European Journal of Clinical Microbiology & Infectious Diseases最新文献

Objective: We aimed to investigate the impact of our institutional sepsis protocol on the empirical treatment of carbapenem-resistant Gram-negative bacteria in a setting where infectious disease consultation (ID) is available 7 days / 24 h and broad-spectrum antibiotic use requires ID approval.

Methods: A total of 612 patients (168 patients pre-guideline, 444 patients post-guideline) who received empirical antibiotics for suspicion of sepsis before documentation of antibacterial susceptibility were included. Demographic, clinical and microbiological data were collected from the hospital's electronic medical record system, retrospectively. Compliance with institutional guidelines and the rate of appropriate antibiotic use prior to the availability of antibiograms were assessed.

Results: There was a statistically significant increase in the utilization rate of empirical antibacterial treatment based on pre-defined risk factors of multidrug resistance [OR (95% CI) 1.73 (1.21-2.48), p = 0.003]. Furthermore, appropriateness of the initial antibacterial treatment according to the antibiogram results increased significantly in the post-guideline period [OR (95% CI) = 3.25 (2.09-5.06), p < 0.001]. The rate of compliance with guideline recommendations (p = 0.004) and the rate of appropriate empirical antibiotic treatment (p < 0.001) by each year were significant when compared with the pre-guideline period. Also, practices that improve drug pharmacokinetics such as loading dose, prolonged infusion of meropenem and adjusting antibiotic doses according to renal function increased statistically after the release of guideline.

Conclusion: An institutional sepsis protocol based on risk factors for multidrug resistance and local epidemiology increased the rate of appropriate empirical antibiotic treatment even in a setting where ID consultation is readily available.

Acinetobacter baumannii is a multidrug-resistant (MDR) pathogen increasingly detected in livestock and food products, raising concerns about zoonotic transmission. This study characterized A. baumannii isolates from retail meat sources in India, assessing their genomic diversity, antimicrobial resistance (AMR), virulence factors (VFs), and mobile genetic elements (MGEs). Nine A. baumannii isolates from chicken, buffalo, pork, mutton, and prawn were identified via CHROMagar™, biochemical tests, BD Phoenix™ M50, and rpoB PCR. Antibiotic susceptibility was determined using MIC assays. Whole-genome sequencing (WGS) was performed, followed by phylogenetic, resistome, virulome, and mobilome analyses with global animal, avian and meat isolates. All nine isolates exhibited resistance to β-lactams (amoxicillin-clavulanic acid, ampicillin, aztreonam, cefazolin, cefoxitin) but remained susceptible to tetracycline, amikacin, ciprofloxacin, and carbapenems. Genomic analysis revealed 3.67-3.9 Mbp genomes with 27-49 contigs, harboring 17-22 AMR genes per isolate. Global phylogenetic analysis identified two major clades with host- and country-specific clustering (e.g., ST-1512-OCL2-KL9 in Indian retail chicken, ST-25-OCL6-KL14 in French companion animals). Core VFs included biofilm formation (ompA, csuA-E, pgaA-D), iron acquisition (basA-J, bauA-F), and LPS biosynthesis genes. Plasmid prediction identified 242 plasmids (55 conjugative, 32 mobilizable), with 112 carrying AMR genes (AAC, APH, sul2, tet(B)). MGEs (IS, Tn, ICE) were linked to bla_OXA-23, bla_NDM-1, and aminoglycoside resistance genes. Capsular (KL) and lipooligosaccharide (OCL) loci showed geographic and host-specific distributions (e.g., KL14-OCL6 in France, KL19-OCL1 in UK livestock). Retail meat serves as a reservoir for MDR A. baumannii, with genomic features mirroring clinical strains. The presence of high-risk clones (IC-2, IC-5), carbapenem resistance genes (bla_OXA-23, bla_NDM-1), and mobilizable AMR plasmids underscores the risk of zoonotic transmission. A One Health approach integrating WGS-based surveillance is critical to mitigate the spread of AMR A. baumannii through food chains.

Purpose: We aimed to investigate the incidence and clinical features of Streptococcus dysgalactiae peripartum infections (SDPI), and to investigate the distribution of emm-types in relation to disease severity and the genetic relatedness of isolates from hospital clusters.

Materials and methods: Patients with growth of S. dysgalactiae in a genital or wound culture, collected between January 2014 and September 2020 at departments for gynecology and obstetrics, were identified. For inclusion, patients had to be pregnant, or given birth, or undergone an abortion within 42 days prior to debut of symptoms. All isolates had previously been emm-typed. A cluster was defined as two or more patients with S. dysgalactiae of the same emm-type admitted to the same hospital within a 30-day period. The cluster isolates were subjected to whole genome sequencing (WGS).

Results: The final study cohort comprised 130 patients. The incidence of S. dysgalactiae postpartum infection was approximately 1 case/1000 births. The patients fulfilled criteria for endometritis (n = 94), postpartum fever (n = 15), wound infection (n = 8) or chorioamnionitis (n = 4). Most patients with endometritis (87%) had onset of symptoms > 48 h post-partum. The most common emm-type was stG62647 (n = 41). Thirteen hospital clusters were identified, of which only three had bacterial isolates that were closely genetically related (0-6 SNP).

