European Journal of Clinical Microbiology & Infectious Diseases最新文献

Background: This study aimed to provide a comprehensive overview of SARS-CoV-2 and other respiratory viruses co-infections and analyse the value of Primary Care Centres (PCCs) as a sentinel network for molecular surveillance of paediatric respiratory viral infections in Catalonia (Spain).

Methods: Between October 2021 and April 2024, upper respiratory tract samples were collected from children under 15 years of age presenting with acute respiratory symptoms at different PCCs across Catalonia. The detection of respiratory viruses was performed using commercial multiplex RT-PCR and transcription-mediated amplification-based assays. The genetic characterisation of select viruses (adenoviruses (AdV), enteroviruses (EV), influenza viruses, SARS-CoV-2) was performed via partial or whole genome sequencing. The results were then compared with hospital-based data and the regional surveillance system (SIVIC).

Results: Among 1,401 positive samples from 1,329 cases, the most prevalent viruses were rhinovirus (RV) (22.77%), SARS-CoV-2 (12.35%), influenza A(H3) viruses (11.06%) and AdV (9.21%). Viral circulation followed typical seasonal patterns, with RV and AdV detected year-round, and influenza and respiratory syncytial virus peaking in winter, showing prevalences similar to those observed in hospital settings and broader community settings. Co-infections were frequent (up to 53.3% for bocavirus), while influenza and SARS-CoV-2 showed the lowest co-infection rates, suggesting possible viral interference. Genomic analysis revealed circulation of different EV (e.g., EV-D68, CV-A6, E-11, etc.) and AdV (B3, C2) types, multiple FLUAV and FLUBV genetic clades and SARS-CoV-2 variants consistent with national waves.

Conclusions: This study highlights the complexity of respiratory virus circulation and co-infections dynamics in paediatric primary care patients. A notable observation was the generally similar viral distribution between PCCs and the community, reinforcing the value of studying this population. The findings also underscore the importance of continued molecular surveillance to inform public health strategies and clinical management of respiratory infections in children.

We describe an atypical case of mpox virus (MPXV) infection in a Polish patient, with a focus on clinical presentation, virological characterisation, and the phylogenetic placement of the viral isolate within the emerging C.1 lineage of Clade IIb. The report aims to contribute to a better understanding of MPXV lineage-specific disease features and viral evolution in non-endemic settings. The patient presented with numerous localised lesions and minimal systemic symptoms. Genomic analysis confirmed infection with an MPXV C.1 lineage of Clade IIb responsible for the 2022-2025 global outbreaks. Infection with C.1 lineage may lead to atypical presentations, particularly in immunocompetent individuals. Continued genomic surveillance and clade-specific clinical correlation are essential for accurate diagnosis, risk stratification, and public health response.

Purpose: Acute pyelonephritis is a common diagnosis in ambulatory settings. The objective of this systematic review was to assess whether oral antibiotic treatment is non-inferior to a single dose of IV antibiotics followed by oral relay in terms of efficacy and complications in adult patients presenting to the emergency department (ED) with acute pyelonephritis.

Methods: The protocol was registered to PROSPERO (CRD42024503968). Five databases (MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science) and grey literature were searched for randomized controlled trials (RCT) and observational studies comparing both treatment strategies. Two reviewers independently performed study selection, data extraction, and quality assessment (RoB 2 and ROBINS-I). The primary outcomes were clinical and microbiological cure. A structured reporting of the effects for each study was conducted since meta-analysis was not appropriate.

Results: The search yielded 2,956 records, with 909 duplicates. After screening, 40 full texts were reviewed, and 3 studies were included. Two studies (1 RCT, 1 non-randomized) reported on the primary outcomes, without assessing non-inferiority. These did not report a difference in clinical and microbiological cure between treatment strategies at end of follow-up. The risk of bias was moderate to serious/high.

