Clinical Microbiology and Infection最新文献

Background: Procalcitonin is known to have moderate diagnostic accuracy for bacteremia. A 2014 meta-analysis showed a 76% sensitivity for a 0.50 ng/mL threshold. Lower thresholds might improve sensitivity.

Objectives: To determine the diagnostic accuracy of procalcitonin for community-acquired bacteremia by conducting a systematic review and meta-analysis, focusing on the ability to exclude bacteremia.

Methods data sources: We searched PUBMED, EMBASE and Web of Science from the 1^st of January 2014 up to the 20^th of May 2025.

Study eligibility criteria and participants: Articles studying diagnostic accuracy of procalcitonin for community-acquired bacteremia in adults.

Test and reference standard: Procalcitonin was compared to blood culture results.

Assessment of risk of bias: Risk of bias was assessed using the QUADAS-2 tool.

Methods of data synthesis: We pooled sensitivity/specificity with a bivariate random-effects model and created a summary receiver-operating (sROC) curve. The main analysis focused on studies reporting on a procalcitonin threshold of 0.10 ng/mL. In addition, we analysed results for all studies, studies with a 0.25 ng/mL and studies with a 0.50 ng/mL threshold.

Results: We included 40 out of 5450 identified articles, reflecting 192.529 patients of whom 31.480 (16%) had bacteremia. 32 out of 40 studies had high risk of bias. The pooled sensitivity for a 0.10 ng/mL threshold was 93% (95% CI: 85% - 97%) with a specificity of 36% (95% CI: 26% to 47%). The area under the sROC curve for all studies was 0.80 (95% CI: 0.76 - 0.83), prediction interval (PI) 0.57 - 0.91.

Discussion: A low cut-off value of PCT can be useful to exclude community-acquired bacteremia, depending on what the treating clinician considers to be an acceptable trade-off between sensitivity and specificity. Procalcitonin may require combination with clinical characteristics for accurate assessment of the risk of bacteremia and safely reducing unnecessary blood cultures.

Objectives: Parapneumonic pleural effusions/empyema (PPE/PE) are serious complications of community-acquired pneumonia in children. While Streptococcus pneumoniae and Streptococcus pyogenes are established major pathogens, the clinical relevance of oral cavity bacteria (viridans streptococci, anaerobic bacteria; VS/AA) in paediatric PPE/PE is largely unclear.

Methods: A nationwide hospital-based surveillance study in Germany recorded children aged <18 years with PPE/PE from 10/2010 to 6/2023, with bacteria detected from pleural fluid and/or blood. We compared clinical characteristics of patients with VS/AA-associated PPE/PE to those with S. pneumoniae- or S. pyogenes-associated PPE/PE (reference group) using multivariable regression analysis, with results presented as regression coefficient (RC) or Odds Ratio (OR) with 95% Confidence Interval (95%CI), respectively.

Results: Among 1,242 children with any identified PPE/PE-associated pathogen, 115 (9.3%) presented with VS/AA and 818 (65.9%) with S. pneumoniae or S. pyogenes. Compared to the reference group, children with VS/AA-associated PPE/PE were older (median [IQR): 11.4 [4.9-14.9] vs. 3.6 [2.2-5.7] years, p<0.001) and had more underlying diseases (46.1% [53/115] vs. 22.2% [182/818], p<0.001), mainly complex neurological comorbidities (25.2% [29/115]). In multivariable analyses, VS/AA vs. reference patients showed a similar duration of hospital stay (median [IQR]: 20 days [15-28] vs. 18 days [14-25], p=0.467), and a similar proportion required treatment at a paediatric intensive care unit (PICU) (80.0% [92/115] vs. 81.5% [667/818], p=0.992). VS/AA patients had a longer time from symptom onset to hospital admission or to discharge (by 4.1 days [RC, 95%CI 2.5-5.7, p<0.001], and by 5.2 days [RC, 95%CI 2.1-8.3, p=0.001], respectively), and needed longer PICU treatment (by 3.1 days, [RC, 95%CI 0.4-5.9, p=0.025]). They showed more frequently pulmonary complications, especially atelectasis (65.2% [75/115] vs. 50.6% [414/818]; OR 1.9, 95%CI 1.2-3.0, p=0.006) and pulmonary abscess (27.8% [32/115] vs. 19.8% [162/818]; OR 1.7, 95%CI 1.0-2.8, p=0.040). They were more likely to develop sequelae (41.6% [47/115] vs. 21.3% [173/818]; OR 2.3, 95%CI 1.5-3.7, p<0.001) but less likely to develop sepsis/SIRS (8.7% [10/115] vs. 18.1% [148/818]; OR 0.4, 95%CI 0.2-0.7, p=0.004).

