European Journal of Clinical Microbiology & Infectious Diseases最新文献

Drug-resistant tuberculosis (TB) is a significant global challenge, especially in children, where diagnosis and treatment are difficult. This report describes a 4-month-old male infant with pre-extensively drug-resistant tuberculosis (pre-XDR-TB) successfully treated with bedaquiline, delamanid, and contezolid. The patient, born prematurely, developed severe pulmonary TB after exposure to drug-resistant TB from the mother. After discontinuing the initial regimen due to adverse effects, the adjusted regimen resulted in negative TB culture conversion, significant pulmonary improvement, and no notable adverse effects.

Introduction: COVID-19, caused by the SARS-CoV-2 virus, had a significant global impact since its emergence in December 2019. In Spain, the pandemic caused multiple waves of infections, with variations in clinical presentation and predominant viral strains. This study analyzed the evolution of COVID-19 in pediatric patients in a pediatric emergency department in Madrid (Spain), focusing on the changes in clinical manifestations over time.

Methods: This single-center, retrospective study was conducted from March 2020 to October 2024, including pediatric patients aged 0-18 years with confirmed SARS-CoV-2 infection. Data collected included demographic characteristics, clinical manifestations, and hospital admission rates. The sample was divided into groups based on the predominant circulating variant during specific periods.

Results: A total of 1,949 confirmed COVID-19 cases were analyzed. The median age of the patients was 1.2 years (IQR: 0.4-7.4). The highest number of recorded cases was in infants aged 1-12 months (43.4%). Fever (77.6%) and respiratory symptoms (68.8%) were the most common clinical manifestations. A statistically significant association was observed between the presence of fever and the XBB variant (p < 0.015), the presence of upper respiratory symptoms and the XBB variant (p = 0.015), the presence of gastrointestinal symptoms and the Omicron BA.2 variant (p = 0.009), and the presence of laryngitis and the XBB variant (p < 0.001). The highest number of admissions was recorded in patients aged 1-12 months (61/133; 45.9%), followed by school-aged children aged 6-11 years (22/133; 16.5%).

Conclusion: The clinical presentation and age distribution of COVID-19 infections have changed over time. Infants aged 1-12 months were the most affected, a consistent trend across the pandemic. Fever remained the most common clinical manifestation throughout the study period, followed by upper respiratory symptoms.

This study focused on genomic epidemiology of metallo-β-lactamase (MBL)-producing Citrobacter spp. in Poland. It included 118 isolates with VIM (n = 100), NDM (n = 17) or IMP (n = 1) enzymes from 2011 to 19, largely C. freundii (n = 94) of 33 sequence types (STs). Three globally-spread STs were more prevalent, namely ST18 (n = 15), ST8 (n = 11) and ST22 (n = 10), each diversified clonally and by VIM and NDM determinants. Only few outbreaks were evidenced, indicating MBL presence to result mainly from independent acquisitions, consistent with co-identifications of Citrobacter isolates (n = 12) with other MBL-producing Enterobacterales. Despite lower outbreak potential, Citrobacter spp. constitute a significant MBL reservoir, requiring attention and surveillance.

Purpose: This systematic review and meta-analysis evaluate the effectiveness of ASPs in managing community-acquired pneumonia (CAP), focusing on antibiotic optimization and resistance mitigation.

Methods: Comprehensive literature searches were conducted in PubMed, Scopus, and Web of Science using PICOS criteria. Studies involving adults with CAP exposed to ASPs were included. Data on clinical, economic, diagnostic, and treatment outcomes were extracted. Random-effects meta-analysis using R software pooled effect sizes. Outcomes reported in at least three studies were analyzed for robustness.

Results: ASPs did not significantly impact in-hospital mortality, length of stay, 30-day readmissions, sample collection rates, or intravenous antibiotic duration. However, notable improvements included shorter time to clinical stability and a 31% reduction in 30-day mortality. Legionella urinary antigen testing frequency increased nearly threefold, and the time from admission to antibiotic initiation was reduced. Enhanced adherence to timely antibiotic administration and recommended regimens was observed, though outcome variability persisted.

Conclusion: ASPs significantly improve CAP management by enhancing clinical stability and accelerating antibiotic initiation. Multifaceted strategies, including rapid diagnostics and clinician education, yield clinical benefits. However, outcome variability suggests a need for tailored interventions. Future research should isolate specific ASP components influencing prescriber behavior. Ongoing investment in education, diagnostics, and interdisciplinary collaboration is vital to optimize CAP treatment and combat antibiotic resistance.

Purpose: The incidence of invasive Group A Streptococcus (iGAS) infection and streptococcal toxic shock syndrome (STSS) is increasing. Early detection and diagnosis of cases that may progress to STSS are currently difficult. In this study, we aimed to identify biomarkers and emm type, one of the virulence factors, associated with STSS development.

