RESUMEN
Infection caused by Candida auris ha C. auris s rapidly become a global health threat. C. auris created a significant healthcare burden due to various complicating factors, including misidentification by commercial identification methods, potent antifungal resistance, high mortality rates and the possibility of nosocomial outbreaks through direct contact. In Vietnam, there are currently no clinical reports on C. auris infections. Here, we present four clinical cases of C. auris infections in the Department of Pulmonary Medicine of Cho Ray Hospital in southern Vietnam. Through this report, we aim to highlight the attention to the emergence of C. auris in Vietnam. Further research on C. auris infections is warranted, focusing on newly observed clinical characteristics present in all cases in this report, including hypoalbuminaemia and corticosteroid usage. Moreover, one case of resistance to amphotericin B has been identified, possibly due to prior exposure to this antifungal agent. LEARNING POINTS: Further research on Candida auris infections is warranted, focusing on newly observed clinical features present in all cases in this report, including hypoalbuminaemia and corticosteroid use during hospitalisation.While Candida auris remains susceptible to commonly used antifungal drugs, one case of resistance to amphotericin B has been documented, possibly due to prior exposure to this antifungal agent.
RESUMEN
The aim of this study was to create a dynamic web-based tool to predict the risks of methicillin-resistant Staphylococcus spp. (MRS) infection in patients with pneumonia. We conducted an observational study of patients with pneumonia at Cho Ray Hospital from March 2021 to March 2023. The Bayesian model averaging method and stepwise selection were applied to identify different sets of independent predictors. The final model was internally validated using the bootstrap method. We used receiver operator characteristic (ROC) curve, calibration, and decision curve analyses to assess the nomogram model's predictive performance. Based on the American Thoracic Society, British Thoracic Society recommendations, and our data, we developed a model with significant risk factors, including tracheostomies or endotracheal tubes, skin infections, pleural effusions, and pneumatoceles, and used 0.3 as the optimal cut-off point. ROC curve analysis indicated an area under the curve of 0.7 (0.63-0.77) in the dataset and 0.71 (0.64-0.78) in 1000 bootstrap samples, with sensitivities of 92.39% and 91.11%, respectively. Calibration analysis demonstrated good agreement between the observed and predicted probability curves. When the threshold is above 0.3, we recommend empiric antibiotic therapy for MRS. The web-based dynamic interface also makes our model easier to use.
RESUMEN
Background Liquid-based cytology (LBC) has shown advantages over conventional smears (CS), but previous applications in bronchoalveolar lavage (BAL) fluid have produced inconsistent results. This study compared LBC and CS for diagnosing lung cancer using BAL fluid. Methodology A prospective study was conducted on 92 patients suspected of having lung cancer. All patients underwent bronchoscopy and had a final diagnosis confirmed by histopathology of lesions tissue through biopsy. The study aimed to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the two cytological methods, in a pair-wise fashion. In addition, the study evaluated the correlation of factors, such as the volume of fluid used in LBC and bronchoscopy lesion morphology, with the sensitivity of LBC. Results The study involved 78 participants who were diagnosed with lung cancer. The sensitivity, specificity, PPV, and NPV of LBC were 25.7%, 100%, 100%, and 19.4%, respectively, whereas those of CS were 15.4%, 85.7%, 85.7%, and 15.4%, respectively. Although the sensitivity of LBC was higher than that of CS, the difference was not statistically significant (p=0.096, McNemar test). Furthermore, the median fluid volume performed during LBC in patients with positive results was significantly higher than in those with negative results (p=0.001, Mann-Whitney U test). Conclusions The application of LBC to BAL fluid has demonstrated similar and potentially superior diagnostic accuracy compared to CS in detecting lung cancer. It is recommended that further investigation be undertaken to examine the relationship between the volume of fluid utilized during the LBC process and its diagnostic accuracy to enhance its sensitivity.
