Clinical Microbiology and Infection最新文献

Background: Nipah virus (NiV) is a highly lethal zoonotic virus that has caused sporadic but severe outbreaks in South and Southeast Asia since its emergence in 1998. Despite the relatively small size of most outbreaks, NiV poses a substantial public health challenge due to its high case fatality rate.

Objectives: To examine the evolving epidemiology, clinical features, virological insights, and preparedness challenges associated with NiV infection in South Asia.

Sources: We conducted a narrative review synthesising epidemiological, clinical, and public health data from national surveillance systems, WHO Disease Outbreak News reports, and published outbreak investigations.

Content: We describe the shift from pig-amplified transmission observed in Malaysia to bat-driven spillover and human-to-human transmission, particularly within household and hospital settings, as characterised by recent outbreaks in Bangladesh and eastern India, and specifically review Kerala's experience since 2018. Particular attention is given to the re-emergence of NiV in West Bengal in early 2026, involving a limited cluster of infections among healthcare workers that was rapidly contained but remains epidemiologically important given the region's prior history of nosocomial spread. We discuss persistent challenges in early diagnosis, access to high-containment laboratory testing, and clinical management, alongside emerging roles for mobile BSL-3 laboratories and point-of-care diagnostics.

Implications: Overall, the South Asian experience underscores that NiV represents a persistent zoonotic threat rather than an episodic emergence, necessitating sustained preparedness, pathogen-agnostic clinical vigilance, and proportionate risk communication to mitigate future outbreaks. Sustained preparedness, rather than episodic alarm, must guide future responses.

Objectives: To compare the incidence of surgical site infection (SSI) between patients receiving cefoxitin via target-controlled infusion (TCI) and those receiving standard dosing during colorectal surgery, and to evaluate differences in intraoperative antibiotic exposure and postoperative safety outcomes.

Methods: In this single-center, parallel-arm randomized clinical trial, 2,494 adults undergoing elective colorectal surgery between April 2022 and July 2025 were assigned to receive cefoxitin via TCI or the standard dosing method. The TCI group received cefoxitin through a pharmacokinetic model-driven infusion pump targeting a plasma concentration of 80 μg/mL until the end of surgery, whereas the standard group received 2 g every 2 hours up to 8 g. The primary endpoint was the incidence of surgical site infection (SSI) within 30 days postoperatively. Secondary endpoints included intraoperative cumulative cefoxitin dose. Acute kidney injury (AKI) was assessed as an additional safety endpoint.

Results: No statistically significant difference in SSI incidence was detected between groups (TCI: 69/1,224 (5.6%) vs standard: 69/1,233 (5.6%); P=0.965; RR: 1.01; 95% CI: 0.73-1.39). The intraoperative cumulative cefoxitin dose was lower in the TCI group (median 1.38 g [IQR, 1.15-1.71]) than in the standard group (2.00 g [2.00-4.00]); Mann-Whitney P<0.001. The median difference was -0.62 g (95% CI, -0.65 to -0.59), representing ∼30% reduction for patients with median operative time (93 min) and body weight (62.5 kg). Pharmacokinetic simulations showed the dosing gap between regimens widened with longer operative duration and lower body weight. AKI incidence did not differ significantly between groups (215/1,224, (17.6%) vs 193/1,233, (15.7%); P=0.223; RR: 1.12; 95% CI: 0.94-1.34).

Conclusion: In this randomized clinical trial, use of target-controlled infusion of cefoxitin was not associated with a reduction in surgical site infection compared with standard dosing, while resulting in lower intraoperative antibiotic exposure.

Trial registration number: NCT05253339.

Background: The increased risk of cardiovascular disease (CVD) in patients living with human immunodeficiency virus (PLWH) remains a significant concern. The process of atherosclerosis in PLWH is accelerated and is believed to be independent of traditional CVD risk factors, as well as being present despite the use of combination antiretroviral therapy.

Objectives: This review is focused on the vasa vasorum (VV) in HIV-associated atherosclerosis and on how the inflammation and immune dysregulation inherent to HIV infection contribute to atheroma formation and instability through VV-dependent pathways.

Sources: We have conducted a structured literature review using PubMed exploring all relevant literature to HIV infection, atherosclerosis, vasa vasorum angiogenesis, plaque vulnerability, and noninvasive vascular imaging.

