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.