Methods: In this multicentre observational study including patients with iGAS infection (n = 305), we investigated the relative associations of host factors, clinical manifestations, biomarkers, and emm type with STSS.

Results: The overall mortality rate was 15.4%; the fatality rate within 28 days of admission was higher in patients with STSS (67.9%, 38/56) than in those without (3.6%, 9/249). The most predominant type was emm1 (38%), detected in 73.2% of the patients with STSS. Risk factors for STSS identified by multivariable analysis included underlying kidney disease (odds ratio [OR], 10.7; 95% confidence interval [CI], 2.1-54.0, p = 0.004), bacteraemia without primary focus (OR, 3.6; 95% CI 1.2-11.1, p = 0.023), necrotizing fasciitis (OR, 8.7; 95% CI 2.6-29.4, p < 0.001), white blood cell count (WBC) < 4,000/µL (OR, 7.8; 95% CI 2.4-25.6, p = 0.001), serum creatine kinase (CK) ≥ 300 U/L (OR, 7.5; 95% CI 2.8-19.8, p < 0.001), and emm1 (OR, 5.2; 95% CI 2.0-13.4, p = 0.001).

Conclusion: WBC < 4,000/µL and CK level ≥ 300 U/L on admission are additional relevant biomarkers for STSS prediction. The most predominant iGAS type, emm1, was significantly associated with STSS.

Background: Lower respiratory infections (LRIs) represent a significant global health issue, especially affecting low- and middle-income countries. In this study, we explored the mortality and disability-adjusted life years (DALYs) associated with Staphylococcus aureus-related LRIs from 1990 to 2021, highlighting trends by age, sex, and Socio-Demographic Index (SDI).

Methods: Data were derived from the 2021 Global Burden of Disease (GBD) database. Temporal trends in age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) rates (ASDR) for S. aureus-related LRIs were analyzed based on the average annual percent change (AAPC), in terms of sex, 20-age groups, 21 regions, 204 countries, and 5 SDI quintiles.

Results: In 2021, S. aureus-related LRIs contributed to 423,837 deaths (95% UI: 382,183-458,926), a 67.56% increase since 1990. In comparison, the global ASMR was 5.43 per 100,000 (95% UI: 4.89-5.90), and the ASDR was 156.80 per 100,000 (95% UI: 139.44-176.08), both exhibiting a declining trend compared to 1990. Rates were higher in low SDI regions, with Central Sub-Saharan Africa reporting the highest ASMR, while Eastern Europe had the lowest. Among the 204 countries analyzed, Zimbabwe recorded high ASMR and ASDR, at 24.84 (95% UI: 19.44-30.16) and 754.34 (95% UI: 591.05-923.06), respectively.

Conclusions: Although the global ASMR and ASDR decreased in 2021, the number of deaths from S. aureus-related LRIs significantly increased driven by the growing population and proportion of aged individuals. Additionally, the emergence of multidrug-resistant strains has made treatment more complex, particularly in low SDI regions, highlighting the urgent need for more targeted strategies, therapies, and vaccines.

Objective: The prevalence of Carbapenem-Resistant Gram-Negative Bacteria (CR-GNB) is rapidly escalating, presenting a significant global public health concern. This study aims to evaluate the survival rate of early appropriate therapy with polymyxin B (PMB), and adverse drug reactions of PMB in treating severe burn sepsis caused by CR-GNB infections.

Methods: We retrospectively analyzed 72 patients with severe burn sepsis caused by CR-GNB infections from January 1, 2018, to December 30, 2023. These patients received a treatment regimen based on PMB for at least three days. We collected data on the patient's clinical characteristics, microbiological results, details of PMB treatment, adverse drug reactions with PMB, and mortality. We compared the 30-day mortality rates between patients who received early appropriate therapy (the timely administration of an active antimicrobial agent within 48 h after the onset of infection) and those who underwent non-early appropriate therapy, multivariate Cox regression analysis was employed to evaluate factors impacting the 30-day survival rate of patients, and the adverse drug reactions caused by PMB were also analyzed.

Results: Among the 72 patients with severe burn sepsis, the clinical effective rate was 69.4% (50/72), the 30-day all-cause mortality rate was 31.9% (23/72) and the 30-day sepsis-associated mortality rate was 27.8% (20/72). The adverse drug reactions of PMB included nephrotoxicity and skin pigmentation, with an incidence of 19.4% (14/72) and 15.3% (11/72), respectively. The patients who received early appropriate therapy had a lower mortality rate, lower SOFA scores and more wound infections compared to those who underwent non-early appropriate therapy (all P < 0.05). The univariate Cox regression analysis showed that age, hypertension, SOFA score at the time of sepsis diagnosis, and early appropriate therapy with PMB were associated with both 30-day all-cause mortality and sepsis-associated mortality in severely burned patients (all P < 0.05). Additionally, In the multivariate Cox regression analysis, early appropriate therapy with PMB was identified as an independent protective factor for both 30-day all-cause mortality (HR = 0.183 [95% CI 0.071-0.468], P < 0.001) and sepsis-associated mortality (HR = 0.150 [95% CI 0.054-0.414], P < 0.001) in severely burned patients.

