Clinical Microbiology and Infection最新文献

Objectives: Intracranial devices may be used to treat or guide treatment of increased intracranial pressure in patients with pneumococcal meningitis. European guidelines do not recommend the routine use of intracranial devices in management of pneumococcal meningitis. However, in some countries, intracranial devices are used routinely, but the effect remains unknown. We aimed to examine whether mortality and sequelae were lower in patients with pneumococcal meningitis admitted to hospitals in regions in which intracranial devices were routinely used compared to regions not utilizing intracranial devices routinely in pneumococcal meningitis management.

Methods: In a registry-based, nationwide, population-based cohort study we examined patients with pneumococcal meningitis (Denmark, 2004-2021). Patients were categorized according to whether the individual was admitted to hospitals in regions where intracranial devices were routinely (exposed patients, n=305 of whom 66 (22%) had an intracranial device) or not routinely used (non-exposed patients, n=333 of whom 4 (1%) had an intracranial devices). We used Cox-regression to calculate adjusted mortality rate ratios (aMRR) and hazard ratios of sequelae for the short-term and long-term periods (<6 or ≥6 months after study inclusion).

Results: The short-term cumulative incidence of death was 22% among exposed patients and 22% among non-exposed patients. We found no association between mortality and routine use of intracranial devices in the region in which patients with pneumococcal meningitis were admitted (short-term aMRR (95% confidence interval [95%CI]): 0.9 [0.6-1.3], long-term aMRR [95%CI]: 1.0 [0.7-1.6]). Furthermore, our study did not demonstrate lower risks of diagnosis of epilepsy, hearing loss, diagnoses suggestive of brain damage, disability pension, or shorter length of stay in exposed compared with non-exposed patients with pneumococcal meningitis.

Conclusions: The routine use of intracranial devices is not associated with lower mortality or morbidity among patients with pneumococcal meningitis.

Background: Saccharomyces cerevisiae is a common environmental fungus and an uncommon, but increasingly recognized, cause of invasive fungal infection. The clinical manifestations of this infection can often be mistaken for histoplasmosis, a major cause of mortality in patients with advanced HIV.

Objectives: To review the current epidemiology, diagnostic approaches, and management strategies for S. cerevisiae infection in patients with HIV.

Sources: A literature search was conducted using PubMed from January 1980 and May 2024.

Content: This review features a case of S. cerevisiae infection in a patient with HIV to highlight the diagnostic challenges and clinical implications of disseminated infection. A summary of published cases in patients with vs. without HIV is provided alongside a review and discussion of both conventional and novel diagnostic methods. The role of current antifungal therapies in managing S. cerevisiae infections is also examined.

Implications: S. cerevisiae is a rare but clinically important opportunistic pathogen in patients with advanced HIV who have epidemiologic risk factors. When found in mucocutaneous lesions under the appropriate clinical scenario, S. cerevisiae should not automatically be dismissed as commensal flora.

Objectives: Our aim was to address existing knowledge gaps regarding risk stratification, best use of diagnostic resources, optimal treatment and general management of SARS-CoV-2 infection in solid organ transplant (SOT) recipients. As high-quality evidence specific to this fragile population is lacking, our final aim was to provide an expert consensus evidence-informed guidance that can aid clinicians in their daily practice.

Methods: This study was conducted within the Working Package 4 (WP4 - Fragile population cohorts) of the H2020 funded ORCHESTRA study [https://orchestra-cohort.eu]. Eight infectious disease and one clinical pharmacology specialists conducted a comprehensive scoping literature review which covered five key areas: the role of SOT as a risk factor for evolution to severe disease; the optimal use of diagnostic resources, considering cost-benefit ratios and appropriateness of active screening; a population-specific therapeutic management, including antiviral use and drug-drug interactions and appropriate duration of treatment; the potential need for withdrawal of immunosuppressive agents and management of potential donors and recipients with recent and/or ongoing SARS-CoV-2 infection at the time of transplantation. Based on this review, a 28-item questionnaire was developed and administered to a panel of experts through two rounds, following the Delphi methodology.

