European Journal of Clinical Microbiology & Infectious Diseases最新文献

Tuberculosis (TB) remains a significant global health challenge, especially in countries with low TB incidence, exacerbated by the influx of migrants from high TB-burden regions. This paper reviews the challenges and strategies for managing TB infection (TBI) among migrants. Challenges in screening and treating TBI among migrants include diagnostic limitations of available tests which are tuberculin skin test (TST) and interferon-gamma release assay (IGRA), socioeconomic barriers, cultural beliefs and mobility. Recommendations vary among guidelines, ranging from proactive screening to targeted approaches. We addressed the issue of two-step testing, discussing the use of an initial TST followed by IGRA confirmation, with consideration of BCG vaccination status and TB exposure history. Treatment options for TBI include isoniazid monotherapy and rifamycin-based regimens in most cases, with varying preferences across guidelines. Challenges in TBI treatment include hepatotoxicity and adherence issues, particularly among migrants. Overall, a comprehensive approach addressing socioeconomic, cultural, and structural factors is crucial for effective TBI management among migrants. Collaboration between healthcare providers, policymakers and migrant communities is essential for developing culturally sensitive screening and treatment protocols. Further research is needed to evaluate the efficacy and feasibility of different screening and treatment strategies, particularly among migrant populations.

Purpose: Helicobacter pylori infection is associated with various digestive disorders, including chronic gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer, posing significant risks to human health. Effective and timely detection of H. pylori is crucial for early intervention and prevention. This review aims to evaluate the sensitivity and specificity of stool antigen detection and assess its clinical application value.

Methods: We conducted a comprehensive review of the literature focusing on studies that compared invasive and non-invasive diagnostic methods for H. pylori, with an emphasis on stool antigen tests. Data on diagnostic performance, including sensitivity, specificity, advantages, and limitations, were synthesized from recent clinical evaluations and meta-analyses.

Results: Stool antigen detection demonstrates high diagnostic accuracy, with sensitivity and specificity often exceeding 90%, particularly when monoclonal antibody-based tests are used. It offers a non-invasive, cost-effective alternative to urea breath tests and is applicable across diverse populations, including children and the elderly. However, factors such as sample handling, antigen stability, and bacterial load can influence results.

Conclusion: Stool antigen testing is a reliable tool for the initial diagnosis and post-treatment monitoring of H. pylori infection. Its high performance and practicality support its use in clinical practice, especially in settings where endoscopy or breath testing is less feasible. Further standardization and technological advances may enhance its utility in global screening programs.

Objective: To analyze clinical features and identify prognostic factors in HIV/AIDS patients with cryptococcal meningitis (CM), and to develop a predictive model for short-term mortality.

Methods: A multicenter retrospective study was conducted on 197 HIV/AIDS patients diagnosed with CM from 2013 to 2023. Clinical data were collected, and multivariate logistic regression was used to construct a prognostic model.

Results: The median age was 48 years (IQR: 33-57.5), with 75.6% males. Common symptoms included headache (68.5%), fever (52.8%), and nausea/vomiting (49.2%). Independent risk factors for mortality were consciousness disturbance (OR = 7.785, P = 0.013) and elevated intracranial pressure (OR = 1.011, P = 0.023), while CD8⁺T lymphocytes (OR = 0.997, P = 0.022) and platelet count (OR = 0.990, P = 0.014) were protective. The prognostic model (AUC = 0.860, 95% CI: 0.776-0.943) demonstrated sensitivity of 71.4% and specificity of 89.3%.

Conclusion: Consciousness disturbance, intracranial pressure, CD8⁺ T cells, and platelets independently predict mortality in HIV/AIDS-associated CM. Early intervention targeting these factors may improve outcomes.

Background: Following the nationwide relaxation of non-pharmaceutical interventions (NPIs) in December 2022 in China, there was considerable uncertainty regarding the resurgence and interaction patterns of major respiratory syncytial virus (RSV), influenza virus (IFV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We hypothesized that this post-NPI era would experience an unusual resurgence of traditional respiratory viruses with altered seasonality and age distribution, alongside distinct epidemic patterns of SARS-CoV-2.

