Infectious Disease Specialists Research Articles

Parenteral Vancomycin in the Treatment of MRSA-Associated Diabetic Foot Infections: An Unnecessary Risk.

Diabetic foot infections (DFIs) are a common and costly complication of diabetes. Soft tissue and bone infections in DFIs frequently lead to amputation and/or sepsis which can be costly for both the patient and the healthcare system. Staphylococcus aureus is the most commonly identified causative agent in DFIs, and people with diabetes may have an increased risk of infection with methicillin-resistant Staphylococcus aureus (MRSA). In addition to increased susceptibility to severe infection, MRSA in DFIs is associated with high rates of treatment failure, morbidity, and hospitalization costs meaning appropriate treatment is a high priority. While hospitalized patients are usually treated with intravenous (IV) vancomycin, this can be costly in terms of inpatient stays, staffing costs, and adverse events. For example, vancomycin-associated acute kidney injury not only delays hospital discharge and increases costs but is also a particular concern for patients with diabetes who already have an increased risk of kidney problems. Vancomycin-resistant strains of S. aureus have also been identified, which means that alternative treatment options may need to be explored. Treatment alternatives to IV vancomycin, including oral antibiotics, have been shown to provide similar efficacy, with reduced costs, outpatient or home-based administration, and with fewer serious adverse effects. Although infectious disease specialists often use IV vancomycin alone, or in combination, as a first-line therapeutic option, they are increasingly seeing the value of outpatient or at-home oral antibiotics as an alternative. This manuscript reviews the evidence for true costs of vancomycin therapy for MRSA-associated DFIs and examines the alternatives.

Antisynthetase syndrome: a case report and review of the literature.

antisynthetase syndrome is a rare autoimmune disease characterized byinterstitial lung disease, non-erosive arthritis, myositis, Raynaud's disease, and/or "mechanichand" when autoantibodies directed against aminoacyl-tRNA synthetases are detected.Antisynthetase syndrome belongs to the group of idiopathic inflammatory myopathies and isthe so-called overlap myositis. The article provides the latest literature data on the diagnosticvalue of myositis-specific autoantibodies based on a literature review for the period from2013 to 2023 using the scientometric databases MEDLINE/ PubMed, Wiley Online Library,and Scopus. Data from the literature show that certain myositis-specific autoantibodies,namely anti-PL-7 and anti-PL-12, can affect the risk of developing interstitial lung disease,and determine the course and prognosis of the disease. The presence of interstitial lungdisease in patients with myositis correlates with increased morbidity and mortality. Thearticle describes a clinical case of the debut of the antisynthetase syndrome from interstitiallung disease, which was falsely diagnosed as a coronavirus disease. The patient's condition
 improved only because of using glucocorticoids, which the patient stopped taking over time,which led to the worsening of pulmonary symptoms, the appearance of new clinical signs ofdamage to the joints and skin, progressive decrease in muscle function, and dysphagia. Afteran examination in the rheumatology department, based on the presence of interstitial lungdisease in the patient - fibrotic alveolitis, which was confirmed by computer tomography,myositis, arthritis, characteristic skin changes, the presence of antinuclear antibodies, anti-SS-A/Ro52, specific antisynthetase antibodies (Jo-1, Pl-7, Pl-12), the diagnosis of theantisynthetase syndrome was established. A detailed laboratory and instrumental examinationmade it possible to rule out a paraneoplastic process at the time of examination. Theprescribed treatment included pulse therapy with methylprednisolone and cyclophosphamide,which led to improvement in the patient's condition. The work carried out emphasizes theneed for interdisciplinary interaction of pulmonologists, rheumatologists, and infectiousdisease specialists at the stage of verification of the final diagnosis and the therapyappointment. Achieving clinical and laboratory remission of the disease requires long-termmonitoring by a rheumatologist.