Conclusion: This review identified few studies comparing oral-only to single-dose IV followed by oral antibiotics for acute pyelonephritis in adults. Non-inferiority of oral-only treatment could not be established, as none of the included studies were designed for this purpose. Clarifying the comparative effectiveness of these two approaches is essential to further optimize the management of acute pyelonephritis.

This study aims to explore the therapeutic efficacy of evidence-based pharmaceutical interventions in pharmacist-integrated clinic for pediatric Mycoplasma pneumoniae pneumonia.A total of 200 children with suspected Mycoplasma pneumoniae pneumonia admitted to our hospital between July 2022 and June 2024 were enrolled and randomly assigned to either the intervention group or the control group using a random number method. The intervention group received standardized diagnostic and therapeutic procedures based on evidence-based medicine principles, while the control group received conventional treatment according to the doctor's standard practices. The two groups were compared regarding basic clinical parameters including time to defervescence, recovery duration, and medication use. Additionally, children treated with doxycycline underwent one-year dental follow-up.The intervention group demonstrated significantly better outcomes compared to controls across all measured parameters: time to defervescence (3.37±1.24 vs 4.77±1.21 d), recovery duration (9.37±4.26 vs 12.51±5.12 d), total treatment costs (¥769±452 vs ¥2988±1899), and medication course length (10.68±3.02 vs 14.88±4.36 d). Additionally, the intervention group showed lower hospitalization cases (8 vs 65), intravenous infusion cases (8 vs 65), and adverse drug reactions (7 vs 18). Notably, no cases of tooth yellowing were observed during the 12-month follow-up period in children who received doxycycline treatment.The evidence-based intervention via a pharmacist-integrated clinic significantly improved diagnostic accuracy and therapeutic efficacy for pediatric Mycoplasma pneumoniae pneumonia, with concomitant treatment costs reduction. No cases of doxycycline-induced tooth discoloration were observed.

Purpose: Current treatment options for infections caused by vancomycin-resistant (VR) Enterococcus faecium remain limited and often suboptimal. This study investigates the in vitro activity of combination therapies involving fosfomycin and oxazolidinones (linezolid, contezolid, delpazolid, and sutezolid) against five vanA and five vanB E. faecium isolates obtained from blood cultures.

Methods: The synergistic activity of fosfomycin combined with each oxazolidinone was assessed using checkerboard and time-kill assays.

Results: Synergistic interactions were demonstrated with all fosfomycin-oxazolidinone combinations, although the effect was more consistent with delpazolid. In some cases (one for contezolid, three for linezolid, four for sutezolid), the interaction was additive rather than synergistic. Synergy was mainly driven by a significant reduction in fosfomycin minimum inhibitory concentration (MIC), up to 16-fold, while decreases in oxazolidinone MIC were modest. Time-kill assays performed on representative isolates Ef-3 (vanB) and Ef-10 (vanA) confirmed the synergistic interactions, showing a reduction in viable cell counts after 24 h.

Conclusion: Our findings provide preclinical evidence supporting the use of fosfomycin in combination with novel oxazolidinones as a promising therapeutic strategy against VR E. faecium infections.

Purpose: Dermatomycoses represent the most frequent form of human fungal infection globally. The conventional diagnostic approach to identify dermatomycoses is based on direct microscopic examination (DME) and fungal culture. However, these procedures suffer from a number of significant limitations. We aim to evaluate the clinical performance of the novel DermatoPlex qPCR assay (SpeeDx) in comparison to conventional methods for the detection of dermatophyte fungi and Candida spp. in skin and nail material.

Methods: Between February and July 2024, 1320 samples from 1252 patients were collected for the investigation of dermatophyte fungi at the Navarra University Hospital in Spain. DME, culture and DNA extraction were systematically executed in all specimens, and the qPCR assay was retrospectively tested. The Novaplex™ Dermatophyte qPCR assay (Seegene) was used in case of discrepancies.

