Clinical Microbiology and Infection最新文献

Objectives: The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.

Methods: A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.

Results: Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45-4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22-3.84), SOFA score (HR: 1.09, 95% CI: 1.03-1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29-3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30-0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52-4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26-0.83).

Discussion: A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.

Background: Infectious encephalitis poses a global health challenge with a high mortality and severe neurological consequences in survivors. Emerging pathogens and outbreaks are reshaping the patterns of the disease.

Objective: To understand the current epidemiology for improving prevention, diagnosis, and treatment.

Sources: MEDLINE/PubMed was searched using "encephalitis" and related MeSH terms from 2020 to September 2024. Population-based and case-control studies on encephalitis were searched for without time restrictions. Other studies known by the authors were also included.

Content: The incidence of infectious encephalitis ranged from 1.4 to 13.8 cases per 100,000 per year with a bimodal peak in infants and older adults. Herpes viruses remain the most common causes of sporadic encephalitis with Herpes simplex virus type 1 and Varicella Zoster virus reported most frequently. In endemic regions, arboviruses such as Japanese encephalitis virus and West Nile virus contribute significantly to the disease burden. Climate change is adding to the spread of these vector-borne viruses and thereby both altering the geographic distribution of causative agents and increasing the frequency of outbreaks. Evidence on risk factors associated to encephalitis is scarce and hampered by the absence of population-based case-control studies. The prognosis of infectious encephalitis remains unchanged during recent decades with high case-fatality rates and may vary according to e.g. aetiology, age, and presence of immuno-compromising conditions or other comorbidities. Importantly, a substantial proportion of survivors are left with disabling neurological sequalae.

Implications: The findings underscore the importance of public health surveillance and prevention strategies to address the changing epidemiology of encephalitis. This can be pursued through vaccination programs and vector control efforts. Future research should focus on identifying risk factors, improving diagnostic tools, optimizing current treatment as well as exploring novel therapies for patients with encephalitis. Timely treatment and specialised post-hospital rehabilitation remain essential for patient management.

Objectives: The objectives were to determine the structure of training programmes and assessment of physicians training to become infectious disease (ID) specialists in Europe in early 2024 and to document the provision of specialists, trainees and training centres in each country.

Methods: Delegates to the ID Section and Board of the European Union of Medical Specialists entered national data on a web-based survey tool in late 2023-early 2024. Results were compared with European Union of Medical Specialists recommendations on the structure and content of postgraduate training in ID in Europe (2018), and to results of a similar survey in early 2021.

Results: Responses were received from all 35 countries; 27/35 (77%) recognize ID as an independent speciality and 7/35 (20%) as a subspeciality. Spain does not officially recognize the speciality. In Cyprus, Iceland, and Luxembourg, despite official recognition of the sub-/speciality, ID training must be completed abroad. Paediatric ID was recognized in 16/35 (46%) countries. The number of adult ID specialists varied from 78.8 per million inhabitants in Sweden to 0.6 in Germany. Only 7/31 (23%) national programmes provide the minimum recommended 6 months of training in medical microbiology. Assessment methods included logbooks/portfolios in 25/31 (81%), final examinations in 25/31 (81%) and workplace-based assessments in 21/31 (68%).

Discussion: There has been little change since 2021 in speciality status or in structure and content of training programmes across Europe. There have been large increases in training position numbers in several countries, possibly in response to COVID-19. Continued low compliance with the 2018 recommendations to increase exposure to medical microbiology during training highlights the slow pace of change. Logistic barriers to change and to harmonization across Europe remain and are discussed in the context of published concerns of trainees.

Objectives: We aimed to study the association between early-onset neonatal infection in near-term and term children and school performance based on mandatory tests in reading and mathematics.

Methods: We conducted a nationwide register-based cohort study including all Danish near-term and term singletons born from 1997 to 2009. Early-onset infection was defined as an invasive bacterial infection during the first week of life. Infections were categorized into diagnosed sepsis or meningitis, and culture-positive sepsis or meningitis verified by bacteria cultured from blood or cerebrospinal fluid. Multivariable mixed model linear regression was used to estimate mean differences in test scores, expressed as standard deviation scores (SDSs) with 95% CI.