Features of the epidemic process in the spread of a new coronavirus infection COVID-19 on the territory of the metropolitan area in the period 2020–2022

Introduction Conducting a comprehensive epidemiological etiological analysis of the development of the СОVID-19 pandemic in a metropolitan area is of interest to specialists of didderent profiles (epidemiologists, infectious disease specialists, pediatricians, therapists, immunologists, virologists). An important element of epidemiological surveillance is the assessment of collective immunity to infectious agents, including the SARS-CoV-2 virus. The natural ability of viruses to variability leads to the emergence of new types and strains. Currently, a number of mutations and polymorphisms have been identified that affect the structure and stability of proteins, factors of susceptibility to SARS-CoV-2 infection, pathogenicity and virulence of the virus, and the ability to “elude” the immune response of the host organism.The aim of the work was to assess evaluate the character of the epidemic process development of a new coronavirus infection on the territory of the metropolitan area in the period 2020–2022.Materials and methods A total of 331,013 people were examined by PCR for the presence of SARS-CoV-2 RNA in nasopharyngeal and oropharyngeal swabs. Specific IgM and IgG antibodies to SARS-CoV-2 in serum were detected by ELISA in 42,955 people. Genetic variants of the virus were typed (by PCR and sequencing).Results During the entire follow-up period, the highest percentage of “positive for Covid-19” was observed in February 2022 (58.9 %) and September 2022 (46.8 %). Among the total number of patients examined (n = 331,013), adult patients accounted for the largest proportion, – 83.9 %, children – 16.1 %. The proportion of individuals with specific IgG to SARSCoV-2 in 2020–2021 ranged from 53.3–82.6 %.Discussion In 2020–2022, there was an increase in the proportion of individuals with detectable RNA virus. The greatest infection was observed in the age groups 19–27 years and 28–65 years. It was found that the linear dependence of the increase in the specific weight of seropositive persons with respect to IgG among the residents of Ekaterinburg has a progressive trend, the approximation reliability coefficient R2 corresponds to 0.8172. In samples of patients examined in April–August 2022, markers of the genetic variant Omicron were detected in 96.9 % of cases. The increase in the structure of infected pediatric population (almost twofold over 2020–2022 years) is probably caused by the adaptation of the pathogen to a new susceptible cohort of people.Conclusion The dynamics of the number of people examined and the proprtion of detectability of SARS-CoV-2 RNA in Ekaterinburg during the entire period of the pandemic (March 2020–December 2022) had a wave-like character. By the end of 2022, the level of seropositive individuals in all age groups increased significantly, which confirms the presence of collective immunity in the territory.

Determinants of implementing the ID ROLL OUT study's interventions: qualitative results

Abstract Issue Antimicrobial stewardship programmes (ASP) and infectious disease (ID) specialists aim to ensure the rational use of antimicrobials and to improve patient outcomes. Whilst ASPs are established to varying degrees, ID specialists are rarely available in secondary and tertiary care hospitals in Germany. Description of the problem With the ID ROLL OUT study, we implemented and evaluated an intervention, which comprises ASP with and without ID specialists’ consultation in ten hospitals (excl. university hospitals) in south-west Germany. Little has been reported on the medical and pharmaceutical staff's perspectives on the implementations. This study describes barriers, facilitators, and suggestions for improvement to successfully establish a large-scale multicentre intervention. The participants responsible for implementing the intervention were interviewed using semi-structured, guided interviews at two time-points (t1: n = 17; t2: n = 18). The recorded interviews were analysed for content, following Kuckartz. Results A high level of acceptance and a positive attitude towards the intervention are conducive to the intervention's successful implementation. The teams find extra time for the study and a close staff collaboration at a local team level to be helpful. The main barriers identified are a high workload, lack of acceptance by colleagues in key roles, and the Covid-19 pandemic. Lack of digitalisation and entrenched internal structures were identified as major barriers. To further improve implementation, more infectious disease training should be provided, along with support from superiors and extension of the intervention phase. Moreover, government-mandated ASP guidelines and quality management by the German Medical Association are desired and expected to contribute in the future. Lessons The identified determinants provide much-needed key information, which is important for the efficient, targeted and successful implementation of future similar interventions. Key messages • Acceptance, positive attitude and staff collaboration help to implement the intervention. • Heavy workloads and lack of support from key colleagues hinder the intervention’s implementation.