Conclusion: Our findings demonstrate that SDPI impact a relatively large number of patients. No patient was critically ill, but the morbidity appeared to be substantial. Hospital outbreaks of SDPI are rare, but when suspected, WGS should be employed to investigate relatedness between isolates.

Facing challenges in the fields of microbial detection and antimicrobial resistance (AMR) monitoring, the scientific community is opening new research avenues with the help of cutting-edge technologies such as molecular biology, genomics, proteomics, nanotechnology, and bioinformatics. In this review, we comprehensively collate and elaborate on revolutionary detection methods and AMR surveillance strategies that go beyond traditional microbial culture techniques. These innovative methods have not only improved the sensitivity and speed of detection but also broadened our understanding of the microbial world, providing new weapons in the fight against drug-resistant microorganisms. Through the integration and innovation of interdisciplinary approaches, we are gradually constructing a more precise, efficient, and comprehensive new paradigm for microbial detection and AMR testing.

Chlamydia trachomatis (CT) infections in children present distinct diagnostic challenges, ranging from perinatal conjunctivitis and pneumonia to trachoma and, in older children, sexually transmitted infections. This review systematically evaluates contemporary laboratory methods for detecting CT in children. The methods are categorized by their distinct targets, beginning with morphological identification via stains (e.g., Giemsa, immunofluorescence) with or without culture; followed by immunological detection of antigens or antibodies (e.g., ELISA); and finally, molecular analysis using NAATs for DNA or RT-PCR for RNA. Each technique is rigorously examined based on analytical sensitivity, specificity, turnaround time, and technical requirements, with particular emphasis on age-specific specimen selection, sampling logistics, and ethical-legal considerations-especially in cases of suspected abuse. Our analysis confirms that NAATs, particularly real-time PCR, are the first-line diagnostic choice for their superior sensitivity in detecting asymptomatic and low-bacterial-load infections in children. RNA-based detection is highlighted as the preferred method for treatment monitoring due to its ability to differentiate viable pathogens. In resource-limited settings, rapid antigen tests offer a practical screening solution, though require NAAT confirmation. The review also discusses emerging technologies, including isothermal amplification and biosensors, for point-of-care (POC) testing. By synthesizing current evidence with pediatric-specific guidelines from the CDC, WHO, and European health authorities, this review aims to establish an evidence-based framework to guide optimal test selection, improve early detection, and inform public health strategies to reduce the CT disease burden in children.

Purpose: To examine the incidence, clinical characteristics, and outcomes of pyogenic liver abscess (PLA) in a population-based cohort.

Methods: We conducted a population-based cohort study of patients diagnosed with PLA in the North Denmark Region from 2010 to 2022. Cases were identified using ICD-10 discharge code (K75.0) and/or microbiology samples, followed by medical record review. We estimated incidence rates, 30-day mortality, and used Cox regression to estimate hazard ratios (HRs) for all-cause mortality within 365 days, stratified by clinical and microbiological factors.

Results: We identified 249 patients (56% male) with a median age of 68 years (IQR, 59-77). The mean annual incidence was 3.1 per 100,000 person-years, increasing from 2.9 in 2010 to 4.8 in 2022. The most common symptoms were fever (57%) and abdominal pain (48%). Biliary tract disease was the most frequent source, accounting for 35%, while 31% were cryptogenic. A microbiological diagnosis was established in 171 patients (69%), most often isolating Escherichia coli and Streptococcus anginosus group. Drainage was performed in 73% of cases, and piperacillin/tazobactam was the most used intravenous antibiotic. The 30-day mortality was 5%, rising to 22% at one year. In multivariable analysis, malignancy (HR 3.19, 95% CI: 1.30-7.82) and polymicrobial abscess cultures (HR 4.15, 95% CI: 1.23-14.07) were associated with increased 365-day all-cause mortality. In contrast, drainage, infected cysts, multifocal abscesses, and blood culture positivity were not.

Conclusion: PLA incidence increased over the study period. While short-term mortality was low, one-year mortality was high among patients with malignancy or polymicrobial infection.

Increased antibiotic resistance highlights the need for new, rapid antibiotic susceptibility tests to guide therapy, especially in critical disease such as bloodstream infections and sepsis. This study investigates a new ultra-rapid AST system in multiple clinical laboratories, with respect to accuracy, speed and turnaround time in comparison to commonly used AST systems. The QuickMIC system is compared to the commonly used automated AST systems BD Phoenix™ (BD, USA), MicroScan WalkAway plus (Beckman Coulter, USA) and VITEK^® 2 (bioMérieux, France) by concurrent testing of incoming positive blood-cultures with Gram-negative bacteria in four clinical laboratories located in the EU and USA, on the basis of agreement of results, time-to-result (TTR, analysis time) and turnaround time (TAT, time from blood culture positivity or blood culture processing to actionable result). A total of 155 patient samples were included, totaling 10 species of Gram-negative bacteria. The overall EA and CA between QuickMIC^® GN and each routine AST system was > 95%, while overall bias was within the acceptable range of ± 30%. QuickMIC time-to-result was on average 3 h and 4 min, compared to 9-19 h for the routine systems. The average QuickMIC system turnaround-time ranged from 10 to 11 h 30 min, compared to 22-45 h for the routine systems. The QuickMIC system represents a promising rapid AST technology with potential to reduce time-to-result and overall turnaround-time of clinically actionable AST results compared with the most common routinely used automated AST methods, while maintaining good accuracy and quality of results.