Conclusions: VS/AA-associated PPE/PE particularly affected older children and those with complex comorbidities. In such patients, it would therefore be advisable to include anaerobic coverage in empirical antibiotic treatment, and distinct clinical features should be considered in therapeutic management.

Objectives: Gonorrhea, caused by Neisseria gonorrhoeae, is a significant public health challenge due to the rising incidence of antimicrobial resistant (AMR) strains. The Valencian Region, one of the top tourist destinations in Eastern Spain, has witnessed an increase of over 200% in the number of cases in recent years. Here, we aimed to investigate the impact of imported AMR lineages in shaping the local gonococcal population and generating sustained transmission events.

Methods: We analysed 1647 N. gonorrhoeae isolates collected in the Valencian Region between 2012-2024 with accompanying phenotypic antimicrobial susceptibility and epidemiological data. Genomic data was obtained through high-throughput sequencing and combined with 5894 genomes from national and international isolates. From these, information on typing and genetic AMR determinants was derived. Phylogenomic and statistical inference were used to investigate the local dynamics of this pathogen.

Results: Results revealed high levels of AMR, including 63.6% (n=449/706) ciprofloxacin resistance, 17.7% (n=195/1102) azithromycin resistance and 8.4% (n=66/783) reduced susceptibility or resistance to ceftriaxone. The two main circulating lineages were NG-STAR CC1615 and CC63, carrying 55.0% (n=121/220) and 26.5% (n=45/170) isolates with a mosaic mtr (mosaic mtrD and mtrR promoter), respectively. Phylodynamic analyses identified multiple introductions of AMR lineages into the region leading to sustained transmissions since the 1990s. These lineages significantly carried more isolates with mtr mosaics (OR=4.17 [3.27-5.34], p-value=1.26E-33) and phenotypic resistance to azithromycin (OR=2.22 [1.60-3.06], p-value=1.14E-06), among other antimicrobials.

Conclusions: This study highlights the dynamic evolution and dissemination of AMR N. gonorrhoeae at the local level, highlighting the role of international mobility, sexual networks and antibiotic usage in shaping resistance patterns. Enhanced genomic surveillance, with special monitoring of mosaic mtr-carrying lineages, together with targeted public health interventions, will be key to curb local and regional spread of resistant gonococcal strains.

Background: The emergence of multidrug-resistant Gram-negative bacteria poses a significant threat to global health. This has prompted the development of novel antimicrobials and combination with ß-lactamase inhibitors.

Objectives: This review aims to shed light on into the resistance mechanisms associated with new drugs against Enterobacterales.

Sources: We searched PubMed relevant English literature in up to 30 June 2025, as well as including articles known to the authors. We analysed Enterobacterales resistance mechanisms for diazabicyclooctanes (DBOs), bicyclic boronates, cefepime/enmetazobactam, cefiderocol, and eravacycline.

Content: The review summarises the main mechanisms of resistance to recently introduced ß-lactamase inhibitor families, including DBOs and bicyclic boronates, as well as other novel combinations or antimicrobials, such as cefiderocol and eravacycline.

Implications: Understanding how microorganisms develop resistance to new antimicrobials or combinations with inhibitor is essential for redesigning treatment strategies and for the design of future antibiotics.

Background: Invasive fungal diseases represent a significant global health concern, with Candidozyma auris (formerly Candida auris) emerging as a major healthcare-associated pathogen. Its multidrug resistance, environmental persistence, prolonged skin colonization, and efficient nosocomial transmission have driven sustained outbreaks and endemicity worldwide, and recent taxonomic changes have further complicated surveillance and diagnostics.

Objectives: This narrative review summarizes current evidence on the taxonomy, epidemiology, clinical impact, antifungal resistance, transmission, and infection prevention and control (IPC) of C. auris, highlighting outbreak drivers, regional endemicity, and key gaps relevant to surveillance and policy.

Sources: We conducted a structured narrative review of peer-reviewed and grey literature published between 2009 and 2025, drawing from PubMed/MEDLINE, Embase, Scopus, Web of Science, and major public health websites, such as the WHO, the CDC, the European Centre for Disease Prevention and Control, the UK Health Security Agency, and national surveillance portals.

Content: C. auris has rapidly evolved into an endemic healthcare threat across multiple continents, with substantial regional variation in incidence, outbreak dynamics, antifungal resistance, and control capacity. Candidemia mortality averages ∼30% but differs by region and patient population. Azole resistance is widespread in several clades, whereas resistance to amphotericin B and echinocandins is increasingly reported, particularly in high-endemic settings. Outbreaks are sustained by environmental persistence, prolonged skin colonization, and healthcare-associated transmission, amplified by intensive care exposure, antimicrobial pressure, and system strain during the COVID-19 pandemic. Despite broadly aligned IPC guidance, major challenges persist in screening, decolonization, laboratory identification, and long-term outbreak control.