Shortage and unequal distribution of infectious disease specialists in Japan: How can we refine the current situation?

This study aimed to assess the distribution of board-certified infectious disease (ID) specialists at medical schools and Designated Medical Institutions (DMIs) in Japan. Data on the number of board-certified ID specialists was extracted by gender, prefecture, and hospital from the Japanese Association for Infectious Diseases database. The numbers and types of Japanese university hospitals that have a Faculty of Medicine, as well as the DMIs legally determined by the Infectious Diseases Control Law, were collected from the database of the Ministry of Health, Labour, and Welfare of Japan. As of November 2022, there were 1,688 board-certified ID specialists in Japan, with 510 employed at 82 university hospitals. Two medical schools had no ID specialists, and six had only one ID specialist. There was no ID specialists in 14.3% of Class I DMIs and 66.7% of Class II DMIs. Additionally, 14.9% of prefectures had no ID specialists at all in their Class II DMIs. The percentage of female doctors among ID specialists was 12.7%, approximately half of the overall male-to-female ratio of medical doctors in Japan. The allocation of Japanese ID specialists to medical schools and legally designated healthcare institutes is inadequate and skewed. Female physicians are expected to play a more active role in this increasing demand.

Tunneled hemodialysis central venous catheters prevalence and bloodstream infection rates in Northern Italy: A survey of the "East Lombardy Nephrological Network".

Tunneled central venous catheter (tCVCs) is a vascular access frequently employed in hemodialysis patients. Catheter-related bloodstream infections (CRBSI) are potentially life-threatening complications. We performed a retrospective survey regarding tCVCs prevalence as well as the CRBSI incidence and management within five hospitals in the Brescia province belonging to the "East Lombardy Nephrological Network"; this study was based upon 18 queries regarding the years 2020 and 2021. The data collected refer to an overall hemodialysis population of 736 patients in 2020 and 745 patients in 2021. The prevalence of tCVCs was respectively 22.1% and 24.2% with the initial placement being performed with fluoroscopy support in 80% of the centers. CRBSI incidence was respectively 0.88 and 0.77 episodes per 1000 days of tCVC use. When the CRBI was caused by Staphylococcus Aureus (SA) or Pseudomonas, differently from the recommendation of the KDOQI guidelines, the removal or the substitution of the tCVC did not occur immediately at the time of the diagnosis of the infection but only when the specific antibiotic therapy failed. A nose swab aimed at identifying SA carriers was performed in 60% of centers. The policy regarding the referral to other specialists (infectious disease specialist and microbiologist) was heterogenous across the centers according to their specific logistics. This retrospective survey performed by the "East Lombardy Nephrological Network" within the Brescia province describes the prevalence of tCVCs use as well as the incidence and management of CRBSIs in the hemodialysis patients of this area. The clinical impact of the differences in terms of clinical approach detected compared to the KDOQI guidelines will need to be clarified ideally in prospective studies.

Paediatric bone and joint infections: a guide from diagnosis to management

Paediatric bone and joint infections (PBJI) can be challenging to diagnose due to their non-specific symptoms including fever, pain, swelling, and limited range of motion of the limb. The diagnosis involves a combination of clinical evaluation, laboratory tests, and imaging studies. Plain radiographs, ultrasound, and MRI can aid in the diagnosis of these infections. The approach to treating PBJI is multidisciplinary, involving paediatricians, infectious disease specialists, orthopaedic surgeons, and radiologists. Family-centred care and close follow-up are crucial to ensure optimal outcomes for children with bone infections. Management involves a combination of medical treatment with intravenous and oral antibiotics, and, if required, surgical interventions centred around debriding all dead bone and soft tissue, draining intra- or extra-osseus abscesses, stabilizing pathological fractures and delivering high doses of local antibiotics. Early diagnosis and prompt initiation of appropriate treatment are crucial to prevent long-term complications such as chronic osteomyelitis, septic arthritis, growth disturbances and limb length discrepancies.

