Clinical Microbiology and Infection最新文献

Background: Incorporating ethics into clinical practice guidelines (CPGs) can be challenging. This is particularly evident for infectious diseases (ID) CPGs because of the complexity of ID ethics (IDE) and the multiplicity of populations at risk for infections.

Objectives: The OPENING project (IncOrPorating Ethics iN ClINical Guidelines: Practical Indications) was initiated by the European Society of Clinical Microbiology and Infectious Diseases Ethics Advisory Committee in collaboration with the European Society of Clinical Microbiology and Infectious Diseases Guidelines Subcommittee to generate guidelines for the systematic inclusion of ethics principles into ID CPGs.

Sources: The first part of the project, presented here, aimed at: (a) performing a scoping review of articles published in PubMed and Google Scholar between 1990 and 2024 discussing ethics inclusion in CPGs; (b) reviewing guidance documents for ethics incorporation in documents from international societies; (c) outlining how the main ethics principles could be included in ID CPGs according to the results retrieved.

Content: We retrieved 21 articles written between 1994 and 2024. None of these specifically focused on IDE. The main topic discussed in articles and societies' guidance was the inclusion of equity principles at different stages of CPGs development. Multiple authors also addressed how specific subgroups and disadvantaged populations should be considered in the preparation of CPGs. Involvement of patients and their representatives in CPGs was also advocated. A structured framework for the systematic inclusion of IDE principles in CPGs was suggested to summarize these points.

Implications: There is a lack of recommendations for incorporating ethics in ID CPGs. Efforts should be made by scientific societies to include ethics guidelines in ID CPGs to fill this gap.

Objectives: The study aims to investigate whether bathing with 2% chlorhexidine gluconate (CHG) reduces the incidence of surgical site infection (SSI) in patients undergoing routine pancreatic surgery.

Methods: A randomized controlled trial was conducted at a large-volume pancreatic centre between 1 January 2021 and 31 December 2022. Patients undergoing clean-contaminated pancreatic surgery were enrolled and randomized into an intervention arm (bathing with a 2% CHG wipe) and a control arm (routine care, soap, and water). The primary outcome was the incidence of SSI after pancreatic surgery within 30 days.

Results: Overall, 614 patients (intervention arm, 311; control arm, 303) were included in intention-to-treat analysis. In total, 8.8% (54/614) patients developed SSI. The incidence of SSI in the intervention arm was 6.8% (21/311) and 10.9% (33/303) in control arm, and the difference did not reach the level of statistical significance (p 0.070). The time to SSI was significantly extended when patients were in the intervention arm (log-rank test, p 0.047). The intervention did not significantly reduce the incidence of healthcare-associated infection, hospital-acquired pneumonia, and bloodstream infection. No adverse events were observed. However, in the per-protocol analysis among 519 patients, the intervention arm showed a significantly lower incidence of overall SSI than that of those in the control arm (21/272, 7.7% vs. 33/242, 13.4%, p 0.036).

Discussion: Bathing with 2% CHG could potentially reduce the incidence of SSI for the patients scheduled to undergo pancreatic surgery for which further well-designed clinical trials are warranted.

Objectives: The study aims to explore the presence, or absence, of virulence genes and the phylogeny of a multidecade United Kingdom collection of clinical and reference Fusobacterium necrophorum isolates.

Methods: Three hundred and eighty-five F. necrophorum strains (1982-2019) were recovered from storage (-80°C). Illumina whole genome sequencing was undertaken with 374/385 genomes available for examination after quality checking. Sequences were analysed, using BioNumerics (bioMérieux; v 8.1), for the presence of known virulence genes. Strain phylogeny was investigated using a bespoke Fusobacterium spp. whole genome multilocus sequence typing (wgMLST) method and single nucleotide polymorphism (SNP) analysis.

Results: F. necrophorum ssp. necrophorum and F. necrophorum ssp. funduliforme phylogeny showed a clear separation of the two subspecies and clustering of F. necrophorum ssp. funduliforme into three distinct clades. Congruence between SNP and wgMLST analysis was high (99.3%) and indistinguishable clusters were observed with wgMLST (n = 3) and SNP (n = 1) analysis of isolates derived from different students attending the same education setting. There was no grouping of strains by disease state or decade of isolation. No association was demonstrated with specific virulence gene detection although conspicuous virulence gene patterns were seen among the different subspecies and clades.

