Clinical Microbiology and Infection最新文献

Background: Procalcitonin is known to have moderate diagnostic accuracy for bacteraemia. A 2014 meta-analysis showed 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 bacteraemia by conducting a systematic review and meta-analysis, focusing on the ability to exclude bacteraemia.

Methods: Data sources: We searched PUBMED, EMBASE and Web of Science from 1 January 2014 to 20 May 2025.

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

Test and reference standard: Procalcitonin was compared with 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 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 of 5450 identified articles, reflecting 192 529 patients of whom 31 480 (16%) had bacteraemia. Of 40 studies, 32 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: 26-47%). The area under the summary receiver-operating curve for all studies was 0.80 (95% CI: 0.76-0.83%; prediction interval 0.57-0.91).

Discussion: A low cut-off value of procalcitonin can be useful to exclude community-acquired bacteraemia, 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 bacteraemia and safely reducing unnecessary blood cultures.

Objectives: Parapneumonic pleural effusions/empyema (PPE/PE) are serious complications of community-acquired pneumonia in children. Although Streptococcus pneumoniae and Streptococcus pyogenes are established major pathogens, the clinical relevance of oral cavity bacteria (viridans streptococci and/or 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 October 2010 to June 2023, with bacteria detected from pleural fluid and/or blood. We compared clinical characteristics of patients with VS/AA-associated PPE/PE with those of patients with S. pneumoniae- or S. pyogenes-associated PPE/PE (reference group) using multivariable regression analysis, with results presented as regression coefficient (RC) or OR with 95% CI, respectively.

Results: Among 1242 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 with the reference group, children with VS/AA-associated PPE/PE were older (median [interquartile range]: 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 [interquartile range]: 20 days [15-28] vs. 18 days [14-25], p 0.467), and a similar proportion required treatment at a paediatric intensive care unit (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 paediatric intensive care unit treatment (by 3.1 days, [RC, 95%CI 0.4-5.9, p 0.025]). They showed more frequent 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/systemic inflammatory response syndrome (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: Gonorrhoea, 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 and 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 1.26E-33) and phenotypic resistance to azithromycin (OR = 2.22 [1.60-3.06]; p 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 combinations with β-lactamase inhibitors.

Objectives: This review aims to shed light on 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, bicyclic boronates, cefepime/enmetazobactam, cefiderocol, and eravacycline.

Content: The review summarises the main mechanisms of resistance to recently introduced ß-lactamase inhibitor families, including diazabicyclooctanes 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 inhibitors is essential for redesigning treatment strategies and for the design of future antibiotics.