Structured approach for infected prosthesis

Endoprosthesis infections represent amajor challenge for doctors and patients. Due to the increase in endoprosthesis implantation because of the increasing life expectancy, an increase in endoprosthesis infections is to be expected. In addition to infection prophylaxis, methods of infection control become highly relevant, especially in the group of geriatric and multimorbid patients. The aim is to reduce the high 1‑year mortality from prosthesis infections through astructured algorithm. Prosthesis infections can basically be divided into early and late infections. According to the criteria of the International Consensus Meeting, alate infection is defined as the occurrence more than 30days after implantation. With respect to the planned approach, the (p)TNM classification offers an orientation. In the early postoperative interval the clinical appearance is crucial as in this phase neither laboratory parameters nor an analysis of synovial fluid show ahigh sensitivity. It is fundamental that, apart from patients with sepsis, environment diagnostics should be initiated. If alate infection is suspected, in addition to radiological diagnostics (X-ray, skeletal scintigraphy and if necessary, computed tomography, CT), laboratory (C-reactive protein, CRP, leukocytes, blood sedimentation, and if necessary, interleukin‑6, procalcitonin) and microbiological diagnostics (arthrocentesis with synovial analysis and microbiology) are indicated; however, in addition to the arthrocentesis result, the clinical appearance is crucial in cases where an exclusion cannot be confirmed by laboratory parameters. If an infection is confirmed, the treatment depends on the spectrum of pathogens, the soft tissue situation and the comorbidities, including amultistage procedure with temporary explantation and, if necessary, implantation of an antibiotic-containing spacer is necessary. Aprosthesis preservation using the debridement, antibiotics and implant retention (DAIR) regimen is only appropriate in an acute infection situation. Basically, radical surgical debridement should be carried out to reduce the pathogen load and treatment of apossible biofilm formation for both early and late infections. The subsequent antibiotic treatment (short or long interval) should be coordinated with the infectious disease specialists. Astructured approach for prosthesis infections oriented to an evidence-based algorithm provides asufficient possibility of healing. An interdisciplinary approach involving cooperation between orthopedic and infectious disease specialists has proven to be beneficial. Surgical treatment with the aim of reducing the bacterial load by removing the biofilm with subsequent antibiotic treatment is of intrinsic importance.

Characteristics of Top-Searched Individuals in Japan's Yen for Docs Conflicts of Interest Database During the COVID-19 Pandemic.

Purpose Transparency in healthcare has led to increased public disclosure of doctors' conflicts of interest, with the "Yen for Docs Database" in Japan emerging as a pivotal source. Nevertheless, there remains ambiguity regarding the backgrounds and influence of highly-searched persons, especially during the COVID-19 pandemic. The primary objective of this study was to examine if the database was utilized for its intended purpose in 2021, a year marked by the introduction of vaccines and treatments, the addition of new COVID-19-related data, and the frequent appearances of expert statements in various media outlets. Methods We conducted a descriptive analysis on the 10 most frequently searched individuals in the "Yen for Docs Database" between August 27 and September 23, 2021, and determined the amount of money they received from pharmaceutical companies and other organizations over the four-year period between 2016 and 2019. To characterize frequently searched individuals' academic profiles and appearances in the mass media, we identified their h-index and affiliation, their activity on Twitter, and the number of TV appearances. Results There were 72,904 searches during the study period, with the top person accounting for 4,905 of those searches. All top 10 were male, mostly affiliated with universities and specialists in infectious diseases or related fields. Their median number of COVID-19 articles was five, and the median h-index was 34. Four of these top 10 had Twitter accounts, with followers ranging from 12,000 to 195,000. The median amount received from pharmaceutical entities over four years was $154,930, ranging from $809 to $705,502. Conclusions In the Yen for Docs Database, a significant portion of searches during the COVID-19 pandemic was concentrated on a selected group of healthcare professionals with considerable payments over the years, and they exhibited prominent academic and media profiles. These observations highlight the need for more transparent conflicts of interest disclosure among physicians with public visibility.

