positive. S. pneumoniae was recovered in 69.4%, NTHi in 24.6%, M. catarrhalis in 5.6%, and S. pyogenes in 4.0% of culture-positive episodes. The proportion of pneumococcal OM has declined since 2012 (P for trend <0.005), but NTHi OM rose simultaneously (P for trend = 0.009). Factors associated with increased risk of NTHi infection included less spontaneous otorrhea (OR 0.15, 95% CI 0.06–0.39, P < 0.001), absence of fever (OR 0.30, 95% CI 0.14–0.66, P = 0.003), concurrent sinusitis (OR 2.91, 95% CI 1.36–6.20, P = 0.006), previous ventilation tube insertion (OR 12.02, 95% CI 3.15–45.92, P < 0.001) and recurrent OM (OR 3.43, 95% CI 1.01–11.71, P = 0.049). The susceptibility of NTHi to amoxicillin/clavulanate was 82.0%.Conclusions
NTHi OM has trended upward in the post-PCV era. Concurrent sinusitis, previous ventilation tube insertion, and recurrent OM were associated with NTHi OM implicated a correlation between NTHi and complex OM. In consideration of NTHi infection, we suggest amoxicillin/clavulanate as the first-line therapy for OM among Taiwanese children. 相似文献9.
MingLi Hung Deh-Feng Huang Wei-Sheng Chen Chien-Chih Lai Ming-Han Chen Hsien-Tzung Liao Chang-Youh Tsai 《Journal of microbiology, immunology, and infection》2019,52(1):114-121
Background
The clinical features and outcomes of cytomegalovirus (CMV) diseases in patients with systemic lupus erythematosus (SLE) are unknown. We analyzed such data from a medical center in Taiwan.Methods
We retrospectively reviewed the medical records of patients with SLE who were diagnosed with CMV diseases between 2006 and 2016 in Taipei Veterans General Hospital Taiwan. Clinical and laboratory parameters and treatment outcomes were analyzed.Results
The study enrolled 56 eligible patients with CMV diseases and separated them into survival (n = 24) and mortality (n = 32) groups. All cases showed a significantly high incidence of pneumonitis (71.43%). The patients in the mortality group had a higher SLE disease activity index (SLEDAI)-2000 (p = 0.009), more cases of recent methylprednisolone pulse therapy (p = 0.013) and pancytopenia (p = 0.001), stronger evidence of CMV infection demonstrated by polymerase chain reaction (PCR) in blood (p < 0.001) and bronchoalveolar lavage (p = 0.021), and more concurrent infections (bacteremia p = 0.026; fungemia p < 0.001).Conclusions
Recent pulse therapy, pancytopenia, and concurrent infections constituted risk factors for mortality in patients with SLE and CMV infection. Among mortality patients, PCR rather than serological tests (IgM antibodies) helped to arrive at an earlier diagnosis. 相似文献10.
C. Adler Sørensen E. Fuglsang C. Sværke Jørgensen R. Pilmann Laursen A. Larnkjær C. Mølgaard C. Ritz K.F. Michaelsen K. Angeliki Krogfelt H. Frøkiær 《Clinical microbiology and infection》2019,21(4):511.e1-511.e7
Objectives
To examine the effect of a combination of probiotics on the antibody response to pneumococcal and pertussis vaccination in healthy Danish children, aged 8–14 months, at the time of starting day care. Moreover, the cytokine response to lipopolysaccharide of whole blood was assessed.Methods
A total of 290 children were randomly allocated to receive a combination of Bifidobacterium animalis ssp. lactis and Lactobacillus rhamnosus GG daily for a 6-month intervention period, and blood samples were drawn at the start and end of the study. Specific antibody response towards Streptococcus pneumoniae serotypes and Bordetella pertussis toxin, as well as endotoxin-induced interleukin-6 (IL-6) and interferon-γ (IFN-γ) production in blood were analysed by Luminex and ELISA.Results
There was no significant difference between the average individual changes from baseline to end of study in antibody concentrations for S. pneumoniae for both the probiotics (340.4% ± 11.2%) and the placebo group (382.9% ± 10.4%) (p 0.525), nor for B. pertussis toxin in the two groups (probiotics 190.1% ± 12.6% versus placebo 238.8% ± 1.1%, p 0.340). The average individual change in IL-6 concentration was significantly lower in the probiotics versus the placebo group (2.9% ± 10.3% versus 33.7% ± 9.0%, p 0.024), whereas there was no difference in IFN-γ concentration (0.0% ± 0.2% versus –0.2% ± 0.1%, p 0.279).Conclusions
The probiotic intervention did not affect the antibody response against S. pneumoniae and B. pertussis toxin in healthy Danish children. 相似文献11.