Results: The panel consisted of 21 experts, 13 females and 8 males, from Italy (n=11), Spain (n=5), Switzerland (n=2), Brazil (n=1), United States (n=1), and United Kingdom (n=1). Consensus was achieved for 18 out of 28 items after the first round and for 9 out of 13 items after the second round, according with agreement/disagreement levels obtained for each question and round, ten statements were finally produced.

Conclusions: The consensus statements derived from this study offer a framework for standardizing care and improving outcomes in SOT recipients affected by SARS-CoV-2 infection in field where high-quality evidence specific to this high-risk population is currently lacking.

Objectives: Acute ischemic strokes (stroke) are frequent and severe extracardiac complications in infective endocarditis (IE). Since intravenous thrombolysis (IV-thrombolysis) is contraindicated, mechanical thrombectomy (thrombectomy) offers potential benefit. We aimed to compare thrombectomy efficacy and safety between IE-related and general stroke cases.

Methods: Multicenter study of consecutive IE cases treated with thrombectomy at nine stroke centers in Spain from 2011 to 2022. Using propensity score matching, 50 IE cases were 1:4 matched with non-IE stroke patients (n=200). Efficacy was defined by successful recanalization rates [modified treatment in cerebral ischemia scale (mTICI) ≥2b], neurological improvement at 24 hours [decrease of National Institutes of Health Stroke Scale (NIHSS) compared to baseline], and good neurological outcome rates at 3 months [modified Rankin scale (mRS) ≤ 2]. Safety was assessed by intracranial hemorrhage (IC-hemorrhage), symptomatic IC-hemorrhage, crude mortality, and stroke-related mortality.

Results: Among 54 IE cases, 50 were matched with 200 controls. Successful recanalization was similarly achieved in both groups (76% vs 83%). Median NIHSS at 24h was comparable, with analogous rates of neurological improvement (78% vs 78%), and early dramatic response (48% vs 46.5%). No differences were seen regarding IC-hemorrhage rates, except for when prior IV-thrombolysis was given. Although crude mortality was higher in the IE cohort, no differences were seen in stroke-related mortality (12% vs 15%). At three months, mRS scores of the two groups were superimposable.

Conclusions: Thrombectomy in IE is as effective and safe as in non-IE patients, and prior IV-thrombolysis could decrease the procedural safety. Clinical practice guidelines may consider including the recommendation to perform thrombectomy alone in IE-related stroke.

Objectives: Passive immunotherapy, including monoclonal antibodies and neutralizing proteins, were used for the treatment of patients with COVID-19 during the pandemic. ACTIV-3/TICO was a multinational, randomized placebo-controlled platform trial that evaluated the effectiveness of multiple passive immunotherapy agents in patients hospitalized with COVID-19. Given the long half-life of some agents studied, participants were followed for an extended period to assess the long-term efficacy and sustained safety of these agents.

Methods: We conducted a pooled analysis of individual participant data from four trials of ACTIV-3/TICO: sotrovimab, amubarvimab-romlusevimab, tixagevimab-cilgavimab, and ensovibep. Cox proportional hazards models were conducted to compare time to mortality and time to mortality or rehospitalization between participants receiving active agents versus placebo through 18 months.

Results: A total of 2311 participants were enrolled between December 16^th, 2020 and November 15^th, 2021. Overall, 56.9% (1315/2311) received an active agent and 77.2% (1784/2311) of participants were unvaccinated for SARS-CoV-2. Median duration between symptom onset and enrollment was 8 days (IQR 6 - 10), and most participants received remdesivir (92.1% [2129/2311]) and corticosteroids (70.4% [1627/2311]) prior to enrollment. There was no difference in mortality across all active (11.9% [157/1315]) versus placebo (14.0% [139/996]) arms (HR 0.87 [95% CI 0.70 - 1.08]). Furthermore, there was no difference in combined mortality or rehospitalization across all active (31.7% [417/1315]) versus placebo (32.1% [320/996]) arms (HR 0.96 [95% CI 0.84 - 1.10]).

Conclusions: In our large study of long half-life passive immunotherapy for hospitalized patients with COVID-19, we did not find evidence of a long-term effect on either mortality or rehospitalization.

Trial registration: NCT04501978.