Evaluation of the Approaches Adopted by the Infectious Diseases and Clinical Microbiology Specialists and Medical Microbiology Specialists in the Case of Myroides spp. Growth in Urine Culture: A Survey Study

Myroides species are bacteria that, although rare, can cause a variety of serious infections, including urinary tract infections, and are often resistant to antibiotics. There are no studies on the knowledge and attitudes of specialists regarding Myroides spp. growth in culture in literature. In our study, the survey forms created with Google Forms (Google LLC, CA, USA) were shared in the e-mail groups of Infectious Diseases and Clinical Microbiology (IDCM) and Medical Microbiology (MM) specialties via electronic communication system. The results were evaluated statistically. 92 IDCM specialists and 75 MM specialists participated in the study. It was found that 48.9% of IDCM specialists and 20% of MM specialists have never seen Myroides spp. growth in a urine sample, and 32.6% of IDCM specialists and 14.9% of MM specialists still use the old name Flavobacterium for Myroides spp. (28.8% of MM specialists do not know that the name Flavobacterium is changed), and 45% of MM specialists who had previously seen Myroides spp. growth were able to recognize the Myroides spp. colony visually, and 53.3% of MM specialists who had previously seen Myroides spp. growth routinely performed antibiograms in case of Myroides spp. growth in urine culture, and 32.6% of IDCM specialists requested typing and sensitivity testing in case of Myroides spp. growth in urine culture, and 31.9% of IDCM specialists who had previously seen Myroides spp. growth considered Myroides spp. growth as a causative agent of infection in the presence of pyuria in urine, while 36.2% always considered it as colonization/contamination, and 61.7% of IDCM specialists only changed the catheter without giving antibiotics when they considered Myroides spp. as a causative agent of infection, while 21.3% gave antibiotics according to the antibiogram result. As a conclusion; our study is the first study in the world to investigate the knowledge and attitudes of infectious disease specialists and medical microbiologists about Myroides spp. growth in urine culture. The findings of our study showed particularly that approximately half of the IDCM specialists had not seen Myroides spp. growth in urine culture and that some of the specialists may have a low level of knowledge about Myroides spp.. Additionally, among the specialists participating in the study, it was shown that attitudes and approaches in the case of Myroides spp. growth in urine were not directly related to the hospital that they worked and their years of experience in specialty. Our findings suggest that MM and IDCM specialists need an update of their knowledge on Myroides spp.

Cardiac implantable electronic device infection: Microbiology and antibiotic prophylaxis

Cardiovascular implantable electronic devices (CIED) improve quality of life of patients with cardiac arrhythmias and also improves chances of survival. CIEDs, however it may cause complications. To avoid these complications surgical prophylaxis in CIED insertion is required to avoid infection. Due to the rise in antimicrobial resistance the use of antimicrobial agents should be rational and under control. To prevent resistance of antibiotics their use and duration of therapy should be monitored. The high-end and restricted antibiotics should be used only if organisms grow in cultures or if suggested by infectious disease specialists. This review focuses on empirical antibiotics used as prophylaxis. The purpose of this document is to outline the antimicrobial options which can be used as an empirical prophylactic agent in CIED infections.

Differentiated approach to diagnosis and treatment to combined pathology of the pharynx, larynx and rhino-orbital zone: interdisciplinary interaction

