European Journal of Clinical Microbiology & Infectious Diseases最新文献

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.

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.