Conclusions: Polymyxin B is an effective option for burn sepsis patients in treating CR-GNB infections. Early appropriate therapy with PMB significantly improved the survival rate of severe burn sepsis patients infected with CR-GNB.

Purpose: To determine diagnostic validity of MALDI-TOF MS (VITEK MS) system for detecting Klebsiella pneumoniae carbapenemases (KPC)-type carbapenemases by identifying the 11,109 Da peak in the mass spectrum generated for species identification as compared to RAPIDEC^® CARBA NP, and the modified carbapenemase inactivation method (mCIM) and the EDTA-modified carbapenem inactivation method (eCIM) in a collection of isolates previously characterized as KPC positive or negative.

Methods: 210 Enterobacterales clinical strains previously characterized having bla_KPC gene, the pKpQIL plasmid and the Tn4401a transposon were evaluated, including 34 positive controls carbapenemase-producing Klebsiella pneumoniae associated with Tn4401a, 30 Enterobacterales bla_KPC positive of unknown plasmid background, and 146 negative controls. Accuracy and agreement were established for Vitek MS, RAPIDEC^® CARBA NP, and mCIM/eCIM) tests; ROC curves were compared among these tests.

Results: The 11,109 Da peak was detected in 100% of KPC Tn4401a positive isolates using Vitek MS, sensitivity of 100% (95% CI 98.53-100), specificity of 95.5% (95% CI 91.7-99.4), positive predictive value (PPV) of 85.0 (95% CI 72.7-97.3), negative predictive value (NPV) of 100% (95% CI 99.6-100) and positive Likelihood Ratio (PLR) of 22.3 (10.2-48.8). Agreement between the three tests was 93.3% Kappa index of 0.90 (95% CI 0.83-0.97, p ≤ 0.05). ROC curves showed areas under the curve (AUCs) of 0.95, 0.96 and 0.96 for the VITEK MS, RAPIDEC CARBA NP and the mCIM/eCIM tests, respectively.

Conclusion: Detection of the 11,109 Da peak by Vitek MS confirms the presence of KPC-type carbapenemase, allowing rapid and simultaneous detection with species identification; a negative result does not rule out the presence of the enzyme and may require additional tests.

Objective: This study aims to investigate the clinical characteristics and analyze the diagnostic approaches employed for pediatric cases of scrub typhus (ST) that present without eschars.

Methods: A retrospective analysis was conducted on 256 ST cases hospitalized at Kunming Children's Hospital in Yunnan Province, China, from January 2015 to November 2022. Patients were categorized into an eschar group (n = 213) and a non-eschar group (n = 43). Clinical data were collected and analyzed for significant differences between the groups. This study particularly highlights the diagnostic methods for confirming ST in cases without eschars.

Results: The non-eschar group exhibited a higher incidence of pneumonia, a lower history of outdoor activities prior to onset, and a longer hospital stay; however, the remaining clinical and laboratory characteristics did not show statistically significant differences. The most common site for eschar formation was the axilla (12.7%, n = 27), followed by the groin (9.4%, n = 20) and auricle (8.9%, n = 19). Other notable sites included the scalp (7.5%, n = 16) and shoulder (6.6%, n = 14). The Weil-Felix test (OXK) demonstrated a positivity rate of 69.7% (23 out of 33 cases), cerebrospinal fluid (CSF) PCR had a positivity rate of 50.0% (3 out of 6 cases), and blood PCR exhibited a positivity rate of 92.3% (24 out of 26 cases).

Conclusion: These findings underscore the importance for clinicians to consider ST in pediatric patients, even in the absence of eschars. A comprehensive evaluation based on epidemiology, symptoms, signs, and laboratory characteristics is essential. Blood PCR testing methods are recommended.

Clinical trial number: Not applicable.

We describe two cases of uncomplicated pharyngitis caused by hypervirulent Klebsiella pneumoniae (hvKp) in a family, initially in an immunocompetent adolescent, followed by possible household spread resulting in similar presentations in the patient's parent. Genomic analysis confirmed hvKp from the two cases were genetically identical and typed as K2-ST3252. Nasopharyngeal carriage and respiratory secretion/droplet may play an important yet underrecognized role in the transmission of hvKp. Enhancing routine screening for hvKp in the upper respiratory culture, followed by genotyping provides an effective pathway for early diagnosis.