Discussion: There was no evidence that the pathogenesis of F. necrophorum infection was associated with the presence of the virulence determinants investigated. Host-pathogen interactions should, therefore, be a focus of future research. Person-to-person transmission is a feature of this important pathogen.

Objectives: The study aimed to investigate the association between quantitative T-SPOT.TB values and the risk of incident and prevalent tuberculosis disease (TBD), identify risk factors, and evaluate test accuracy.

Methods: This retrospective cohort study followed patients tested consecutively with T-SPOT.TB at Aarhus University Hospital from 2010 to 2017, with follow-up for incident TBD through 2022. Data on demographics, comorbidities, medications, and TB status were collected from patient records and national registries. Cox proportional hazard models with restricted cubic splines assessed the risk of incident TBD (occurring ≥3 months post-test) by quantitative spot counts. Cox and log-binomial regressions identified risk factors for incident and prevalent TBD (occurring between 3 months before and after the test). Sensitivity, specificity, and predictive values assessed test accuracy. T-SPOT.TB was the index test, and microbiologically and/or clinically confirmed TBD was the reference standard.

Results: Among 8542 individuals with complete follow-up, 59 developed incident TBD over 67 456 person-years. Among 9014 individuals tested once, 162 had prevalent TBD at the time of testing. The risk of incident TBD increased with higher spot counts, plateauing for tests with more than ten spots. The strongest risk factors for both incident and prevalent TBD were categorical T-SPOT.TB results: compared with negative tests (≤4 spots), adjusted hazard ratios for incident TBD were 5.0 (95% CI: 1.9-13.1) for borderline (5-7 spots) and 8.0 (95% CI: 4.0-15.7) for positive tests (≥8 spots). Adjusted risk ratios for prevalent TBD were 14.9 (95% CI: 7.7-28.9) for borderline and 35.6 (95% CI: 21.4-59.2) for positive tests. Sensitivities for incident and prevalent TBD were 54.0% (95% CI: 39.3-68.2%) and 78.4% (95% CI: 71.3-84.5%), respectively. Specificities were 84.8 (84.0-85.4) and 83.7 (82.9-84.4), respectively.

Discussion: Incident TBD risk increases with T-SPOT.TB values but plateaus beyond 10 spots. Borderline and positive T-SPOT.TB results are strongly linked to TBD risk.

Objectives: Chlamydia trachomatis (CT) is the most commonly reported bacterial sexually transmitted infection worldwide. Diagnosis relies on nucleic acid amplification techniques, such as PCR, which does not distinguish between viable pathogens and residual bacterial DNA, leading to potential overdiagnosis and overtreatment. PCR with confirmation of pathogen viability has not been widely explored in the sexually transmitted infection field. We aimed to establish a CT viability PCR (V-PCR) and to apply it to anorectal swabs from men who have sex with men (MSM).

Methods: We validated a published V-PCR protocol by preparing artificial samples with known ratios of viable and non-viable CT. Mock samples were treated with propidium monoazide (PMAxx) before DNA extraction and quantitative PCR (qPCR) to detect CT. The V-PCR was then applied to CT PCR-positive anorectal swabs from MSM. Viability was expressed as the difference in CT copies between PMAxx untreated and treated samples (ΔLog10 CT/mL). The anorectal samples were inoculated in cell culture for isolation. Genotyping was performed by examining the ompA gene sequence.

Results: Of 236 anorectal swabs, 69 (29.2%) were CT PCR positive, and we obtained V-PCR data from 54. There were 7 of 54 (12.9%), samples with <1% viable CT (>2.52 ΔLog10 CT/mL) 4 of 54 (7.4%) samples with 1% to 10% viable CT (1.59-2.52), 16 of 54 (29.6%) with 10.01% to 50% viable CT (0.86-1.59) and 27 of 54 (50.0%) with 50.01% to 100% viable CT (<0.35-0.86). CT was isolated successfully from 39 of 69 (56.5%) samples in cell culture. Genotypes based on ompA were obtained for 62 of 69 (89.9%) samples: G (n = 15/62), D/Da (n = 15/62), J (n = 15/62), E (n = 11/62), L1 (n = 4/62), and L2 (n = 2).

Discussion: We successfully implemented a viability test based on PCR, which can distinguish, detect and quantify viable CT in anorectal swabs from MSM. Rapid, reliable assessment of CT viability could help to improve antimicrobial stewardship.