Content: VV contributes to atherogenesis in PLWH through several mechanisms, including the promotion of inflammation, angiogenesis, lipid deposition, and monocyte and other inflammatory cell infiltration, leading to the formation of highly unstable, lipid-laden lesions. These prone-to-erosion lesions are associated with high-grade inflammatory vascular disease (i.e., HIV-induced endothelial dysfunction, chronic vascular inflammation), which predisposes to exaggerated VV angiogenesis and impaired vascular function, increasing the risk of acute cardiac and cerebral events. Information on VV angiogenesis and plaque vulnerability can be obtained non-invasively using, for example, contrast-enhanced ultrasound and high-resolution MRI. The possibility of improving atherosclerotic vascular disease in the PLWH population through therapeutic anti-angiogenic and anti-inflammatory approaches is also an area for further investigation and better elucidation of what is optimal for interventions in the vasculature of PLWH.

Implications: New-generation imaging techniques and the identification of new biomarkers associated with VV-related vascular risk may facilitate earlier identification of VV-related vascular risk and more tailored strategies to manage cardiovascular risk in PLWH. This will enhance the impact of VV assessment on cardiovascular disease prevention in this at-risk population.

Objective: We aimed to systematically assess acute respiratory infection (ARI) episodes outside medical settings in older adults in Germany to capture real-time, community-based data on incidences, symptoms, healthcare use, and work absenteeism.

Methods: German adults aged ≥50 years enrolled in the VACCELERATE Volunteer Registry received multipathogen antigen test kits (MAK5) for self-testing, detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A and B viruses, respiratory syncytial virus (RSV), and adenovirus (AdV). From May 2024 to May 2025, participants self-tested upon ARI symptoms and reported test results, symptoms, episode duration, medical consultations, illness-related work absenteeism, pre-existing conditions, vaccination history, and previous infections.

Results: Of 3,162 individuals enrolled, 2,890 (91.4%) actively participated. Overall, 45.5% (1,314/2,890) reported no ARI, 31.4% (908/2,890) one, and 22.8% (658/2,890) ≥2 episodes (median: 2; interquartile range [IQR]: 1-3; range: 0-6). Among 2,569 tests, 752 (29.3%) were positive, including 53 (7.0%) co-detections, yielding 833 pathogen detections. Cumulative incidence was 18.5% (524/2,890) for SARS-CoV-2, 4.0% (114/2,890) for AdV, 3.8% (110/2,890) for influenza A virus, 1.8% (52/2,890) for RSV, and 1.1% (33/2,890) for influenza B virus. Median ARI duration ranged from 6 days (IQR: 5-8, range: 1-20) for SARS-CoV-2 to 9 days (IQR: 5-15, range: 1-26) for RSV. Median age ranged from 56 years (IQR: 54 -61; range: 50-80) for AdV to 61 years (IQR: 56-67; range: 51-81) for RSV. Medical consultation occurred in 28.8% (15/52) RSV, and 15.3% (80/524) SARS-CoV-2 cases. SARS-CoV-2 detections accounted for 31.1% (222/713) of illness-related work absences and 2/9 (22.2%) hospitalizations.

Conclusion: This study enabled real-time, community-based monitoring of five endemic pathogens. While SARS-CoV-2 accounted for highest cumulative incidence and overall disease burden, RSV detections, though less frequent, were predominantly observed in older adults and were associated with greater per-case burden, reflected in longer illness duration and increased healthcare utilization.

Objectives: Optimal treatment for E. faecalis bloodstream infection (EF-BSI) remains a topic of debate. We aim to evaluate the effectiveness of combination therapy compared to monotherapy in patients with EF-BSI and no endocarditis.

Methods: This was a target trial emulation based on a prospective, multicenter, international dataset collected in 24 international centers from January 2019 to December 2024. We included all adult patients with monomicrobial EF-BSI with negative echocardiography within 7 days from BSI onset. Exclusion criteria were diagnosis of endocarditis, not receiving or completed the therapy at randomization. Primary endpoint was clinical failure defined as a composite of death, relapse of EF-BSI, and diagnosis of endocarditis, at 90 days.

Results: Overall, 373 patients were eligible for inclusion, of whom 267/373 (71%) received monotherapy, mainly ampicillin (174/267, 65%); most prescribed combination regimens were ampicillin with either ceftriaxone or gentamicin (80/106, 75%). The composite clinical failure was met by 114/373 (31%) patients. The outcomes among patients that received monotherapy or combination treatment were [75/267 (28%) versus 39/106 (36%); p=0.185] leading to an overall risk difference in favor of monotherapy of 2% (95%CI -10% to 15%). Sepsis or septic shock at the time of presentation was the only independent variables associated to clinical failure, after performing a weighted uni and multi-variable Cox regression model [aHR=0.85, 95%CI=0.52-1.39].

