European Journal of Clinical Microbiology & Infectious Diseases最新文献

Purpose: We recently demonstrated the utility of the 'TB Concentration & Transport' kit for bio-safe, ambient-temperature transport of dried sputum samples on Trans-Filter, along with the 'TB DNA Extraction' kit for efficient DNA extraction from Trans-Filter for use in the Line Probe Assay (LPA) for diagnosing drug-resistant tuberculosis (TB). The present study aimed to develop and evaluate a new 'Quick TB DNA Extraction' kit ('Quick DNA' kit) for rapid DNA isolation from Trans-Filter samples and assess its compatibility with LPA for the detection of multidrug-resistant TB (MDR-TB).

Methods: Consecutive presumptive TB/MDR-TB/XDR-TB patients (n = 1823) were screened using LED-FM and/or TBDetect microscopy at 2 Designated Microscopy Centres associated with the National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi. Smear-positive samples (n = 235) were processed in duplicate using the 'TB Concentration and Transport' kit. Dried sputum on bio-safe Trans-Filters was transported at ambient temperature, along with sputum samples, in a 3-layer packing in cooling conditions to NITRD Hospital (a National Reference Laboratory). DNA was extracted from Trans-Filters using 'Quick DNA' kit and the 'TB DNA Extraction' kit, and from sputum using Hain's GenoLyse® DNA Extraction kit for first-line LPA for MDR-TB detection.

Results: Quick Kit-LPA and Kit-LPA (LPA with DNA extracted from Trans-Filter using 'Quick DNA' kit and 'TB DNA Extraction' kit, respectively) showed similar sensitivity of 88.9% (95% CI: 65.3-98.6) and 88.5% (95% CI: 69.9-97.5) and specificity of 100% (95% CI: 98.2-100) and 99.5% (95% CI: 97.3-99.9) for rifampicin and isoniazid resistance detection, respectively against Direct-LPA (LPA with DNA extracted from sputum samples using GenoLyse kit). User feedback obtained from laboratory technicians corroborated that the one-step 'Quick DNA' kit procedure was rapid (5 minutes), easy to perform, seamlessly integrated with LPA testing, and was suitable as a replacement for Kit-LPA or Direct-LPA.

- , conclusion: The gap between drug-resistant TB detection and treatment initiation can be narrowed through Universal-Drug Susceptibility Testing by implementing (i) bio-safe and ambient temperature transport of sputum from primary healthcare centres to central laboratories, and (ii) by using Quick Kit-LPA over Direct-LPA in patients residing in remote areas.

To explore the molecular characteristics of Neisseria meningitidis carried by healthy individuals in Meigu County, Liangshan Yi Autonomous Prefecture, Sichuan Province, and to provide scientific evidence for preventing and controlling epidemic meningitis, this study analyzed 240 N. meningitidis isolates collected from 2021 to 2024. PCR-based genogrouping and second-generation whole-genome sequencing (WGS) were performed. The results showed that genogroup B was the most common, accounting for 65%. Multilocus Sequence Typing(MLST) analysis identified 78 sequence types(STs), with ST-18,628 and ST-2146 being the most frequent. Notably, 41% of the STs (ST-18,620 to ST-18,856) were newly identified. While 29 STs were allocated to six known clonal complexes, 49 STs couldn't be assigned to any. Genogroup B N. meningitidis (MenB) isolates showed high heterogeneity and the most common clonal complexes were CC4821, CC175, CC198. The NG N. meningitidis isolates were predominately CC198, CC4821, CC5. Genogroup W N. meningitidis (MenW) isolates were predominately CC4821. Genogroup Y N. meningitidis (MenY) isolates were belonged to CC175.Three AMR genes were detected, with mtrC and mtrD having the highest detection rate. Also, sixty-eight virulence genes were found. Core genome SNP analysis indicated same-year isolates clustered phylogenetically. In conclusion, the N. meningitidis isolates in Meigu County have diverse virulence genes and a high rate of novel STs, showing a regional epidemic trend, and continuous monitoring is necessary.

Introduction: The efficacy and safety of high-dose rifampicin in patients with tuberculous meningitis (TBM) remain uncertain.

