European Journal of Clinical Microbiology & Infectious Diseases最新文献

Objectives: Neonatal sepsis is one of the causes of neonatal mortality and bacterial resistance to antibiotics is one of the challenges facing NICU. The aim of this study was to provide a basis for empirical antibiotic selection by comprehensively searching Chinese and non-Chinese databases for studies related to neonatal sepsis pathogenesis conducted in China and synthesizing all the results of the studies conducted in hospitals in China during the period under study METHODS: In this study, we conducted extensive searches of Pubmed, Web of Science, Cochrane, China Biology Medicine disc (SinoMed), China National Knowledge Infrastructure (CNKI) and Wanfang Data. We screened studies published from 2014 to 2023 that were conducted in hospitals in mainland China and involved bacterial blood cultures and susceptibility tests in neonates with neonatal sepsis and extracted the data, which were summarized using Stata 18.0 software to determine the bacterial characteristics of NS and its antimicrobial resistance in China.

Results: A total of 97 articles were finally included in the study, involving 27 provinces, municipalities and autonomous regions, and a total of 18,796 bacterial strains were isolated. Among them, Gram-positive bacteria (G+) accounted for 63.4% (95% CI 59.6%~67.3% ), and Gram-negative bacteria (G-) accounted for 36.6% (95% CI 32.7%~40.4%). The most common bacteria were, in order, Coagulase-negative Staphylococcus (43.6%, 95% CI 37.9-49.3%), Enterobacter (16.4%, 95% CI 14.8-18.1%), and Klebsiella (12.4%, 95% CI 10.8-14.0%). More than 80% of G + were resistant to penicillin, ampicillin, and benzathine, and no strains resistant to minocycline or daptomycin were found. More than 80% of G- were resistant to benzoxicillin, ampicillin, and cefotaxime, and no strains resistant to vancomycin, clindamycin, tigecycline, teicoplanin, and linezolid were identified.

Conclusion: Coagulase-negative Staphylococcus is still the main causative agent for children with neonatal sepsis in China, followed by Enterobacter and Klebsiella. In addition, Group B Streptococcus is no longer in the top three common causative agents. Resistance to penicillin antibiotics is evident among the causative organisms of neonatal sepsis in China.

We describe two cases of uncomplicated pharyngitis caused by hypervirulent Klebsiella pneumoniae (hvKp) in a family, initially in an immunocompetent adolescent, followed by possible household spread resulting in similar presentations in the patient's parent. Genomic analysis confirmed hvKp from the two cases were genetically identical and typed as K2-ST3252. Nasopharyngeal carriage and respiratory secretion/droplet may play an important yet underrecognized role in the transmission of hvKp. Enhancing routine screening for hvKp in the upper respiratory culture, followed by genotyping provides an effective pathway for early diagnosis.

Purpose: To evaluate diagnostic performance of four diagnostic methods for rapid determination of methicillin resistance in S. aureus positive blood cultures (BCs).

Methods: Clinical and spiked BCs were subjected to the evaluation of the following methods and protocols: a. Eazyplex^® MRSA Plus loop-mediated isothermal amplification (LAMP) assay directly from BC fluid; b. MALDI-TOF MS subtyping on BC pellet extracted with Rapid Sepsityper^® protocol and on 4-h short-term subculture; c. Clearview™ Culture Colony PBP2a SA immunochromatography assay on BC pellet and on 4-h short-term subculture; d. EUCAST RAST cefoxitin screen test performed directly from BC and including reading times at 4-h, 6-h and 16-20-h.

Results: Eazyplex^® MRSA plus exhibited the best performance, showing 100% sensitivity, specificity, positive predictive value, and negative predictive value, followed by PBP2a SA Culture Colony Clearview assay and EUCAST RAST cefoxitin screen. MALDI-TOF MS subtyping showed the lowest diagnostic accuracy (59.8 and 65.7% directly from BC and from 4-h subculture, respectively). In detail, sensitivity and specificity ranged from 24.3% to 20.4% and from 88.9% to 98.3% for protocols performed from BC pellet and 4-h subculture, respectively.

Conclusions: The Eazyplex^® MRSA Plus and the immunochromatographic Clearview™ PBP2a SA Culture Colony methods can provide reliable results within 1 h from the start of positive BC processing. MALDI TOF MS subtyping showed unacceptable specificity by performing analysis from BC pellets, while its sensitivity depends on the prevalence of PSM-positive MRSA strains. The EUCAST RAST, based on disc diffusion, showed excellent performance with a time-to-result of at least 4 h.

Introduction: Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising treatment option for Gram-negative infections, particularly those caused by CAZ-Non-Susceptible (NS) pathogens. This systematic review and meta-analysis aim to assess the efficacy and safety of CAZ-AVI in these challenging infections.

Methods: We systematically queried EMBASE, Cochrane CENTRAL, and PubMed/Medline for studies published until September 15, 2024. Randomized Controlled Trials (RCTs) evaluating CAZ-AVI against Gram-negative infections were included. A meta-analysis was performed to calculate pooled odds ratios (OR) for both clinical and microbiological success.