Results: Among 638 402 children, 2 362 046 test scores were available from 9 to 15 years of age. A total of 5347 children were diagnosed with sepsis and 73 with meningitis, while 135 also had culture-positive sepsis and 20 had culture-positive meningitis. Diagnosed sepsis was associated with lower test scores with mean differences in reading of -0.08 SDS (95% CI: -0.10 to -0.05) and mathematics of -0.08 SDS (95% CI: -0.10 to -0.05). Diagnosed meningitis was associated with even lower test scores with mean differences in reading of -0.22 SDS (95% CI: -0.43 to 0.00) and mathematics of -0.31 SDS (95% CI: -0.55 to -0.07). These findings remained consistent even in sibling-matched analyses. Similar results were also found when only culture-positive infections were compared with the reference population. Sepsis caused by Escherichia coli showed the largest reduction in test scores, whereas group B Streptococcus appeared not to affect point estimates.

Discussion: Early-onset sepsis was associated with modest reductions in test scores. This may be insignificant for the individual but could be important on a public health level. Early-onset meningitis was associated with more substantial reductions, emphasizing the severity of this condition even in children able to attend public school.

Background: Community-acquired pneumonia (CAP) is a frequent and potentially life-threatening condition. Even though the disease is common, evidence on CAP management is often of variable quality. This may be reinforced by the lack of a systematic and homogeneous way of defining the disease in randomized controlled trials (RCTs).

Objectives: This study aims to assess the diagnostic criteria and definitions of the term 'community-acquired' used in RCTs on CAP management.

Data sources: On the basis of the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search of Medline/PubMed and the Cochrane Register of Controlled Trials for RCTs published or registered between 2010 and 2024.

Study eligibility criteria: Study eligibility criteria included completed and ongoing RCTs.

Participants: Participants included adults hospitalized with CAP.

Methods of data synthesis: Data were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were synthesized in a narrative and tabular form.

Results: In total, 7173 records were identified through our searches. After removing records that did not fulfil the eligibility criteria, 170 studies were included. Diagnostic criteria were provided in 69.4% of studies, and the term 'community-acquired' was defined in 55.3% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (94.1%), cough (78.8%), fever (77.1%), dyspnoea (62.7%), sputum (57.6%), auscultation/percussion abnormalities (55.9%), and chest pain/discomfort (52.5%). The different criteria were used in 87 different sets across the studies. The term 'community-acquired' was defined in 57 different ways.

Conclusions: The diagnostic criteria and definitions of CAP in RCTs exhibit significant heterogeneity. Standardizing these criteria in clinical trials is crucial to ensure comparability across studies.

Objectives: In this nationwide cohort study in a Scandinavian setting, we aimed to investigate the magnitude of association between flucloxacillin use and drug-induced liver injury (DILI).

Methods: Nationwide cohort study among adults in Sweden, 2006-2018. Register data on filled prescriptions, patient characteristics, co-medications, and DILI were linked. All filled prescriptions for flucloxacillin and oral clindamycin, among Swedish adults aged 18-85 years were identified. Entropy balancing methods were used to control for confounding. Cox regression was used to estimate hazard ratios for a first diagnosis of DILI, defined as admission to hospital, emergency department or specialist care, or death due to DILI, within 45 days from start of treatment.

Results: Within the main 45 day risk period, there were 219 events of DILI among 1,443,622 flucloxacillin users (incidence rate [IR] 14/10,000 person-years) as compared to 9 events among 583,847 oral clindamycin group (IR 1.4/10,000 person-years). This corresponded to a hazard ratio (HR) of 7.32 (95% confidence interval [CI] 4.1 - 13.0). The absolute risk difference for users of flucloxacillin compared to clindamycin in the main period, was 11 cases of DILI (95% CI 5 - 20) per 100,000 courses. The risk diminished in the subsequent periods, 46-90 days (HR 4.17; 95% CI 1.44 - 12.10), 91-180 days (HR 0.72; 95% CI 0.36 - 1.44).

Conclusions: In this nationwide cohort study, the use of flucloxacillin was associated with a seven-fold increased risk of DILI, predominantly in the first 45 days of exposure.