Tzu-I Yang Tu-Hsuan Chang Chun-Yi Lu Jong-Min Chen Ping-Ing Lee Li-Min Huang Luan-Yin Chang 《Journal of microbiology, immunology, and infection》2019,52(2):329-335
Background
Mycoplasma pneumoniae is a common pathogen for pneumonia in children, especially in the post-pneumococcal conjugate vaccination era. Though self-limited disease was found in the majority of the patients, severe diseases occurred occasionally. The emergence of macrolide resistance was reported worldwide. It is important to delineate whether macrolide resistance or delayed treatment affects outcome.Methods
We retrospectively collected pediatric patients with M. pneumoniae infection confirmed by positive PCR in a tertiary medical center in Taiwan from 2010 to 2017. Patients’ clinical characteristics, bacterial load, macrolide resistance and treatment outcome were analyzed.Results
Among 471 children with positive M. pneumoniae PCR, 95% were diagnosed with pneumonia. Seventeen percent of patients had extrapulmonary complications, and 1.5% had respiratory failure. Delayed treatment was associated with prolonged fever after appropriate treatment, fulminant disease, and extrapulmonary manifestations (p < 0.05). The mean rate of macrolide resistance was 24% and macrolide resistance was related to longer febrile duration, longer hospital stay, lung consolidation and impaired liver function tests (P < 0.05).Conclusions
Macrolide resistance was fairly common and might lead to delayed appropriate antibiotic treatment. Delayed appropriate antimicrobial treatment, no matter macrolide resistance or not, was associated with more severe and/or prolonged diseases. Early diagnosis of M. pneumoniae as well as the awareness of macrolide resistance make early effective antibiotic treatment possible and may improve clinical outcomes. 相似文献12.
Chia-Ying Liu Chih-Cheng Lai Hsiu-Tzy Chiang Min-Chi Lu Ling-Fang Wang Tsai-Ling Tsai Mei-Yu Kang Yi-Ni Jan Yi-Ting Lo Wen-Chien Ko Shu-Hui Tseng Chun-Ming Lee Po-Ren Hsueh 《Journal of microbiology, immunology, and infection》2019,52(1):62-74
Background/purpose
This study investigated the distribution and persistence of multidrug resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and multidrug-resistant Acinetobacter baumannii (MDRAB) in six long-term care facilities (LTCFs).Methods
We investigated the distribution of MDROs in residents of six LTCFs and their environments from January to December 2016 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples from the residents every three months. Multilocus sequence typing (MLST) was conducted, and genes for panton-valentine leukocidin (PVL) from MRSA isolates were determined.Results
A total of 521 samples were positive for MDROs, and MRSA was the most common organism (65.1%), followed by MDRAB (11.3%), carbapenem-resistant Klebsiella pneumoniae (11.1%), carbapenem-resistant Escherichia coli (4.6%), and carbapenem-resistant P. aeruginosa (2.1%, n = 11). By a linear regression model, positive MRSA isolates from the environment were found to be statistically significant and associated with the number of colonized LTCF residents (p = 0.01), while the timing of the surveillance culture was not (p = 0.227). The main MLST types associated with PVL-production were sequence type (ST) 59, (40.0%, 24/60), ST30 (21.4%, 3/14), ST8 (87.5%, 14/16), and ST45 (3.6%, 1/28). The susceptibility rates of tetracycline (96.7%), trimethoprim-sulfamethoxazole (96.7%), and ciprofloxacin (81.7%) were statistically significant and higher in MRSA ST59, compared to the rates in MRSA ST45 isolates.Conclusions
MRSA was the most commonly colonized MDRO, both in the LTCF residents and in the environment, followed by MDRAB and carbapenem-resistant K. pneumoniae. 相似文献13.