Results: A total of 146 studies were identified through database searches, leading to the inclusion of 17 studies. Among the efficacy studies for Gram-negative pathogens, there was no significant difference in clinical success rates for CAZ-AVI compared to comparators (pooled OR: 0.90, p = 0.22), and a non-significant increase in microbiological success was observed (pooled OR: 1.20, p = 0.41). In contrast, for CAZ-NS pathogens, six studies reported no significant difference in clinical cure rates (pooled OR: 0.77, p = 0.24), while four studies indicated a non-significant increase in microbiological cure rates (pooled OR: 1.83, p < 0.02).

Conclusions: This study suggests that CAZ-AVI is a viable option for treating Gram-negative infections, including CAZ-NS pathogens. While it has shown promising activity against these resistant pathogens, its clinical and microbiological success rates are comparable to other antibiotics in the overall analysis. However, CAZ-AVI may offer an advantage in managing resistant infections. These findings underscore the need to consider CAZ-AVI in treatment guidelines and emphasize the importance of antibiotic stewardship programs to optimize its use and prevent resistance. Ongoing monitoring of resistance patterns and patient outcomes is essential to ensure its long-term efficacy.

Purpose: Infective endocarditis (IE) can be complicated by vertebral osteomyelitis (VO). This study investigates risk factors associated with VO in patients with infective endocarditis, and 6-month mortality and relapse rates in patients with IE and concomitant VO.

Methods: We performed a observational study in two hospitals between September 2016 and October 2022. Patients with possible or definite IE according European Society of Cardiology (2015) modified criteria were retrieved from the local endocarditis team registries. The VO diagnosis was based on radiological signs, irrespective of clinical symptoms. Multivariable logistic regression analysis was performed to identify risk factors for vertebral osteomyelitis.

Results: We included 633 consecutive patients with IE. A total of 229 (36.2%) patients had prosthetic valves and 127 (20.1%) had cardiac implantable electronic devices. The most frequent causative micro-organism was Streptococcus species (217, 34.3%), followed by Staphylococcus aureus (167, 26.4%). VO was diagnosed in 73 patients (11.5%, 95% CI 9.0%-14.0%). Enterococcus spp.(OR 2.48, 95% CI 1.31-4.52) and age (OR 1.04 per year, 95% CI 1.02-1.06) were independently associated with concomitant VO. The 6-month mortality risk did not differ between patients with (16/73, 21.9%) or without (110/560, 19.6%) VO (HR 1.13, 95% CI 0.67-1.91). Relapse rate was higher in patients with VO but the difference was not statistically significant (16.1 vs. 7.5%, OR 3.62, 95% CI 0.94-13.34).

Conclusions: Twelve percent of patients with IE also had VO. Among older patients and patients with IE caused by enterococci, there should be a higher index of suspicion for vertebral infection.

Purpose: To prospectively monitor the evolution of the resistome of OXA-48-producing Klebsiella species in a patient with long-term colonization, with a particular focus into the plasmid dynamics and the evolution of ceftazidime/avibactam resistance.

Methods: All OXA-48-producing Klebsiella spp. isolates from a single patient admitted to a hospital during seven months were prospectively collected. MICs were determined through reference broth microdilution. Multilocus sequence types, SNPs analysis, resistance mechanisms, genetic context of β-lactamases and plasmid dynamics were determined by WGS and bioinformatic analysis. The impact of β-lactamase variant obtained after ceftazidime/avibactam exposure was determined via cloning experiments.

Results: Four isolates, two before (one OXA-48-producing K. pneumoniae and one CTX-M-15-like-producing K. pneumoniae) and two after treatment with ceftazidime/avibactam (one OXA-48- and CTX-M-15-like-producing K. pneumoniae and one OXA-48- and CTX-M-15-like-producing K. aerogenes) were collected. The plasmid dynamics analysis demonstrated that the IncL and IncFIIK plasmids, in which bla_OXA-48 and bla_{CTX-M-15-like} genes were located, respectively, exhibited a high degree of conservation indicating a potential for both intra- and interspecies transmission. The K. pneumoniae isolate obtained after treatment, which differed from the previous isolate by just six SNPs, exhibited resistance to ceftazidime/avibactam through P167S substitution in CTX-M-15, which is now designated CTX-M-273. Cloning experiments demonstrated enhanced resistance to ceftazidime/avibactam.

Conclusion: The transfer of plasmid-borne β-lactamase resistance genes between intra- and interspecies bacterial populations enables the rapid diversification of the bacterial genome. The emergence of ceftazidime/avibactam resistance through the modification of CTX-M-enzymes represents a mechanism by which OXA-48-producing Enterobacterales may evolve toward ceftazidime/avibactam resistance in vivo.

Purpose: The aim is to encourage the creation of innovative prevention and treatment measures and to help readers in selecting the most effective ones.