Implications: The continued global expansion of C. auris has major clinical, economic, and public health implications. Effective control requires sustained investment in laboratory capacity, standardized nomenclature adoption, active surveillance, genomic monitoring, and rigorous IPC measures tailored to the pathogen's unique biology. Without coordinated regional and international responses, C. auris is likely to continue shifting from epidemic emergence to entrenched endemicity in diverse healthcare systems worldwide.

Objectives: To investigate the incidence and clinical implications of the discrepancy of trimethoprim/sulfamethoxazole (TMP-SMX) susceptibility results produced by VITEK-2 and disc diffusion methods for Staphylococcus aureus.

Methods: A retrospective matched-cohort study was conducted in a remote Australian hospital on S. aureus clinical isolates with reported TMP-SMX resistance by VITEK-2 from 1 August 2020 to 31 August 2023. Patient demographics, clinical information, TMP-SMX susceptibility by disc diffusion, TMP-SMX prescriptions, 30-day mortality, and 30-day presentation to the hospital emergency department (ED) were collected. Susceptibility data were compared between two susceptibility testing methods - VITEK-2 and disc diffusion. Clinical outcomes of patients with skin-and-soft-tissue infections (SSTI) caused by S. aureus with discrepant susceptibility (TMP-SMX-resistant by VITEK-2 but TMP-SMX-susceptible by disc diffusion) who were prescribed TMP-SMX were compared with a control group (patients treated with TMP-SMX for TMP-SMX-VITEK-2 susceptible S. aureus) in an approximate 1:1 ratio.

Results: A total of 768 S. aureus isolates with reported TMP-SMX-resistance by VITEK-2 were identified and reassessed using disc diffusion. Only 13/768 (1.69%) were reported as TMP-SMX-resistant by disc diffusion. A total of 168/755 patients with discrepant susceptibility received a course of TMP-SMX; 102/168 (60.7%) were female, 154/168 (92.2%) were First Nations people. When comparing the discrepant susceptibility group with control, the number of 30-day ED presentations due to treatment failure of the original SSTI treated with TMP-SMX was not significantly different (6/168 versus 6/184, p=0.87).

Conclusions: We report a 98.3% (755/768) discrepancy rate of TMP-SMX resistance between VITEK-2 and disc diffusion methods in TMP-SMX-VITEK-2-resistant S. aureus isolates. There was no significant difference in outcomes between those with discrepant susceptibility and controls. This provides reassurance that TMP-SMX is effective in this setting and may significantly impact antimicrobial prescribing in settings with a high prevalence of methicillin-resistant S. aureus infections.

Objectives: Traditionally, the detection of intestinal parasites, including Cryptosporidium, has relied on microscopic examination of bulk stool samples. However, obtaining bulk stool samples requires waiting time, collection can be messy, and children may not readily produce a sample, particularly if severely dehydrated. This study aimed to evaluate the diagnostic performance of rectal swab samples in comparison with bulk stool samples for the point-of-care diagnosis of cryptosporidiosis using light-emitting diode auramine-phenol (LED-AP) fluorescence microscopy.

Methods: A cross-sectional study was conducted among diarrhoeic children aged 1-59 months attending six health centres in Dire Dawa and Shinile, Eastern Ethiopia. Both rectal swabs and bulk stool samples were collected, stained with auramine-phenol and examined for Cryptosporidium spp. oocysts using LED-AP fluorescence microscopy, blinded to the results obtained from the corresponding sample. The diagnostic performance of rectal swabs was evaluated against bulk stool results by estimating sensitivity, specificity, positive and negative predictive values, and the kappa coefficient. McNemar's test was used to assess whether discordant results between rectal swabs and bulk stools were statistically significant.

Results: Stool and rectal swab samples were obtained from 485 children with median age of 16 months (interquartile range: 12-28). Most children (71.5%, 347/485) were below 2 years of age. Cryptosporidium was detected in 19.4% (94/485) of stool and 17.1% (83/485) of rectal swab samples by LED-AP fluorescence microscopy, with 96.9% (95% CI 95.0-98.3%) overall concordance. Compared with bulk stools, rectal swabs showed 86.2% (95% CI 83.1-89.2%) sensitivity, 99.5% (95% CI 98.5-100.0%) specificity, and excellent agreement (κ = 0.90, 95% CI 0.81-0.99). Oocyst numbers were consistently higher in bulk stool samples than in rectal swabs.

Conclusions: Rectal swabs demonstrated high diagnostic accuracy and excellent agreement with bulk stools, supporting their use as a reliable and practical alternative when rapid results are needed or stool collection is challenging.