Method: A comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Database was conducted to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of high-dose rifampicin treatment in patients with TBM, up to October 8, 2024. The primary outcome was all-cause mortality at the longest follow-up period reported by individual trials, while the secondary outcome was the incidence of serious adverse events. We applied a random-effects model and calculated risk ratios (RR) with 95% confidence intervals (CIs) of pooled outcomes.

Result: Seven RCTs involving 1,296 TBM patients were included. High-dose rifampicin did not reduce all-cause mortality (RR = 0.88, 95% CI: 0.55-1.43,P= 0.61). Similarly, it was not associated with a reduction in serious adverse events (RR = 0.96, 95% CI: 0.62-1.50,P= 0.87).

Conclusion: This meta-analysis of seven RCTs involving 1,296 patients with TBM found that high-dose rifampicin treatment neither significantly reduced all-cause mortality nor decreased serious adverse events.

We evaluated in vitro activity of sulbactam/durlobactam in combination with different antimicrobials against Carbapenem-Resistant Acinetobacter baumannii (CRAB) clinical isolates with different susceptibility profiles, including sulbactam/durlobactam-resistant strains. The genomes of 13 CRAB clinical isolates were characterized by whole-genome sequencing and synergy testing was performed with MIC Test Strips. Sulbactam/durlobactam, when combined with piperacillin/tazobactam or ceftazidime/avibactam, showed synergistic activity against 53.8% (7/13) of CRAB isolates and restored meropenem MIC values below the clinical breakpoint in 46.2% (6/13) of them. Our results demonstrate that sulbactam-durlobactam in combination with β-lactams exhibited high in vitro synergistic activity against CRAB strains.

Purpose: This study aims to investigate the effect of seasonal influenza vaccination on hospitalization rates among patients presenting to the emergency department with influenza-like illness.

Methods: A retrospective, single-center observational study was conducted, involving adult patients with influenza (ICD-10 codes J10 and J11) diagnosed in the emergency department between May 2024 and April 2025. Clinical and demographic information was collected from electronic records, and vaccination status was confirmed through follow-up phone calls. To tackle the "zero event" problem-no hospitalizations among vaccinated individuals-advanced statistical modeling was employed, including standard logistic regression, and Bayesian logistic regression using Markov Chain Monte Carlo (MCMC) simulations. Odds ratios (OR) and 95% Highest Density Intervals (HDI) were calculated to assess the effectiveness of vaccination.

Results: A total of 878 patients were enrolled: 3.3% (n = 29) received vaccinations, while 2.7% (n = 24) required hospitalization. None of the vaccine recipients were hospitalized. Standard logistic regression indicated that age was a significant indicator of hospitalization. Furthermore, Bayesian logistic regression followed, which confirmed vaccination's statistically significant protective effect. The OR for vaccination was 0.526 (95% HDI: 0.336-0.739), indicating a 47% reduction in hospitalization risk among vaccinated individuals.

Conclusion: Seasonal influenza vaccination was significantly associated with a lower risk of hospitalization in patients presenting with influenza-like illness to the emergency department. These findings support public health initiatives to enhance influenza vaccine coverage, particularly for the elderly.

Purpose: Systematic collection and analysis of antimicrobial resistance data from key bacterial pathogens is essential to contribute to control antimicrobial resistance (AMR). The aim of this work was to survey the drug resistance on clinically relevant organisms stratified according to age, gender, clinical specimens and facilities.

Methods: Microbiological data were collected from 55 centers across 24 states in Mexico between January 1 and March 31, 2025. Bacterial identification and antimicrobial susceptibility testing were performed at each participating center using locally available methods. Data was processed using WHONET 2025. Isolates obtained from lower respiratory specimens, urine, blood, biopsies and abscesses were analyzed. Carbapenem non-susceptible isolates were further analyzed by PCR for common carbapenemase-encoding genes. Resistance frequencies were compared using the chi-square test.