Background: Acne vulgaris is the most prevalent skin condition of adolescents, affecting approximately 9% of the global population. Patients become more prone to mental and psychological problems because of it. Several strategies have been established to effectively improve acne vulgaris. However, the complexity of its pathogenesis and the limitations of the existing strategies to control it in terms of bacterial resistance, patient compliance, and safety have made the development of new control strategies a hot topic in skin health research.

Results: This review systematically summarizes the pathogenesis and prevention strategies of acne vulgaris according to the most recent studies. The limitations of the current research on acne vulgaris and future research directions are presented based on the analysis of the strengths and weaknesses of the existing prevention and treatment strategies.

This study aimed to standardize qPCR techniques using these molecular markers kDNA and 18S rDNA across three sample types: peripheral blood, guanidine-treated blood, and tissue. The secondary objective is to evaluate the performance of 18S rDNA target in samples from 46 patients with confirmed tegumentary leishmaniasis. After obtaining the standard curve from reference strains with Leishmania, qPCR curves were standardizations and the Cts results of the patient samples were described using abstract measures. Specific specification equations (EEG) with normal distribution and identity link function were constructed to compare each type of clinical sample. To identify the differences among samples and techniques, multiple comparisons with Bonferroni post-test was performed. The kDNA and 18S rDNA demonstrated high sensitivity, detecting as few as 10⁻¹ parasites/mL. However, 18S rDNA showed limited species discrimination. qPCR performance was evaluated using blood and tissue samples, showing a sensitivity of 54.2% in blood, 12.5% in guanidine-treated blood, and 86.4% in tissue. qPCR agreement with the 18S rDNA target with the three types of samples, positive and negative, in relation to screening were 56.2% in blood, 31.8% in guanidine- blood and tissue 78.6%. As for true positives (PPV), tissue samples presented a probability percentage of individuals being sick of 86.4%, while in blood it was 81.3%. The results underscore the importance of molecular diagnostics in blood samples, improving the accuracy and monitoring of tegumentary leishmaniasis.

Purpose: We designed and tested a point of care test panel to detect E.coli and antibiotic susceptibility in urine samples from patients at the point of care in the urological department. The aim of this approach is to facilitate choosing an appropriate antibiotic for urinary tract infections (UTI) at first presentation in the context of increasing antibiotic resistance in uropathogens worldwide.

Methods: We analyzed 162 E.coli isolates from samples from a university urological department to determine phenotypic and genotypic resistance data. With this data we created customized LAMP (loop-mediated isothermal amplification) panels for a commercial machine with which to detect and possibly quantify E.coli and six antibiotic resistance determinants. In a second step we tested these panel(s) for diagnostic accuracy on 1596 urine samples and compared with routine microbiological culture.

Results: E.coli was detected with 95.4% sensitivity and 96.1% specificity. Dynamics of the LAMP amplification could be used to gauge bacterial loads in the samples. Antibiotic sensitivity was detected with good negative (sensitive) predictive values: ampicillin 92.8%, ampicillin/sulbactam 96.4%, cefuroxime 92.8%, cefotaxime 97.8%, trimethoprim/sulfamethoxazole 96.5%, ciprofloxacin 96.8%.

Conclusion: The LAMP panel provided E.coli detection and sensitivity information within one hour and thus could principally guide initial antibiotic therapy upon patients presenting with UTI. The panel helps to select initial adequate antibiotic therapy as well as providing diagnostic stewardship. Follow up investigations will expand the test system to other uropathogens.

The increasing threat of antimicrobial resistance has prompted a need for more effective antimicrobial stewardship programs (AMS). Artificial intelligence (AI) and machine learning (ML) tools have emerged as potential solutions to enhance decision-making and improve patient outcomes in AMS. This systematic review and meta-analysis aims to evaluate the impact of AI in AMS and to assess its predictive performance and diagnostic accuracy. We conducted a comprehensive literature search across PubMed/MEDLINE, Scopus, EMBASE, and Web of Science to identify studies published up to July 2024. Studies included were observational, cohort, or retrospective, focusing on the application of AI/ML in AMS. The outcomes assessed were the area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We calculated the mean pooled effect size (ES) and its 95% confidence interval (CI) using a random-effects model. The risk of bias was assessed using the QUADAS-AI tool, and the protocol was registered in PROSPERO. Out of 3,458 retrieved articles, 80 studies met the inclusion criteria. Our meta-analysis demonstrated that ML models exhibited strong predictive performance and diagnostic accuracy, with the following results: AUC [ES: 72.28 (70.42-74.14)], accuracy [ES: 74.97 (73.35-76.58)], sensitivity [ES: 76.89; (71.90-81.89)], specificity [ES: 73.77; (67.87-79.67)], NPV [ES:79.92 (76.54-83.31)], and PPV [ES: 69.41 (60.19-78.63)] across various AMS settings. AI and ML tools offer promising enhancements due to their strong predictive performance. The integration of AI into AMS could lead to more precise antimicrobial prescribing, reduced antimicrobial resistance, and better resource utilization.