Background. The main complaint of patients with inflammatory diseases of the pharynx is a sore throat; rhino-orbital pathology, in turn, is manifested by symptoms associated with impaired nasal breathing, lacrimal drainage and other ophthalmological disorders. With pathology of the larynx, dysphonia is often present. As a rule, such patients initially fall into the hands of general practitioners, therapists and pediatricians, less often otolaryngologists, however, periodically the clinical situation requires the involvement of other specialists and additional laboratory and instrumental studies. The article presents a number of clinical observations of patients with combined pathology of the pharynx, larynx and rhino-orbital zone, who initially turned to an otolaryngologist, who subsequently required a team approach from various specialists.
 Aim. Demonstration of a differentiated approach to the diagnosis and treatment of combined pathology of the pharynx, larynx and rhino-orbital zone within the framework of interdisciplinary interaction of specialists based on clinical observations of patients.
 Materials and methods. We observed 5 patients who initially sought consultation with an otorhinolaryngologist with complaints of pain or discomfort in the throat, impaired nasal breathing, lacrimal drainage, itching in the eye area, and dysphonia.
 Results. The article presents clinical cases of syphilis, leptotrichosis of the oropharynx, herpesvirus infection type VI, infectious mononucleosis, infectious-toxic paresis of the larynx, the diagnosis and treatment of which was carried out through interdisciplinary interaction of otorhinolaryngologists with doctors of other specialties. The presented observations demonstrate that, despite the reason for treatment, patients with combined pathology of the pharynx, larynx and rhino-orbital zone require the help of not only otolaryngologists, but also other specialists, primarily infectious disease specialists.
 Conclusion. In order to improve the quality of diagnosis, routing and treatment of patients with combined pathology of the pharynx and rhino-orbital zone, it is necessary to develop interdisciplinary interaction and create conditions for expanding the professional erudition of doctors dealing with the problems of pathology of the same anatomical areas.

The results of a survey of Russian doctors in order to identify the compliance of the management of children with chronic urticaria with clinical recommendations

Introduction. Primary observation of children with (CU) in Russia is performed by pediatricians, dermatologists, and algologists. It is unclear how clinical guidelines are used in a heterogeneous group of specialists.Materials and methods. Online survey of pediatricians, allergists, and dermatologists (n = 304) in the Russian Federation using a questionnaire, from 5 blocks of questions related to etiology, diagnosis, and therapy. 316 physicians with a median experience of 10 [5; 20] years were included in the questionnaire.Results. 83.3 % of respondents observed no more than 2 children with CU per month. Self-education to expand knowledge (video lectures, special literature) was indicated by 72.6 % of participants. The clinical guidelines used by physicians were documents of pediatric and allergy associations of Russia (77.3 and 55.9 %, respectively), international guides were used by 27 % of respondents.The most frequent deviations from the recommended algorithm were the prescription of biochemical blood tests (64.9 %), ultrasound examination of organs (56.9 %), consultations of specialists without indications: gastroenterologist (48.2 %), infectious disease specialist (31.8 %), rheumatologist (27.1 %). The autologous serum test in children is not used by 87.2 % of physicians for various reasons.During allergy testing, respondents recommend: the concentration of total IgE in serum (63.9 %), the number of eosinophils in the blood (61.2 %). The importance of determining specific IgE was indicated by no more than one third of the respondents. Skin tests during remission period were supported by 59.1 % of all physicians, who considered allergologic examination to be necessary. Diet: 18.6 % of respondents do not recommend a special diet for children; 27.7 % exclude from the diet foods to which sensitization is detected, the rest recommend an nonspecific elimination diet.Antihistamines of 2nd generation (AG II) are the most used in clinical practice (86.5 %). Physicians named cetirizine (25.7 %) and levocetirizine (19.7 %) as the drugs of choice up to 12 years of age. The need to double the dose of AG II in the absence of response to the standard dose was supported by 59.5 % of physicians. The other physicians preferred a change of AG II molecule in the standard dose. Experience with the use of omalizumab was reported by 20 % of specialists, with 76.3 % understanding the significance and willingness to use biologic therapy. If omalizumab is ineffective, 44.1 % of physicians consider glucocorticosteroids to be the drug of choice; 38.8 % — cyclosporine A. About one third of physicians use alternative therapies not considered in the clinical guidelines.Conclusion. A significant number of physicians do not use recommendations based on evidence-based studies in real practice. AG II are the basis of CU therapy in children in all age groups.