Results: A total of 11,290 clinical isolates were analyzed, mostly from urine (n = 7,149; 63.3%), followed by blood (n = 1,370; 12.1%). The most prevalent was Escherichia coli (n = 6,185; 54.8%), followed by Klebsiella pneumoniae (n = 1,365; 12.1%) and Pseudomonas aeruginosa (n = 1,110; 9.8%). Resistance to carbapenems in E. coli was higher in respiratory isolates (imipenem: 5.8%, p = 0.016; meropenem: 5.3%, p < 0.001), with 75.9% producing extended-spectrum ß-lactamases (ESBLs). K. pneumoniae had the highest resistance to ampicillin/sulbactam (52.5%, p = 0.028) and sulfamethoxazole/trimethoprim (62.1%, p = 0.014) in blood isolates, and 63.2% were ESBL-producers (p = 0.001). In P. aeruginosa, urine isolates showed significantly higher resistance to ceftolozane-tazobactam (24.7%, p = 0.008), ceftazidime-avibactam (36.6%, p < 0.001), and meropenem (34.5%, p = 0.009) compared to other clinical specimens included. For A. baumannii, respiratory isolates had 73.6% resistance to meropenem (p < 0.001). S. aureus from blood showed 25.7% resistance to oxacillin (p < 0.004). The most frequent carbapenemase genes were bla_OXA-48-like in E. coli (26/56, 46.4%), bla_NDM for K. pneumoniae (7/17, 41.2%), bla_OXA-24 in A. baumannii (79/108, 73.1%) and bla_IMP for P. aeruginosa (18/108, 16.7%).

Conclusion: This surveillance study underscores the elevated levels of antimicrobial resistance, ESBL production, and carbapenemase activity among priority pathogens, including some Enterobacterales, P. aeruginosa, and A. baumannii. These findings emphasize the urgent need to strengthen epidemiologic surveillance programs in Mexican healthcare settings.

Purpose: Escherichia coli (E.coli) represents the predominant Gram-negative bacterial causing bloodstream infection (BSI) in patients with acute leukemia (AL). This study sought to determine the risk factors for antibiotic-resistant E.coli strains and for 30-day mortality in this specific patient cohort.

Methods: This retrospective study enrolled adult patients with AL and E.coli BSI hospitalized between January 2017 and December 2023 at Fujian Medical University Union Hospital. Risk factors for antibiotic-resistant E.coli and for 30-day mortality were identified using multivariate logistic regression and Cox proportional hazards regression, respectively, while the Kaplan-Meier method was employed to plot survival curves.

Results: This study included 127 patients with AL and E.coli BSI. The rates of ESBL-producing E.coli (ESBL-E.coli) and carbapenem-resistant (CR) E.coli were 7.9% and 54.3%, respectively. Multivariate analysis identified prior cephalosporins use as an independent predictor for ESBL-E.coli BSI. The 30-day mortality rate of patients with AL and E.coli BSI was 17.3%. Age, pulmonary infections, CR E.coli, ESBL-E.coli, and inappropriate empirical therapy exhibited higher 30-day mortality rates. Nevertheless, only pulmonary infection and inappropriate empirical therapy were independent risk factors. Consequently, patients with pulmonary infection or receiving inappropriate empirical therapy had a worse prognosis.

Conclusions: Prior cephalosporins use independently increased the risk of developing ESBL-E.coli. 30-day mortality was independently associated with pulmonary infections and inappropriate empirical therapy. Thus, prompt initiation of appropriate antimicrobial therapy and prevention of pulmonary infection are essential in patients with AL and E.coli BSI.

Oritavancin is a long-acting lipoglycopeptide with excellent bone penetration and activity against biofilm-embedded bacteria, making it a promising candidate for the treatment of bone and joint infections (BJIs). To explore its potential in this clinical context, we assessed the in vitro activity of oritavancin in comparison with other glyco-, lipo- and glycolipo-peptides against a panel of 148 multidrug-resistant staphylococcal clinical isolates, mainly collected from BJI cases. Although oritavancin showed lower overall activity than dalbavancin, resistance to oritavancin could not be reliably inferred from the activity of related antibiotics. This lack of cross-resistance highlights the need for dedicated phenotypic susceptibility testing prior to clinical use.