European Journal of Clinical Microbiology & Infectious Diseases最新文献

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.

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.