European Journal of Clinical Microbiology & Infectious Diseases最新文献

Sepsis after neonatal necrotizing enterocolitis (NEC) onset was associated with substantially adverse outcomes. However, effective tools for predicting sepsis risk in this special population remain lacking. This study aimed to investigate the influence of sepsis after NEC onset on the outcomes and develop a prediction model for early identification of sepsis. Retrospective review of 530 patients diagnosed with NEC was reviewed with clinical data. In this study, the overall proportion of sepsis was 56.2% (298/530). The rates of surgical intervention (63.09% vs. 18.10%) and mortality (17.11% vs. 3.88%) were higher in patients with sepsis than in those without (P < 0.05). The entire cohort was randomly assigned to a training set (n = 371) or testing set (n = 159) at a 7:3 ratio. LASSO-Logistic regression analysis showed that gestational age, age at NEC onset, C-reactive protein level, ventilator support, and hypoproteinemia were independently associated with sepsis (all P < 0.05), and a Nomogram model was developed based on these determinants. The area under the receiver operator characteristic curve of the training set was 0.937 (95% confidence interval [CI]: 0.813-0.960) and that of the testing set was 0.917 (95% CI: 0.876-0.957). The H-L goodness-of-fit test and calibration curve showed the forecast was in good agreement with the actual situation (both P > 0.05), whereas the decision curve analysis indicated the model's practical utility for clinical decision-making with a probability threshold of 0.03. This Nomogram model for predicting sepsis demonstrated desirable discriminative performance, aiding clinicians in enhancing risk assessment and facilitating early preventive interventions.

Objectives: Community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae is a frequent and challenging diagnosis in Emergency Departments (EDs), often leading to unnecessarily broad-spectrum or ineffective antibiotic therapy. We hypothesize that rapid diagnostic tools, such as point-of-care (POC) devices, could improve initial antibiotic therapy appropriateness and reduce unnecessary additional diagnostic tests.

Methods: We conducted a retrospective, single-centre, study involving 81 patients visiting our ED with Mycoplasma pneumoniae CAP diagnosed between January 2023 and June 2024. Patients were divided into two groups depending on whether their nasopharyngeal swab, taken to detect viruses or selected bacteria such as Mycoplasma pneumoniae, was handled at the ED with a POC device (POC group) or at the main laboratory (Lab group). Primary outcome was the appropriateness of initial antibiotic therapy, defined as the use of macrolide (or tetracycline or fluoroquinolone in allergic patients) alone or, in case of severe disease, in combination with third-generation cephalosporin.

Results: Initial antibiotic therapy was more frequently appropriated in patients of the POC group than in patients of the Lab group (28 of 43 [65%] vs. 6 of 38 [16%], adjusted OR: 9.9, 95% confidence interval: 3.4 to 29.1; p < .001). Point-of-care testing was associated with fewer additional biological and radiological tests performed in the ED.

Conclusion: POC improved the management of Mycoplasma pneumoniae CAP by increasing the appropriateness of initial antimicrobial therapy and reducing unnecessary additional diagnostic procedures. Larger multicentre studies are needed to confirm these findings, assess the impact on overall healthcare costs, and investigate the integration of POC devices into routine clinical workflows.

Digestion and decontamination during acid-fast bacilli (AFB) culture processing are performed to suppress growth of normal microbiota in respiratory specimens; however, these steps may render AFB nonviable. This study aimed to evaluate the performance of NTM Elite agar, a decontamination-free selective medium, for the recovery of nontuberculous mycobacteria (NTM) compared to standard of care (SOC) processing and solid and liquid media inoculation for AFB culture in five hundred lower respiratory samples from non-cystic fibrosis patients. Concurrently, the same specimens were directly inoculated onto NTM Elite agar (NTM Elite-Direct Inoculation) or centrifuged and washed with saline prior to inoculation onto NTM Elite agar (NTM Elite-Concentrated) and incubated up to 28 days. The overall median time to positivity was 7.0 days (IQR = 7-18) for NTM Elite-Direct Inoculation and 14 days (IQR = 7-14) for NTM Elite-Concentrated, which were similar to SOC broth but shorter than SOC solid agar at 35 days (IQR = 2-41). Breakthrough non-AFB growth rate was 1.4% (7/500) NTM Elite-Direct Inoculation, which was less than NTM Elite-Concentrated at 9.0% (45/500) and SOC media at 10.0% (50/500). Forty-five unique isolates were included in the analysis for sensitivity of NTM detection. Sensitivity was 43.5% (95% CI = 30.2-57.8) for SOC media, 20.0% (95% CI = 10.9-33.8) for NTM Elite-Direct Inoculation, and 82.6% (95% CI = 69.3-90.9) for NTM Elite-Concentrated. Combined with SOC broth culture, sensitivity was 93.3% (95% CI = 82.1-97.7) for NTM Elite-Concentrated. The high sensitivity of the latter procedure indicates potential for NTM Elite agar to replace SOC solid agar for detection of NTM in areas of high NTM incidence but low incidence of tuberculosis.

Purpose: The aims of this study were to describe the microbiological profile and antibiotic susceptibility of acute and chronic prosthetic joint infection (PJI) after total knee arthroplasty (TKA) and to propose appropriate empirical antibiotics.

Methods: We performed a retrospective review using our institution's database to collect data from patients with PJI who underwent reoperation following a primary TKA, between 2021 and 2024. Demographic data, microbiological results and antimicrobial susceptibility testing were analysed.

Results: Forty patients met the study criteria and were included in the study. Chronic infections (> 6 weeks after implantation) were the most common, accounting for 75% of the forty cases. Regardless of classification by time to infection, gram-positive organisms were the predominant causative agents. The most frequently identified pathogens were Staphylococcus aureus (24.2%), Staphylococcus epidermidis (16.7%) and Staphylococcus lugdunensis (13.6%). Vancomycin proved to be the most effective antimicrobial, with a susceptibility of 100% in all cases, in both acute and chronic infections. As for chronic infections, Cotrimoxazole (Sulfamethoxazole/Trimethoprim) demonstrated low levels of resistance, with 97% susceptibility among the main pathogens involved in these cases.

Conclusions: The choice of antibiotic for empirical treatment should consider the time since prosthesis implantation, as pathogen distribution and their susceptibilities differ slightly between acute and chronic infections. For acute infections, vancomycin should be considered the first-line treatment. In chronic infections, Cotrimoxazole may serve as a potential alternative treatment, due to its low resistance profile. Nevertheless, de-escalation to targeted therapy should be implemented as soon as the final culture results become available.

Saprochaete species are emerging fungal pathogens, particularly affecting immunocompromised individuals, with clinical manifestations ranging from superficial to invasive infections. We present three cases of pediatric Saprochaete spp. infections, detailing clinical presentation, diagnostic workup, and treatment strategies. Two patients with acute myeloid leukemia developed bloodstream infections with Saprochaete clavata; both required prolonged antifungal therapy due to deep organ involvement, and one experienced relapse after treatment discontinuation. The third case involved a patient with cystic fibrosis, in whom Saprochaete capitata was isolated from sputum; she improved with antifungal therapy and had no relapse. Saprochaete spp. infections in pediatric populations present diagnostic and therapeutic challenges. Further research is needed to optimize management strategies and improve patient outcomes.