European Journal of Clinical Microbiology & Infectious Diseases最新文献

In recent years, the use of antibiotics in pediatric patients has received widespread. Tosufloxacin is a quinolone antimicrobial used to treat pneumonia, otitis media, cholera, and anthrax. Guidelines have recommended that quinolone antimicrobials can be used as alternatives for the treatment of bacterial infections in children. However, due to the potential adverse effects on bones and joints, the clinical application of fluoroquinolones requires further evaluation. This article reviewed the latest clinical evidence on the efficacy and safety of tosufloxacin for treating bacterial infections in children. Pharmacokinetic results suggested that drug clearance and volume of distribution were significantly correlated with body weight in children, and the higher the AUC and C_max, the higher the incidence of adverse drug effects. The efficacy results suggest that for Macrolide-resistant Mycoplasma pneumoniae (MRMP), tosufloxacin may have better efficacy compared to macrolide antibiotics, with minocycline being more efficacious than tosufloxacin. Tosufloxacin has good efficacy in the treatment of otitis media infections in children as well as children under 2 years of age, and it can be used as a second-line choice for children with persistent otitis media. The safety results suggest that the most important adverse effect of tosufloxacin is diarrhea, and there are almost no joint-related adverse effects. The rate of adverse effects of 6 mg/kg tosufloxacin is higher than 4 mg/kg group. Tosufloxacin may be safe and effective in children pneumonia and otitis media, but is less effective than minocycline in MRMP.

Background: Pseudomonas aeruginosa bloodstream infections pose challenges due to recurrence and mortality. Identifying these outcomes may support more targeted empiric therapy.

Methods: A population-based cohort study was conducted in Queensland (2000-2019). Patients were classified into four outcomes. Multinomial (relative risk ratios [RRR]) and binary logistic regression (with odds ratio [OR]) identified baseline factors associated with recurrence and mortality.

Results: Among 5,742 patients with P. aeruginosa BSI, 20.5% died within 30 days, 21.3% died between 30 days and three years, 4.6% experienced recurrence, and 53.6% survived to three years without recurrence. Factors associated with recurrence included malignancy (RRR 3.43; 95% CI 2.55-4.62), metastatic cancer (RRR 2.16; 95% CI 1.27-3.66), and uncomplicated diabetes (RRR 2.25; 95% CI 1.31-3.86). Mortality was associated with malignancy (OR 2.65; 95% CI 2.22-3.16), congestive heart failure (OR 1.67; 95% CI 1.38-2.04), dementia (OR 1.97; 95% CI 1.46-2.65), renal disease (OR 1.85; 95% CI 1.55-2.19), pulmonary disease (OR 1.32; 95% CI 1.08-1.62), and advancing age (OR 1.02; 95% CI 1.02-1.03). Community-onset infections and a genitourinary source were associated with a reduced risk of both recurrence (RRR 0.52; 95% CI 0.33-0.81 and RRR 0.70; 95% CI 0.43-1.14) and mortality (OR 0.68; 95% CI 0.55-0.85 and OR 0.66; 95% CI 0.52-0.84, respectively). Among patients with recurrence, resistance emerged to ceftazidime (10.7%), and ciprofloxacin (10.1%), although most susceptibility profiles remained stable.

Conclusions: Among patients with P. aeruginosa BSI, rates of mortality and clinically relevant recurrence were high. These findings may assist clinicians in making more informed empiric treatment decisions.

We analysed 498 global Aspergillus fumigatus isolates using multilocus variable-number tandem-repeat (MLVA) typing to investigate regional clustering, environmental-clinical overlap, and azole resistance patterns. The dataset, which included 155 newly genotyped Korean strains, revealed extensive genotypic diversity and four distinct phylogeographic clusters. Resistance-associated mutations (TR34/TR46) appeared concentrated within certain clusters that largely comprised isolates from Germany, South Korea, and China, suggesting country-level enrichment rather than broader continental trends. These findings support the presence of geographically structured populations and localised emergence of resistance and demonstrate the utility of MLVA for molecular surveillance, particularly in settings where whole-genome sequencing is limited.

Purpose: Benzylpenicillin is regaining attention as a treatment option for susceptible S. aureus, including in severe invasive diseases such as blood stream infections. Timely and reliable susceptibility determination is essential to support its use in clinical practice. In this study, we assessed the EUCAST-recommended methodology of interpreting zone edges in a national multicenter trial.

Methods: In total, nine microbiology laboratories in Austria participated. Each center received 10 isolates in blinded duplicates, all with inhibition zones of ≥ 26 mm. Three were blaZ-positive with sharp edges and seven were blaZ-negative with fuzzy edges. Benzylpenicillin susceptibility testing according to EUCAST guidelines using 1 unit discs was performed by two independent technicians in duplicate on two separate days. All plates were interpreted by two different assessors generating a total of 1440 data points.

Results: Overall, 85.5% of all interpretations were correct. Both, major and very major errors occurred. There was high variability between laboratories with overall accuracy ranging from 61.9% to 100%. There were statistically significant differences in the average inhibition zone between MH agars from different manufacturers. Laboratories using agars giving rise to a smaller average inhibition zone (i.e. lower diffusion of benzylpenicillin) performed less well. Laboratories with the methodology implemented performed better than those without experience.

Conclusion: In summary, our study demonstrates that benzylpenicillin susceptibility testing using the EUCAST-recommended methodology is feasible, but accurate and reproducible assessment of zone edges requires both experience and optimal materials. Thorough validation of locally used materials is therefore essential before implementing this approach for routine use.

Background: Enterococcus faecalis (E. faecalis) infective endocarditis (EFIE) treatment consists of a penicillin backbone and a synergistic agent (gentamicin or ceftriaxone). Due to the instability of aminopenicillins in continuous infusion in the outpatient context, benzylpenicillin is used as an alternative to ampicillin, though concern regarding reduced synergy with ceftriaxone has emerged. Clinical Laboratory Standards Institute (CLSI) provides MIC breakpoints for penicillin and ampicillin. European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines only provide breakpoints for ampicillin. We evaluated the changing antimicrobial prescribing practices, and laboratory reporting (from CLSI to EUCAST guidelines) related to EFIE treatment and outcomes at our centre.

Methods: This was a retrospective study at Monash Health, Melbourne. Adult patients aged ≥ 18 years, who were treated for EFIE from 2014 to 2022, were included. Univariable associations were evaluated (p < 0.05).

Results: 104 patients treated for EFIE were included. Following EUCAST guideline implementation, there was a significant increase in ampicillin-based regimens prescribed as initial antimicrobials for directed EFIE therapy (64.3 to 82.3% p = 0.00135); benzylpenicillin regimens decreased across the same period (36.7% to 8.1%, p = 0.0007). In patients who received combination therapy, ceftriaxone use increased in the EUCAST period (p < 0.0001). Vancomycin prescriptions as subsequent regimen increased in the EUCAST period (0 to 19.3%, p = 0.0071). Ampicillin or benzylpenicillin monotherapy prescription as initial EFIE treatment reduced when comparing CLSI to EUCAST periods (p = 0.00001).

Conclusion: There is significant heterogeneity in the antimicrobials prescribed for EFIE at our centre, reflective of evidence that emerged over the last decade, changes in susceptibility testing and reporting and lack of randomised control trial (RCT) data supporting any one regimen. RCT data is required to further inform and refine directed EFIE treatment recommendations.