Chih-Cheng Lai Min-Chi Lu Hung-Jen Tang Yen-Hsu Chen Yi-Hui Wu Hsiu-Tzy Chiang Li-Hung Wu Wen-Chien Ko Po-Ren Hsueh Yu-Hui Chen 《Journal of microbiology, immunology, and infection》2019,52(2):345-351
Background/purpose
This study investigated the cause of hand hygiene deficit, and further implemented a quality improvement program using WHO's hand-hygiene strategy to enhance the compliance of hand hygiene in the nursing home in Taiwan.Methods
This prospective study was conducted in eleven nursing homes in Taiwan from January 2015 to December 2016. After intervention, we monitor the compliance, and accuracy of hand hygiene. In addition, we also calculated the number of episodes of infection per 1000 resident-days in each nursing home in the intervention period (July–December 2015) and post-intervention period (January–October 2016).Results
Overall, the consumption of alcohol-based handrubs increased from 10.1 ml per resident-day in intervention period to 12.2 ml per resident-day in post intervention period. The compliance of hand hygiene increased from 74% in intervention period to 79% in post-intervention period and the rate of correct hand hygiene increased from 81% in intervention period to 87% in post-intervention period. Most importantly, the infection density decreased from 2.39 per 1000 resident-day in intervention period to 1.89 per 1000 resident-day.Conclusions
A national quality-improvement program using WHO's hand-hygiene strategy to enhance hand hygiene and reduce healthcare associated infection is effective in nursing homes in Taiwan. 相似文献14.
Background
Rhodococcus equi is a recognized cause of disease in humans, especially in individuals who are immunocompromised. Because diphtheroids are regarded as part of normal respiratory flora, the importance of R. equi as a pulmonary pathogen may not be fully appreciated and its prevalence may be underestimated. Most treatment recommendations for R. equi infection were established before antiretroviral drugs became available for human immunodeficiency virus/AIDS therapy, and therapeutic strategies may need to be updated.Objectives
To review the role of R. equi as a cause of pulmonary infection; to highlight its importance for clinicians and microbiologists; and to challenge current approaches to treatment, whether in immunodeficient or immunocompetent individuals.Sources
A PubMed search using combinations of the following terms: ‘Rhodococcus (automatically including Corynebacterium) equi’ AND ‘pneumonia’ OR ‘pulmonary’ infection, then cross-checking references in the resulting cases, case series and reviews.Content
We provide a review that details the challenges in the diagnosis, microbiology and pathogenesis of pulmonary infection caused by R. equi and the options for treatment.Implications
Ten to 14 days of treatment may be effective for pneumonia due to R. equi. Our review suggests that longer courses of therapy are needed for cavitary lesions and lung masses. However, recommendations for excessively prolonged treatment of all pulmonary infections arose during a time when many cases occurred in individuals with AIDS and before effective antiretroviral therapy was available. We suggest that the rationale for prolonged therapy with multiple antibiotics needs to be re-evaluated. 相似文献15.
