European Journal of Clinical Microbiology & Infectious Diseases最新文献

Purpose: To develop a machine learning-based clinical prediction model for macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in children, facilitating early identification of resistant cases and guiding targeted therapeutic interventions.

Methods: In this retrospective, single-center study, we developed a stacking ensemble prediction model using demographic, laboratory, and inflammatory data from pediatric patients with MPP. A feature selection protocol was implemented to identify key predictors. The final model was validated using both internal cross-validation and an independent external temporal cohort. Model interpretability was assessed using SHapley Additive exPlanations (SHAP).

Results: The stacking ensemble model achieved an area under the curve (AUC) of 0.857 during internal validation, with a sensitivity of 0.769 and specificity of 0.841; the AUC during external validation was 0.812. Key predictive factors included interleukin-17 A (IL-17 A), interferon-gamma (IFN-γ), C-reactive protein (CRP), albumin-to-globulin ratio (A/G), History of pre-hospital macrolide use, and Pre-hospital course. The model is implemented as a web tool, facilitating rapid assessment of resistance risk.

Conclusion: The machine learning model developed in this study can initially identify children at high risk for MRMPP, serving as a data-driven decision-making tool for the rational use of antibiotics in clinical practice and demonstrating significant clinical translational value.

Objective: To investigate the pathogens and clinical characteristics of necrotizing pneumonia (NP) in our hospital from January 2019 to June 2025.

Methods: We retrospectively analyzed the clinical data of children with NP. Patients were divided into a single- bronchoalveolar lavage (BAL) group and a multiple-BAL group. Pathogens and clinical characteristics were compared between the two groups.

Results: This study included 365 patients with NP, 193 of whom were males. The incidence of NP significantly increased in 2023-2024. The pathogen identification rate was 98.36%, with Mycoplasma pneumoniae (MP) being the most commonly pathogen (91.00%). There were 138 cases of mixed infection and 227 cases of single infection. The 335 cases underwent BAL, with 139 cases assigned to the single-BAL group. Follow-up within 6 months after discharge was conducted for 238 patients, and the majority exhibited a favorable prognosis. No statistical differences were observed between the two groups regarding gender, age, time from onset to diagnosis, or duration of fever. However, a significant difference was noted in the length of hospital stay (P < 0.05). The infection rate of MP in the single-BAL group was lower than that in the multiple-BAL group (P < 0.05).

Conclusion: The incidence of NP significantly increased in 2023-2024, with MP as the predominant pathogen. Children with NP present with severe clinical symptoms, a prolonged disease course, and significantly elevated inflammatory markers. Most NP patients have a favorable prognosis. Patients requiring multiple BAL procedures demonstrate a higher MP infection rate.

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.

Purpose: To identify predictors of hospital readmissions within 30 days after discharge following a bloodstream infection (BSI).

Methods: Population-based study of 30,843 patients surviving after their first BSI episode, 2007-2016. Using multivariate competing risk regression analyses, we estimated subhazard ratios (sHRs) and 95% confidence intervals (CIs) for all-cause, infection-related, and unplanned readmissions. Predictors included sex, age, comorbidities, causative microorganisms, length of stay (LOS), and prior hospital admissions.

Results: Within 30 days of discharge, 9655 patients (31.3%) were readmitted of which 3333 (34.5%) were infection-related and 7725 (80.0%) unplanned. Higher risks of all-cause readmissions were observed for males (sHR [95% CI]: 1.07 [1.03-1.12]), those aged 0-15 years (1.41 [1.26-1.58]), and patients with several comorbidities, especially malignancies and liver diseases (sHR 1.26-2.09). BSIs caused by most microorganisms other than Escherichia coli also predicted an increased readmission risk (sHR 1.11-1.39). LOS in the first, third, and fourth quartiles also predicted a higher readmission risk (sHR 1.26, 1.14, and 1.25, respectively). Patients with prior hospitalization also had a higher readmission risk, within 31-365 (sHR 1.22 [1.16-1.28]) and 1-30 days (1.70 [1.61-1.79]). Results were similar for unplanned readmissions. For infection-related readmissions, only LOS in the first quartile (1-5 days) was associated with a higher readmission risk (1.67 [1.52-1.85]). Over the study period, the median LOS decreased, whereas readmission rates increased.

Conclusion: Nearly one-third of patients discharged alive after a BSI were readmitted within 30 days. Further studies are needed to determine whether some of these readmissions may be avoidable.

