European Journal of Clinical Microbiology & Infectious Diseases最新文献

Introduction: Metallo-β-lactamase (MBL)-producing Enterobacterales are increasing in frequency and treatment options are limited. Aztreonam/avibactam (AZA) and aztreonam (ATM) plus ceftazidime/avibactam (CZA) showed activities against these organisms. Escherichia coli with PBP3 insertions (YRIN, YRIK) showed decreased activities to AZA and have been linked with treatment failures.

Methods: We used well-characterized global collections of MBL-producing Enterobacterales (n = 86) to evaluate if MICs generated by AZA MIC Test Strips (MTS) could be used as substitute testing for ATM-CZA Broth Disk Elution (ATM-CZA BDE). We also determined if AZA (breakpoint of 4/4 µg/ml) or ATM-CZA BDE could detect E. coli with PBP-3 insertions.

Results: The AZA MTS at ≤ 2/4µg/ml and ≥ 8/4µg/ml) showed 100% categorical agreement with ATM-CZA BDE but was less labour-intensive and more cost-effective. A strain with AZA MIC of 4/4 µg/ml tested not susceptible with ATM-CZA BDE, resulting in a very major error rate of 1/9 (11%). ATM-CZA BDE and AZA MICs (1-4 µg/ml) reported 76% (42/55) of E. coli with bla_NDMs that contained YRIK/YRIN insertions, as susceptible.

Conclusions: AZA MIC Test Strips can reliably predict ATM-CZA BDE results, except for strains with MICs of 4/4 µg/ml. ATM-CZA BDE failed to detect most of E. coli with PBP-3 insertions. E. coli with AZA MICs ranging from 1/4 to 4/4 µg/ml could be screened for PBP-3 insertions, and patients infected with such isolates, should be monitored for possible treatment failures with AZA or ATM-CZA.

Purpose: Timely knowledge of local epidemiology is essential for guiding appropriate antibiotic therapy in severe infections such as bloodstream infections (BSI). In 2024, we developed "eBIMIC", a web-based application that enables real-time parameterized consultation of cumulative antimicrobial susceptibility data base on demographic and microbiological parameters. Avaliable to all clinicians within the Clínico-Malvarrosa Health Department (Valencia, Spain). This study evaluated its potential impact on optimizing antibiotic therapy in BSI patients admitted from the Emergency Department (ED).

Methods: We retrospectively analyzed 212 adult patients with positive blood cultures from the ED between January and December 2023. Empirical and semi-targeted treatments were compared with eBIMIC-based susceptibility data using patient sex, age, ED location, and Gram stain results (for empirical therapy), or species identification (for semi-targeted therapy). A susceptibility rate ≥ 85% was considered optimal. Potential for antibiotic de-escalation was also evaluated.

Results: Empirical therapy was adequate in 85% of cases, and eBIMIC correctly predicted optimal coverage in 74.4% of them. Among inadequate treatments, eBIMIC successfully identified 78.1% as suboptimal. Concordance with semi-targeted therapy was high (92.6%). eBIMIC also revealed opportunities for safe de-escalation in 86% of patients receiving high-impact antibiotics. Retrospective simulation confirmed that eBIMIC would have recommended at least one effective empirical option in 99.5% of cases and matched in vitro susceptibility patterns in 92.9% of semi-targeted therapies.

Conclusion: eBIMIC is a mobile-accessible platform that integrates real-time microbiological data with demographic parameters to support individualized antibiotic selection and de-escalation. Its implementation has the potential to enhance antimicrobial stewardship by promoting timely, evidence-based therapeutic decisions in routine clinical settings.

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.