Hung-Jen Tang Chih-Cheng Lai Chi-Chung Chen Chun-Cheng Zhang Tzu-Chieh Weng Yu-Hsin Chiu Han-Siong Toh Shyh-Ren Chiang Wen-Liang Yu Wen-Chien Ko Yin-Ching Chuang 《Journal of microbiology, immunology, and infection》2019,52(2):273-281
Background/Purpose
In vitro studies of the combination of an aminoglycoside with tigecycline or doxycycline against Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates are rarely published. The goal of this study was to evaluate the antibacterial activity of the combination regimens.Methods
Thirteen genetically different KPC-producing K. pneumoniae isolates were randomly selected. Drug concentrations of amikacin, gentamicin, tigecycline, and doxycycline were adjusted to 1-, 1/2-, and 1/4-fold of respective minimum inhibitory concentrations (MICs). Each drug alone or the combinations of amikacin or gentamicin with tigecycline or doxycycline were tested by combination studies.Results
Treatment with the 1× MIC concentration in combinations of amikacin or gentamicin and tigecycline or doxycycline for 24 hours resulted in bactericidal activity of 84–100% in the isolates. Treatment with 1/2× MIC combinations resulted in synergism of 69–100% in the isolates. Notably, doxycycline plus gentamicin or amikacin was synergistic for all tested isolates. However, bactericidal or synergistic effect was barely evident following 1/4× MIC combinations. There was no antagonism in any of the combination regimens.Conclusion
Enhanced activity was noted following treatment with doxycycline combined with gentamicin or amikacin against KPC-producing K. pneumoniae isolates, warranting further in vitro and animal investigations before clinical application. 相似文献16.
Objectives
A comprehensive overview of the ways control measures directed at carriers of multidrug-resistant organisms (MDRO) affect daily life of carriers is lacking. In this systematic literature review, we sought to explore how carriers experience being a carrier and how they experience being subjected to control measures by looking at the impact on basic capabilities.Methods
We searched Medline, Embase and PsychINFO until 26 May 2016 for studies addressing experiences of MDRO carriers. Twenty-seven studies were included, addressing experiences with methicillin-resistant Staphylococcus aureus (n = 21), ESBL (n = 1), multiple MDRO (n = 4) and other (n = 1, not specified). We categorized reported experiences according to Nussbaum's capability approach.Results
Carriage and control measures were found to interfere with quality of care, cause negative emotions, limit interactions with loved ones, cause stigmatization, limit recreational activities and create financial and professional insecurity. Further, carriers have difficulties with full comprehension of the problem of antimicrobial resistance, thus affecting six out of ten basic capabilities.Conclusions
Applying Nussbaum's capability approach visualizes an array of unintended consequences of control measures. Carriers experience stigmatization, especially in healthcare settings, and have limited understanding of their situation and the complexities of antimicrobial resistance. 相似文献17.
M.J. Maze K.J. Sharples K.J. Allan M.P. Rubach J.A. Crump 《Clinical microbiology and infection》2019,21(4):437-444
Background
Leptospirosis is under-diagnosed by clinicians in many high-incidence countries, because reference diagnostic tests are largely unavailable. Lateral flow assays (LFA) that use antigen derived from heat-treated whole cell Leptospira biflexa serovar Patoc have the potential to improve leptospirosis diagnosis in resource-limited settings.Objectives
We sought to summarize estimates of sensitivity and specificity of LFA by conducting a systematic review and meta-analysis of evaluations of the accuracy of LFA to diagnose human leptospirosis.Data sources
On 4 July 2017 we searched three medical databases.Study eligibility criteriaArticles were included if they were a study of LFA sensitivity and specificity.Participants
Patients with suspected leptospirosis.Interventions
Nil.Methods
For included articles, we assessed study quality, characteristics of participants and diagnostic testing methods. We estimated sensitivity and specificity for each study against the study-defined case definition as the reference standard, and performed a meta-analysis using a random-effects bivariate model.Results
Our search identified 225 unique reports, of which we included nine (4%) published reports containing 11 studies. We classified one (9%) study as high quality. Nine (82%) studies used reference tests with considerable risk of misclassification. Our pooled estimates of sensitivity and specificity were 79% (95% CI 70%–86%) and 92% (95% CI 85%–96%), respectively.Conclusions
As the evidence base for determining the accuracy of LFA is small and at risk of bias, pooled estimates of sensitivity and specificity should be interpreted with caution. Further studies should use either reference tests with high sensitivity and specificity or statistical techniques that account for an imperfect reference standard. 相似文献18.