Results: The DermatoPlex qPCR assay performed well for the molecular detection of dermatophyte fungi and Candida spp. in skin and nail material; with an overall agreement of 75.4% when compared with culture. Among discrepancies, the majority (75.6%) were ultimately confirmed as true-positives, while only 12.4% resulted in false-negative results. Overall, sensitivity of the qPCR method for the diagnosis of dermatomycoses was 2.3x and 1.7x greater (1.7x and 1.6x for dermatophytosis) when compared with DME and culture, respectively.

Conclusion: This is the largest clinical evaluation of a qPCR method for the diagnosis of dermatomycoses. Considering the greater sensitivity of molecular techniques over conventional procedures, the DermatoPlex assay emerges as a reliable and promising qPCR method for the diagnosis of cutaneous mycoses.

Objectives: Recent shortages of amoxicillin and amoxicillin/clavulanate in France have raised concerns about a possible impact on the management and outcome of acute sinusitis. We therefore assessed the rates of complicated sinusitis occurring during two time periods, one with and one without antibiotic shortages.

Methods: We reviewed cases of sinusitis from two periods: December-February 2018-19 and 2019-20 (no antibiotic shortages) and December-February 2021-22 and 2022-23 (shortages of amoxicillin and amoxicillin/clavulanate). We included all patients over 15 years of age who had been treated in the hospital's ear, nose and throat department of Lariboisiere hospital for sinusitis. The primary outcome was the rate of complicated sinusitis among the total number of cases of sinusitis treated at Lariboisière hospital during the two study periods.

Results: One hundred and forty-two patients were treated for sinusitis during the study periods: 60 during the no-shortage period and 82 during the shortage period. The rate of complicated sinusitis was significantly higher during the shortage period (23/82, 28%) than during the no-shortage period (3/60, 5%) (OR 7.32, CI [2.04-40.15], p=0.0003). The use of alternative antibiotics prior to attendance was independently associated with an increased risk of complications (OR 7.88, CI [1.58-77.87], p=0.004). The presence of oral streptococci was also associated with complications, suggesting a correlation between microbial patterns and antibiotic shortages.

Conclusions: Shortages of first-line antibiotics for sinusitis was associated with an increased rate of complications, highlighting the need to explore alternative treatments and reinforce public health actions to anticipate shortages.

Background: We retrospectively analyzed the epidemiological characteristics, mixed infections, and complications of chlamydial infection in pediatric inpatients based on a national database.

Methods: The discharge data of pediatric inpatients with chlamydial infection was obtained from the Futang Research Center of Pediatric Development database from January 2016 to December 2022.

Results: A total of 10,211 patients with chlamydial infection were obtained, with patients < 1 year old predominantly (44.17%, 4510/10211). Bronchopneumonia was the most prevalent (42.67%, 4355/10207) complication, followed by bronchitis (11.11%, 1134/10207) and chlamydial pneumonia (10.15%, 1036/10207). Mixed infections were identified in 60.40% of cases, with Mycoplasma pneumoniae being the predominant co-pathogen (47.69%, 2941/6167). Among viral and bacterial co-infections, respiratory syncytial virus (21.91%, 632/2885) and Streptococcus pneumoniae (26.67%, 268/1005) were most frequently detected, respectively. From 2016 to 2018, the rate of hospitalized patients with chlamydial infection exhibited an almost constant level (16.95%-18.27%), peaked to 21.75% in 2019, then declined to 6.75% in 2022. The epidemics of chlamydial infection were mainly in winter (33.29%), with the highest proportion in January (12.11%, 1237/10211). The highest median hospitalization expense was incurred by patients aged < 1 year and co-infected fungi infection. Four patients died, all with respiratory failure, co-infected with multiple pathogenic infections, and other associated complications.

Conclusion: Hospitalized pediatric chlamydial infection primarily occurred in patients under four years old. Bronchopneumonia was the most prevalent complications in pediatric chlamydial infection. Over half chlamydial infection cases were identified with mixed infections with Mycoplasma pneumonia predominantly.