European Journal of Clinical Microbiology & Infectious Diseases最新文献

Background: Invasive pulmonary aspergillosis (IPA) is a common cause of fungal infection acquired in intensive care unit (ICU) whose clinical landscape may differ according to SARS-CoV2 infection status.

Method: We included all mechanically ventilated patients hospitalized (≥ 48 h) participating in ICU of the REA-REZO network during a 6-year period. Among IPA patients, initial characteristics and outcomes were compared according to COVID-19. Additionally, to account for potential confounders, we performed an inverse probability of treatment weighting (IPTW). Rates of IPA were also compared according to SARS-CoV2 infection. Finally, we investigated risk factors associated with mortality among IPA patients using a Cox model regression.

Results: Among 120 993 patients included during the study period, IPA was diagnosed in 254 patients. COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients were significantly older (median age 69 [62-73] years versus 63 [56-70] years; p < 0.001), less immunosuppressed (23.5% versus 32.4%; p = 0.001) and less severe at baseline (median SAPS II score 45 [35-54] versus 55 [39-65]; p < 0.001) compared to non-COVID-IPA patients. CAPA patients exhibited both a longer duration of mechanical ventilation (16 [9-33] days versus 8 [4-26] days; p = 0.002) and a longer ICU length of stay (LOS) (18 [10-38] days versus 14 [6-30] days, p = 0.015) after IPA diagnosis. However, survival did not differ according to COVID-19 status either in the raw population (log-rank test; p = 0.43) or after weighted Cox regression (HR 0.92 [95%CI 0.61-1.38]; p = 0.69). Incidence of IPA was higher in COVID-19 patients (incidence rate ratio: 8.45 [95%CI 6.59-10.87]; p < 0.001).

Conclusion: In this large multicenter cohort, IPA had a similar impact on survival depending on SARS-CoV2 infection status. However, despite lower severity, CAPA patients experienced longer duration of mechanical ventilation and LOS.

Purpose: We recently demonstrated the utility of the 'TB Concentration & Transport' kit for bio-safe, ambient-temperature transport of dried sputum samples on Trans-Filter, along with the 'TB DNA Extraction' kit for efficient DNA extraction from Trans-Filter for use in the Line Probe Assay (LPA) for diagnosing drug-resistant tuberculosis (TB). The present study aimed to develop and evaluate a new 'Quick TB DNA Extraction' kit ('Quick DNA' kit) for rapid DNA isolation from Trans-Filter samples and assess its compatibility with LPA for the detection of multidrug-resistant TB (MDR-TB).

Methods: Consecutive presumptive TB/MDR-TB/XDR-TB patients (n = 1823) were screened using LED-FM and/or TBDetect microscopy at 2 Designated Microscopy Centres associated with the National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi. Smear-positive samples (n = 235) were processed in duplicate using the 'TB Concentration and Transport' kit. Dried sputum on bio-safe Trans-Filters was transported at ambient temperature, along with sputum samples, in a 3-layer packing in cooling conditions to NITRD Hospital (a National Reference Laboratory). DNA was extracted from Trans-Filters using 'Quick DNA' kit and the 'TB DNA Extraction' kit, and from sputum using Hain's GenoLyse® DNA Extraction kit for first-line LPA for MDR-TB detection.

Results: Quick Kit-LPA and Kit-LPA (LPA with DNA extracted from Trans-Filter using 'Quick DNA' kit and 'TB DNA Extraction' kit, respectively) showed similar sensitivity of 88.9% (95% CI: 65.3-98.6) and 88.5% (95% CI: 69.9-97.5) and specificity of 100% (95% CI: 98.2-100) and 99.5% (95% CI: 97.3-99.9) for rifampicin and isoniazid resistance detection, respectively against Direct-LPA (LPA with DNA extracted from sputum samples using GenoLyse kit). User feedback obtained from laboratory technicians corroborated that the one-step 'Quick DNA' kit procedure was rapid (5 minutes), easy to perform, seamlessly integrated with LPA testing, and was suitable as a replacement for Kit-LPA or Direct-LPA.

- , conclusion: The gap between drug-resistant TB detection and treatment initiation can be narrowed through Universal-Drug Susceptibility Testing by implementing (i) bio-safe and ambient temperature transport of sputum from primary healthcare centres to central laboratories, and (ii) by using Quick Kit-LPA over Direct-LPA in patients residing in remote areas.