H. Li L. Liu W. Zhou Y. Rui B. He Y. Shi X. Su 《Clinical microbiology and infection》2019,21(4):504-510
Objectives
Pentraxin 3 (PTX3) contributes to resistance to Aspergillus infections. This study aimed to evaluate the presence of PTX3 in bronchoalveolar lavage fluid (BALF) and plasma in non-neutropenic patients with pulmonary aspergillosis.Methods
BALF (n = 211) and plasma samples (n = 307) were collected from patients initially suspected of having pulmonary aspergillosis. Among these, 112 cases (51 BALF samples and 89 plasma samples) were proven to be pulmonary aspergillosis. These cases were classified as invasive pulmonary aspergillosis (IPA), subacute invasive aspergillosis (SAIA) and chronic pulmonary aspergillosis (CPA). The remaining cases were non-aspergillosis controls and were diagnosed with community-acquired pneumonia (CAP), lung cancer and pulmonary cryptococcosis. Plasma samples from healthy controls (n = 30) were also collected.Results
The median (interquartile range, IQR) BALF PTX3 for aspergillosis cases was significantly higher than for non-aspergillosis cases: 6.97 (2.91–13.51) ng/mL versus 1.26 (0.76–1.76) ng/mL. When the PTX3 threshold was set at 1.9 ng/mL, sensitivity and specificity of BALF PTX3 for aspergillosis were 86.3% (95%CI 83.8–88.4%) and 82.5% (95%CI 79.7–85.0%), respectively. The median (IQR) plasma PTX3 for aspergillosis cases was significantly higher than for non-aspergillosis cases and healthy controls: 7.10 (3.36–9.53) ng/mL versus 1.57 (0.86–2.35) ng/mL versus 1.10 (0.49–1.51) ng/mL. With a PTX3 threshold of 2.3 ng/mL, sensitivity and specificity were 79.8% (95%CI 70.1–81.2%) and 72.1% (95%CI 69.5–74.5%) respectively.Conclusions
BALF and plasma PTX3 may be biomarkers for differentiating aspergillosis from other conditions such as CAP, lung cancer, and pulmonary cryptococcosis in non-neutropenic patients. 相似文献19.
Hsiao-Chuan Lin Jang-Jih Lu Lee-Chung Lin Cheng-Mao Ho Kao-Pin Hwang Yu-Ching Liu Chao-Jung Chen 《Journal of microbiology, immunology, and infection》2019,52(1):81-89
Background
Group B Streptococcus (GBS) is an important invasive pathogen in neonates, pregnant women and the elderly. Serotype VI GBS, which has been rarely reported globally, has emerged as a significant pathogen in Asia. However, traditional serologic latex agglutination (LA) methods may fail to type isolates that lack of or low expression of CPS.Methods
A total of 104 GBS strains were analyzed by MALDI-TOF MS. Multiplex PCR and multilocus sequence typing (MLST) were also performed to confirm their strains. The protein markers were purified with gel electrophoresis and LC-column, followed by identification with nanoLC–MS/MS analysis.Results
Protein peak of 6251-Da was appeared in most (20/24, 92%) serotypes VI (94% ST-1 or single locus variant of ST-1), and protein peak of 6891-Da was appeared in most serotypes III (15/18, 83%) and Ib (19/23, 83%) strains. The protein peak of 6251-Da and 6891-Da were identified as CsbD family protein and UPF0337 protein gbs0600, respectively.Conclusions
The protein peak of 6251 Da may play a role of emergence of ST-1 clone, serotype VI GBS in central Taiwan and could be useful in rapid identifying invasive serotype VI from III isolates, which is hardly achieved by LA. 相似文献20.
Jinyi Yuan Biwen Mo Zhuang Ma Yuan Lv Shih-Lung Cheng Yanping Yang Zhaohui Tong Renguang Wu Shenghua Sun Zhaolong Cao Jufang Wu Demei Zhu Liwen Chang Yingyuan Zhang 《Journal of microbiology, immunology, and infection》2019,52(1):35-44