Conclusion: With the limitation of our sample size and observational design we were not able to observe a better outcome associated with combination treatment for EF-BSI. If confirmed, these results would promote therapeutic simplification according to antimicrobial stewardship principles.

Background: Non-ventilated hospital-acquired pneumonia (NV-HAP) is a significant cause of morbidity and mortality within healthcare settings. Despite advancements in diagnostic and therapeutic approaches over recent decades, the supporting evidence for diagnostic criteria remains limited. Information regarding the etiology of this condition is scarce, and many methodological aspects related to the collection and analysis of respiratory samples are still under debate. Furthermore, recommendations from leading scientific societies on these topics vary and have not been updated in many instances.

Objectives: Our aim is to critically assess the current understanding of NV-HAP diagnosis and management, highlight gaps in the existing literature, provide perspectives from a team specializing in infectious diseases and clinical microbiology, and identify areas where future research should be directed.

Sources: We have formulated a series of questions addressing various facets of NV-HAP to a multidisciplinary group of experts and conducted a literature review to seek appropriate answers.

Content: We present our insights mainly on topics where evidence is lacking. The subjects covered include the definition of the condition, epidemiological factors, recommendations for diagnosis and microbiological sample collection, radiological evaluation, and empirical treatment strategies.

Implications: This narrative review highlights the heterogeneity in major guidelines regarding NV-HAP, offers practical recommendations for clinical decision-making, and identifies priorities for future research.

Objective: We assessed the timing and causes of death in subjects hospitalised with community-acquired pneumonia (CAP).

Methods: A cohort of 2,918 immunocompetent adults hospitalised with CAP followed for 90 days between 2017-2020. Each immediate and underlying cause of death was independently assessed by two physicians.

Results: Overall, 19% (562/2918) of patients died within 90 days. Pneumonia-related deaths (243/562 [43%]) primarily occurred within the first two weeks of admission, and respiratory failure was the most common cause of death overall (272/562 [48%]). Later deaths were either unrelated to pneumonia (159/562 [28%]) or unknown (160/562 [28%]), if they occurred out of hospital. Of deceased patients 314/562 (56%) transitioned to palliative care within the last 7 days of life.

Conclusion: In a contemporary cohort, CAP-related mortality occurred early while later deaths were driven by comorbidities and increased frailty. Understanding the burden of CAP through specific cause-of death assessment is critical to evaluate treatment effects, and to improve outcomes for increasingly frail patient populations.

Objectives: Like influenza, respiratory syncytial virus (RSV) is a common cause of severe acute respiratory infection (ARI) in adults. With RSV vaccines recently approved, data on the burden of disease are required. Our objective was to investigate the short- and long-term clinical and economic burden of ARI in Danish adults over the past decade, with a primary focus on RSV, contextualising with influenza.

Methods: A nationwide cohort study in Denmark, including adults ≥18-year-old recorded with an ARI from 1 July 2011 to 30 June 2022 (i.e., exposed), matched 1:3 with individuals without ARI (unexposed). We assessed adverse clinical outcomes, direct and indirect healthcare resource utilisation (HCRU), and direct and indirect costs over 365 days following ARI.

Results: We identified 762,443 ARIs, of which 5,289 were attributed to RSV and 48,047 to influenza. Common comorbidities in RSV patients were chronic obstructive pulmonary disease (COPD) (23.9%, 1,264/5,289), diabetes (13.5%, 712/5,289), and asthma (12.2%, 647/5,289), while 32.1% (1,700/5,289) were immunocompromised. RSV was associated with an increased risk of adverse clinical outcomes compared with matched unexposed individuals during the 365-day follow-up, including death (relative risk 2.7; 95% confidence interval: 2.4-3.0), COPD exacerbations (3.1; 2.8-3.4), asthma exacerbations (4.6; 3.6-5.9), and sepsis (4.0; 3.1-5.2). RSV was associated with increased risks of respiratory support (5.5; 4.3-7.0) and antibiotic treatment (2.0; 1.9-2.1). Direct and indirect costs were higher among RSV patients than their unexposed peers, with a mean difference in direct costs of €12,096. Influenza patients had fewer comorbidities than RSV patients, but they also presented worse clinical and economic outcomes than their unexposed peers, with a mean difference in direct costs of €7,992.

Conclusions: The severe long-term clinical and economic burden of RSV in adults, which is comparable to influenza, provides evidence for adult vaccination strategies.