To explore the molecular characteristics of Neisseria meningitidis carried by healthy individuals in Meigu County, Liangshan Yi Autonomous Prefecture, Sichuan Province, and to provide scientific evidence for preventing and controlling epidemic meningitis, this study analyzed 240 N. meningitidis isolates collected from 2021 to 2024. PCR-based genogrouping and second-generation whole-genome sequencing (WGS) were performed. The results showed that genogroup B was the most common, accounting for 65%. Multilocus Sequence Typing(MLST) analysis identified 78 sequence types(STs), with ST-18,628 and ST-2146 being the most frequent. Notably, 41% of the STs (ST-18,620 to ST-18,856) were newly identified. While 29 STs were allocated to six known clonal complexes, 49 STs couldn't be assigned to any. Genogroup B N. meningitidis (MenB) isolates showed high heterogeneity and the most common clonal complexes were CC4821, CC175, CC198. The NG N. meningitidis isolates were predominately CC198, CC4821, CC5. Genogroup W N. meningitidis (MenW) isolates were predominately CC4821. Genogroup Y N. meningitidis (MenY) isolates were belonged to CC175.Three AMR genes were detected, with mtrC and mtrD having the highest detection rate. Also, sixty-eight virulence genes were found. Core genome SNP analysis indicated same-year isolates clustered phylogenetically. In conclusion, the N. meningitidis isolates in Meigu County have diverse virulence genes and a high rate of novel STs, showing a regional epidemic trend, and continuous monitoring is necessary.

Introduction: The efficacy and safety of high-dose rifampicin in patients with tuberculous meningitis (TBM) remain uncertain.

Method: A comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Database was conducted to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of high-dose rifampicin treatment in patients with TBM, up to October 8, 2024. The primary outcome was all-cause mortality at the longest follow-up period reported by individual trials, while the secondary outcome was the incidence of serious adverse events. We applied a random-effects model and calculated risk ratios (RR) with 95% confidence intervals (CIs) of pooled outcomes.

Result: Seven RCTs involving 1,296 TBM patients were included. High-dose rifampicin did not reduce all-cause mortality (RR = 0.88, 95% CI: 0.55-1.43,P= 0.61). Similarly, it was not associated with a reduction in serious adverse events (RR = 0.96, 95% CI: 0.62-1.50,P= 0.87).

Conclusion: This meta-analysis of seven RCTs involving 1,296 patients with TBM found that high-dose rifampicin treatment neither significantly reduced all-cause mortality nor decreased serious adverse events.

We evaluated in vitro activity of sulbactam/durlobactam in combination with different antimicrobials against Carbapenem-Resistant Acinetobacter baumannii (CRAB) clinical isolates with different susceptibility profiles, including sulbactam/durlobactam-resistant strains. The genomes of 13 CRAB clinical isolates were characterized by whole-genome sequencing and synergy testing was performed with MIC Test Strips. Sulbactam/durlobactam, when combined with piperacillin/tazobactam or ceftazidime/avibactam, showed synergistic activity against 53.8% (7/13) of CRAB isolates and restored meropenem MIC values below the clinical breakpoint in 46.2% (6/13) of them. Our results demonstrate that sulbactam-durlobactam in combination with β-lactams exhibited high in vitro synergistic activity against CRAB strains.

Purpose: This study aims to investigate the effect of seasonal influenza vaccination on hospitalization rates among patients presenting to the emergency department with influenza-like illness.

Methods: A retrospective, single-center observational study was conducted, involving adult patients with influenza (ICD-10 codes J10 and J11) diagnosed in the emergency department between May 2024 and April 2025. Clinical and demographic information was collected from electronic records, and vaccination status was confirmed through follow-up phone calls. To tackle the "zero event" problem-no hospitalizations among vaccinated individuals-advanced statistical modeling was employed, including standard logistic regression, and Bayesian logistic regression using Markov Chain Monte Carlo (MCMC) simulations. Odds ratios (OR) and 95% Highest Density Intervals (HDI) were calculated to assess the effectiveness of vaccination.

Results: A total of 878 patients were enrolled: 3.3% (n = 29) received vaccinations, while 2.7% (n = 24) required hospitalization. None of the vaccine recipients were hospitalized. Standard logistic regression indicated that age was a significant indicator of hospitalization. Furthermore, Bayesian logistic regression followed, which confirmed vaccination's statistically significant protective effect. The OR for vaccination was 0.526 (95% HDI: 0.336-0.739), indicating a 47% reduction in hospitalization risk among vaccinated individuals.

Conclusion: Seasonal influenza vaccination was significantly associated with a lower risk of hospitalization in patients presenting with influenza-like illness to the emergency department. These findings support public health initiatives to enhance influenza vaccine coverage, particularly for the elderly.