European Journal of Clinical Microbiology & Infectious Diseases最新文献

Background: (Candida glabrata C. glabrata) is classified as a high-priority pathogen by the World Health Organization (WHO). It causes mucosal and deep infections in immunocompromised individuals, yet its diagnosis currently relies on slow culture processes. This highlights the urgent need for rapid and accurate detection methods.

Methods: Ten primers targeting different regions of the C. glabrata ITS2 gene were designed to create a multiple cross displacement amplification (MCDA) assay coupled with a nanoparticle lateral flow biosensor (LFB). Following optimisation of temperature and time, the multiple cross displacement amplification coupled with lateral flow biosensor (MCDA-LFB) system was employed to detect C. glabrata DNA in clinical specimens.

Results: Under optimal conditions (63 °C, 40 min), the C. glabrata-MCDA-LFB assay achieved a limit of detection (LoD) of 10 fg/µL.The assay successfully detected all C. glabrata strains tested and demonstrated no cross-reactivity with non-C. glabrata isolates. Findings showed that the C. glabrata-MCDA-LFB assay promptly and successfully detected all 57 C. glabrata-positive samples among 240 clinical specimens identified by traditional culture methods. The entire process, including sample processing (20 min), the MCDA reaction (40 min) and result documentation (2 min), was completed within 62 min.

Conclusion: The C. glabrata-MCDA-LFB assay developed in this study is a rapid, simplified, sensitive and specific technique that is straightforward to use. It can be used to screen for or diagnose C. glabrata infections in clinical settings, particularly in regions with limited resources.

Our aim was to determine risk factors of enterococcal bacteraemia (EB) in urology. In a prospective study including all positive blood cultures (PBC) in urology for 18 months in five institutions, one hundred seventy-six PBC diagnosed, including 111 cases related to Gram negative bacilli (63%), 32 EB (18%) and 33 cases related to other pathogens (19%). The main characteristic of EB was their occurrence exclusively in male gender. In logistic regression, EB appeared to be associated with transurethral resection of the prostate: adjusted odds ratio (AOR) [95% CI]: 3.75 [1.30-10.78].

Background: Post-lung transplantation pneumonia (pLuTP) is among the most frequent complications following lung transplantation, predominantly caused by Gram-negative bacteria (GNB). The emergence of multidrug-resistant (MDR) non-fermenting GNB as aetiological agents of pLuTP represents a major therapeutic challenge due to limited treatment options.

Methods: We present a retrospective case series describing 20 episodes of pLuTP successfully treated with cefiderocol.

Results: Thirteen patients, with a median age of 56 years (IQR 44-59), experienced a total of 20 episodes of pLuTP. In 3 cases (25.0%), polymicrobial pneumonia was diagnosed. Acinetobacter baumannii was isolated in 13/20 episodes (65.0%), followed by Pseudomonas aeruginosa (6/20, 30.0%), Achromobacter xylosoxidans and Klebsiella pneumoniae (2/20, 10.0% each). Cefiderocol was administered in all episodes: as monotherapy in 5/20 cases (25.0%), in combination with high-dose ampicillin/sulbactam in 7/20 cases (35.0%), aminoglycosides or intravenous colistin (2/20, 10.0% each), and other regimens in the remaining 4/20 cases (20.0%). Clinical cure was achieved in 17/20 cases (85.0%). Microbiological eradication was not achieved in any case. Relapse occurred in 4/20 episodes (20.0%), with no evidence of in vitro cefiderocol resistance. No major adverse events were reported.

Conclusions: Cefiderocol may represent a valuable therapeutic option for managing pLuTP caused by difficult-to-treat GNB in lung transplant recipients.

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.

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.

Background: Pneumonia remains a major cause of morbidity and mortality worldwide. Rapid diagnostic testing with molecular syndromic panels (MSP) has proved useful for the management of antimicrobial treatment of hospital-acquired pneumonia (HAP). In this study, we evaluated the impact of early use of MSP testing in the Emergency Department (ED) for the management of antibiotic therapy in patients with moderate to severe CAP with risk factors for multi-drug-resistant pathogens (CAP-MDR).

Patients and methods: Patients presenting at the ED with diagnosis of moderate to severe CAP-MDR underwent microbiological analysis of lower respiratory tract specimens by culture and MSP testing (bioMérieux, FilmArray^® Pneumonia Plus Panel). The primary outcome was the percentage of cases in which MSP testing modified the empiric antimicrobial therapy started according to local protocols. Among the secondary outcomes we included the time elapsed from ED admission to antibiotic change or confirmation upon receipt of the MSP results.

Results: Between June 2024 and May 2025, 93 patients were enrolled (age, 72.9 ± 13.9 years; 62.4% males). MSP testing identified one or more pathogens in 91.4% of cases. Modification of empiric antibiotic therapy, started according to local protocols, occurred in 65.6% of patients (escalation in 44.1% and de-escalation in 21.5% of cases) after 11.4 ± 6.3 h (IQR 12.0) since ED presentation.

Conclusions: The early use of MSP on lower respiratory samples collected in the ED from patients with diagnosis of moderate to severe CAP-MDR could allow a rapid and targeted modification of the empiric antibiotic therapy in these patients, with potential advantages on antimicrobial stewardship and patient management.

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.

Purpose: This review aims to provide an overview of current knowledge on the involvement of QS in phage infection. The role of QS in bacterial defence against phages is emphasized, without overlooking the fact that QS can sometimes also promote phage infection. We also review the implications of QS in phage therapy and current perspectives.

Methods: For the bibliographic review, PubMed and Google Scholar were used to search for publications on "quorum-sensing" and "phage infection".

Results: The relationships between bacteria and phages are extremely complicated and involve several mechanisms. Quorum sensing (QS) is a communication system involved in controlling bacterial fitness, both at population and individual levels. Phages (viruses that infect bacteria) play a major role in the natural regulation of bacterial populations. In order to protect themselves, bacteria have developed several defence mechanisms involving different levels of protection, such as prevention of phage entry and phage assembly, degradation of phage nucleic acids, and entrance in a dormant state (persistence). QS has recently been shown to affect some of these phage defence mechanisms. In this review, the main influence of QS in phage infection is discussed. Finally, some innovative treatment approaches, including using engineered phages harbouring T7aiiA QQ enzyme and QS inhibitors such as SsoPox-W2631 and penicillinic acid, are also considered. However, it is important to note that the use of QS-interfering molecules may also reduce the efficacy of phage therapy.

Conclusion: QS is an important mechanism that affects several bacterial metabolisms, particularly in phage defence. Despite the complex interaction between QS and phages, modifying QS has been found to enhance phage therapy.