Purpose: International guidelines recommend invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) before surgery for infective endocarditis (IE). Given the low level of evidence for this recommendation, we aimed to assess the impact of coronary evaluation in this context.

Methods: This multicenter retrospective study included adult patients diagnosed with IE who underwent cardiac surgery, and whose coronary status was considered unknown at the time of IE diagnosis. Patients were divided in two groups: those who underwent a coronary evaluation (C group) and those who did not (NC group). The primary endpoint was to determine the prevalence of coronary evaluation during the preoperative workup for IE. Secondary endpoints included the safety of coronary evaluation, the prevalence of coronary revascularization, and the one-year post-operative prognosis.

Results: 323 patients were included, with 43% in the NC group and 57% in the C group (ICA for 149 patients, CCTA for 35 patients). Coronary evaluation found no lesion, non-significant coronary artery disease (CAD), and significant CAD in 51.1%, 28.8%, and 20.1% of cases, respectively. Thirteen patients underwent coronary artery bypass graft during the IE surgery. Tolerability of ICA was excellent: no embolic events and no additional renal toxicity.

Conclusion: While coronary evaluation was recommended for almost all patients, it was only performed in just over half of the cases. Preoperative coronary assessment remains useful and safe, but should probably not delay urgent valvular surgery.

Purpose: To investigate the pharmacokinetics (PK) of ceftazidime/avibactam and optimize dosing regimens in patients with severe intra-abdominal infection (sIAI) receiving continuous veno-venous hemofiltration (CVVH).

Methods: Seven patients with sIAI treated with ceftazidime/avibactam and CVVH were enrolled. Blood samples were collected at pre-dose and post-dose (2, 3, 4, 6, and 8 h) during hemodynamic stability. Plasma concentrations were measured, and PK parameters were calculated. Monte Carlo simulations (MCSs) were used to assess the probability of target attainment (PTA) and cumulative fraction of response (CFR) for different dosing regimens.

Results: CVVH increased the clearance (CL) significantly (ceftazidime: 2.46 ± 0.29 vs. 0.9 ± 0.11 L/h; avibactam: 2.89 ± 0.41 vs. 1.09 ± 0.08 L/h, p < 0.001). For the target of 100%fT ≥ MIC (ceftazidime) + 100%fT ≥ C_{T = 1.0 mg/L} (avibactam), during CVVH, PTA > 90% at MIC ≤ 8 mg/L. Outside CVVH, PTA > 90% at MIC ≤ 16 mg/L, and only 3000 mg + 750 mg q8h achieved PTA > 90% at MIC = 64 mg/L. For the target of 100%fT ≥ 4× MIC + 100%fT ≥ C_{T = 4.0 mg/L}, during CVVH, PTA > 90% at MIC ≤ 2 mg/L. Outside CVVH, PTA > 90% at MIC ≤ 4 mg/L, and only 3000 mg + 750 mg q8h achieved PTA > 90% at MIC = 16 mg/L. No regimen met the optimal dosing criteria for this target.

Conclusion: CVVH enhanced the CL significantly. Dosing should be "individualized" based on the MIC and patient-specific factors.

Purpose: Mycoplasma pneumoniae, a globally prevalent cause of community-acquired pneumonia in children and young adults, is typically diagnosed using molecular methods, including DNA- or RNA-based nucleic acid amplification tests (NAATs). While RNA-based NAAT is considered to reflect the viability and replication status of M. pneumoniae, a direct comparison of the clinical performance between DNA- and RNA-based NAATs has been lacking. This study aimed to compare these NAATs in clinical pediatric M. pneumoniae samples and elucidate the reasons for their differential detection outcomes.

Methods: This study analyzed clinical M. pneumoniae samples from pediatric patients across different sample types, seasons, age, and sex subgroups between January and December 2018. The underlying reasons for their differential detection outcomes were further elucidated through in vitro culture and cell infection models.

Results: A total of 3180 clinical samples were analyzed. The performance of DNA- and RNA-based NAATs showed specific disparities, particularly associated with sample type and patient age, but not with sampling season or patient sex. In vitro experiments revealed that M. pneumoniae-RNA (MP-RNA) has higher synthesis and degradation rates, whereas M. pneumoniae-DNA (MP-DNA) accumulates and is sustained longer in the growth dynamics of the pathogen.

Conclusion: The differential nucleic acid kinetics of M. pneumoniae across respiratory microenvironments likely explain the observed variations in clinical detection. These findings may enable evidence-based selection of DNA- or RNA-based NAATs according to patient age and sample type, thereby improving the reliable detection of M. pneumoniae in children.