Methods: This retrospective observational study analyzed comprehensive surveillance data of RSV, IFV, and SARS-CoV-2 from pediatric acute respiratory tract infection (ARTI) cases at a major maternal and child health hospital in Hubei Province, China, spanning September 2017 to August 2024. We examined temporal trends across pre-pandemic, pandemic, and post-NPI periods, age distribution shifts across four defined age groups, and coinfection patterns.

Results: A large dataset of 105,264 RSV, 177,754 IFV and 23,090 SARS-CoV-2 test records were analyzed. Following the lifting of NPIs, delayed RSV and IFV outbreaks occurred in 2022-2023 season with unusual seasonality (e.g., RSV peaking atypically in April). In the 2023-2024 season, a partial return to traditional seasonality was observed, though IFV exhibited an unprecedentedly high peak. Significant age distribution shifts occurred, with RSV infections increasing markedly in the 3 - 6 years age group and IFV infections surging in the 6 - 14 years age group during 2023, largely consistent with an immunity debt phenomenon. SARS-CoV-2 outbreaks consistently followed the peaks of IFV and RSV, showing distinct spring and summer epidemic patterns, particularly affecting young children. Coinfections of RSV and IFV remained consistently rare (about 1%).

Conclusions: The post-NPI era in China brought profound shifts in pediatric respiratory virus epidemiology, characterized by altered seasonality and age distribution for RSV and IFV, and a distinct sequential pattern for SARS-CoV-2. These findings underscore the impact of NPIs on viral dynamics and highlight the concept of immunity debt. Our study provides crucial insights for adaptive public health strategies, emphasizing the need for continued, integrated surveillance and tailored interventions to address the evolving characteristics of these key respiratory pathogens.

Purpose: Despite advances in medical care, bacterial meningitis still poses a considerable health issue from a global perspective. An ageing population and increasing development and use of vaccines are likely to affect the incidence and aetiology. The aim of this study was to describe the incidence and aetiology of community-acquired bacterial meningitis (CABM) in our setting, as well as the serotypes of Streptococcus pneumoniae and Neisseria meningitidis causing CABM, in relation to available vaccines.

Method: Patients of all ages with CABM in southern Sweden 2013-2023 were included. Patients were identified through records of cerebrospinal fluid tests from the Department of Clinical Microbiology, and through International Classification of Diseases 10 codes for bacterial meningitis. Age-standardised incidence rates were calculated based on the European Standard Population 2013.

Results: During the study period, 244 episodes of CABM in 238 individuals were identified. Definitive aetiology could be established in 93% of episodes. Mean incidence rate was 1.63 per 100,000 person-years, with a trend of declining incidence during the study period. Streptococcus pneumoniae was the most common pathogen, accounting for 46.7% of episodes. 63.6% of the episodes of pneumococcal meningitis were caused by serotypes included in current vaccines.

Conclusion: Pneumococcal meningitis is the primary driver of incidence and trends of all-cause community-acquired bacterial meningitis in southern Sweden. Further studies are warranted to investigate how vaccination could influence both disease incidence and shifts in serotype distribution, while also identifying optimal patient populations for targeted interventions.

We report a fatal case of necrotizing fasciitis in a dog caused by Acinetobacter baumannii producing New Delhi metallo-β-lactamase (NDM). The isolate was extensively drug-resistant, showing resistance to all tested antimicrobials except colistin and polymyxin B. Clinical progression was rapid, with extensive tissue necrosis and sepsis leading to death despite supportive therapy. To our knowledge, this is the first description in Brazil of necrotizing fasciitis in a dog associated with an NDM-producing A. baumannii. This case highlights the zoonotic and epidemiological relevance of antimicrobial resistance in companion animals.

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.

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.