Algorithm for monitoring patients after tick bite in the context of Lyme-borreliosis

Timely diagnosis of Lyme-borreliosis (LB) is the key to its successful treatment. Outpatient monitoring of patients after tick bite based on the algorithm is able to optimize the early diagnosis of LB, shorten the start of treatment and improve the disease surveillance.Purpose. Creation of an algorithm for monitoring patients after tick bite for use in outpatient settings by primary care physicians. Material and methods. A retrospective, non-randomized, single-center cohort study was conducted based on the analysis of data from 660 outpatient records of patients consulted by an infectious disease specialist in the Infectious clinical hospital No.1 in Moscow. Patients were divided by age and the presence or absence of a diagnosis of LB. Confirmation of the diagnosis was carried out according to clinical and/or laboratory criteria using methods of enzyme-linked immunoassay and immune blot. Results. The analysis of the results of enzyme immunoassay of antibodies to borrelia in patients with LB was carried out. The optimal sampling time was 7 or more weeks from the moment of tick bite and 4 or more weeks from the moment of onset of symptoms. The specificity of immunological diagnostics in patients with excluded LB was evaluated. The proportion of doubtful and false positive results in such patients was high — 28.1%. False positive results were more common in adults (37.6%) compared with children (9.8%), which is associated with more frequent false positive results of IgM determination (34.1% in adults, 4.9% in children). Based on the data of our study, an algorithm for monitoring patients after tick bite has been developed, focused on use in outpatient settings by primary care physicians.

Successful treatment of multiple intracerebral aspergillosis with voriconazole alone in an Egyptian diabetic patient with autoimmune hemolytic anemia

Aspergillosis is a common fungus that lives in soil and decaying vegetation. Inhalation of the spores causes infection mostly in immunocompromised patients. Invasive aspergillosis has an extremely high mortality, and a definitive diagnosis requires histopathological evidence of deep tissue invasion or positive culture; however, this evidence is often difficult to obtain due to the critical nature of the patients in these situations. The sensitivity of culture in this setting is also low. The galactomannan test is a recent antigen–antibody serologic test that depends on detecting an antigen which is a molecule found in the cell wall of aspergillus species. A positive result supports the diagnosis of invasive aspergillosis. We present a case of multiple intracerebral brain abscesses in an immunosuppressed patient due to an aspergillus species diagnosed by the galactomannan test with an excellent response to the treatment with the novel voriconazole alone, without any surgical intervention, and the purpose is to alert the physicians, neurologists, and infectious disease specialists to consider the intracranial aspergillosis among the differential diagnosis of the acute onset encephalitis especially in immunocompromised patients as early diagnosis and treatment may be life-saving.

Infectious disease evaluations in a psychiatric unit, an observational study.

To know the frequency and infectious and non-infectious complications treated by infectious disease specialists in a psychiatric intensive-care hospitalization unit for adults and their outcomes. Observational study between 2016 and 2021. 37 patients with 41 events were evaluated. Almost half of the visits to these events originated from an antimicrobial stewardship program (46.3%). In 68.3% of the events, complementary studies were requested; in 14.6%, referral to other specialties; in 26.8%, an antimicrobial treatment was started; and in 75%, modifications were made to previous schemes. An infectious cause was identified in 30 of 41 events (73.2%) that included the following conditions: respiratory (31.7%), skin (9.8%), urinary (7.3%), gynecological (2.4%), one case of bacteremia with unknown source (2.4%), sequential infections (4.9%) and HIV therapy dropouts (7.3%). In the 11 remaining events, non-infectious causes were identified (26.8%): pulmonary thromboembolism, drug hepatotoxicity, false positive VDRL and HIV tests, steroid-induced psychosis in an HIV patient with thrombocytopenia, fever without etiology, residual positive SARS-CoV-2 PCR test, low O2 pulse oximetry due to oversedation and neuroleptic malignant syndrome. There was no mortality. Patients in psychiatric hospitalization wards suffer from a great diversity of infectious problems during their stay with conditions that simulate infections. An antibiotic surveillance system can detect half of these conditions. The infectious diseases visits allow for advising or reorienting of the study and modifying the antibiotic treatment.

Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

BackgroundPeople with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists). MethodsA committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only). ResultsIDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation. ConclusionOur findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis.

This study aimed to determine the effect of prophylactic use of carbapenems for acute pancreatitis on clinical outcomes. It was conducted according to the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the keywords "Pancrea * AND carbapenem OR imipenem OR ertapenem OR meropenem OR doripenem." Primer outcomes were mortality, surgical intervention, and pancreatic and non-pancreatic infection. Subgroup analyses were also performed to reduce the risk of bias. Ten studies with 4038 patients were included in the meta-analyses. While eight of ten were randomized controlled trials, two were observational studies. The prophylactic use of carbapenems had no statistically significant effect on mortality (OR=0.82, 95% CI=0.65-1.04, I²=0%) and surgical intervention. (OR=0.81, 95% CI=0.57-1.17, I²=0%). However, the real impact of prophylaxis on reducing the incidence of mortality and surgical intervention was uncertain due to the insufficient sample size. The prophylactic use of carbapenems was significantly associated with a lower risk of peripancreatic (OR=0.37, 95% CI=0.25-0.55, I²=61%) and non-pancreatic infection risk (OR=0.60, 95% CI=0.46-0.78, I²=65%). The definitions of infection in the articles were not clear, and the diagnostic approach to infection was based on subjective criteria. In addition, there was inadequate collateral damage and safety assessments. In high-quality studies with a low risk of bias, prophylactic carbapenems had no effect on peripancreatic infection (RR=1.54, 95% CI=0.65-3.47, I²=0%) and non-pancreatic infection (RR=0.72, 95% CI=0.48-1.07, I²=0%). Although there is a reduction in the infection risk, routine carbapenem use in acute pancreatitis cases should not be recommended based on current evidence. Cooperation with Infectious Disease specialists and developing diagnostic algorithms are required instead of routine prophylaxis to prevent infection, especially non-pancreatic infection.

After the HIV/AIDS Congress 2022 (24-27 November 2022, Antalya): Gains, Challenges and Recommendations for the Future Response to HIV Infection in Türkiye

The National HIV/AIDS Congress, organized every year by the Turkey HIV/AIDS Platform, which was formed by the five physician associations operating in the field of HIV infection in Turkey, was held in Antalya on 24-27 November 2022. This congress, AIDS and Sexually Transmitted Diseases Association (AIDS and STD Association), HIV/AIDS Prevention and Education Association (HAKED), HIV Infection Association (HIVEND), Turkish Infectious Diseases and Clinical Microbiology Specialist Association (EKMUD) and Turkish Clinical Microbiology and Infectious Diseases (KLİMİK) Association. In addition, the Red Ribbon Association, Positive-iz Association, and Positive Living Association, three subject associations operating in the field, contributed. This report aims to summarize the data presented by the health professionals, health authorities, and non-governmental organizations working at the forefront of the response to the HIV/AIDS epidemic in our country, their shares and discussions during the congress, and to determine the needs by analyzing the current situation in our country in the light of these.

Usutu Virus (&lt;i&gt;Flaviviridae, Orthoflavivirus&lt;/i&gt;). Potential Danger and Possibility of Spread on the Territory of the Russian Federation

In recent decades, an increase in the number of cases of detection of the Usutu virus (Usutu, USUV, Orthoflavivirus usutuense) (family Flaviviridae, genus Orthoflavivirus) has caused great concern among medical professionals, including virologists and specialists in infectious diseases, especially since its appearance in Europe, where the pathogen caused mass birds die-off, and annually registered human cases. This review provides information about the structure of the virus and its genetic variants, geographical distribution and features of circulation in Europe and Africa, the methods and principles used to indicate and identify this pathogen, as well as the main symptoms of the disease it causes. An assessment of the environmental prerequisites for the occurrence of outbreaks of the disease caused by the Usutu virus on the territory of the Russian Federation was also carried out.