European Journal of Clinical Microbiology & Infectious Diseases最新文献

Background: High-risk human papillomavirus (HR-HPV) infection is the primary cause of cervical cancer and precancerous lesions. Approximately 35% of women with low-grade cervical intraepithelial neoplasia (CIN1) may experience persistence or progression to high-grade lesions. Yet, the dynamic characteristics of HR-HPV infection in women with CIN1 remain unclear.

Methods: A total of 564 women diagnosed with CIN1, recruited from a community-based cohort, underwent a 24-month follow-up at 6th, 12th, and 24th month intervals. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated to evaluate the risk of HR-HPV infection prognosis and their associated factors. Kaplan-Meier survival curves illustrated the dynamic changes of HR-HPV infection and association between HR-HPV infection prognosis and various influencing factors.

Results: HPV16 was the predominant carcinogenic genotype, followed by HPV58 and HPV52. Over the 24-month follow-up, persistent HPV16 infection occurred in 10.6% of women, with 14.4% converting from positive to negative and 4% developing HPV16 positivity from baseline HR-HPV negativity. Rates of persistent infection for HPV58, 52, 18, and 56 decreased over time, with HPV58, 52, and 31 infections more likely to turn HR-HPV negative. Additionally, rates of positive conversion from negative for HPV58, 56, 33, and 66 increased with extended follow-up time. Variables associated with dynamic characteristics of HR-HPV infection prognosis included personal hygiene, age of first menarche, age at first sexual intercourse, educational level, age, and menopausal status (all P < 0.05).

Conclusions: These findings contribute to understanding the dynamic characteristics of HR-HPV infection prognosis in women with CIN1 and its association with non-viral factors.

Background: Public health issues related to tuberculosis still exist. Because Xpert MTB/RIF Ultra is more effective than conventional TB diagnostic techniques are, it is now regarded as an emerging technology. The diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculosis was assessed in this systematic study.

Methods: We searched the PubMed, Cochrane, EMBASE, and Web of Science databases for pertinent literature published before January 18, 2024. The quality of the collected literature was assessed via Review Manager 5.3 software, which applies the quality assessment of diagnostic accuracy studies criteria. Using Metadisc 1.40 software, the sensitivity, specificity, and summary receiver operating characteristic curves were plotted and examined. Stata 12.0 was the program we utilized to assess publication bias in this investigation. The Prospero prospective register of systematic reviews included this study (reference number CRD42024569674).

Results: Analysis of 187 fourfold tables from 72 studies revealed that Xpert MTB/RIF Ultra demonstrated an overall pooled sensitivity of 76% and specificity of 95% for detecting pulmonary tuberculosis. The positive likelihood ratio (PLR) was 14.91, and the negative likelihood ratio (NLR) was 0.23, with an area under the curve (AUC) of 0.9351 and a diagnostic odds ratio (DOR) of 73.39. For detecting rifampin resistance, the combined sensitivity and specificity were 94% and 97%, respectively. The pooled PLR was 24.94, the NLR was 0.07, and the DOR was 429.05. The area under the summary receiver operating characteristic (SROC) curve was 0.9868.

Conclusion: In conclusion, developing effective laboratory diagnostic tools for identifying Mycobacterium tuberculosis is essential for epidemiological research. This study demonstrated that Xpert MTB/RIF Ultra effectively diagnosed Mycobacterium tuberculosis infection, including pulmonary tuberculosis, as well as rifampin resistance, highlighting its potential as a valuable tool for both diagnosis and resistance detection.

Cefepime-tazobactam (FEP-TAZ) consists of cefepime combined with tazobactam, a penicillanic acid-sulfone recognized as an established beta-lactamase inhibitor. This study aims to investigate the in-vitro effectiveness of FEP-TAZ against cefepime-resistant clinical isolates of Escherichia coli (E. coli). A total of 105 E. coli clinical isolates characterized by cefepime-resistant/susceptible dose-dependent and carbapenem-sensitive profiles were tested for susceptibility by broth microdilution (BMD) method against cefepime and FEP-TAZ (tazobactam at a fixed concentration of 4 mg/L). Minimum inhibitory concentration (MIC) values for cefepime were determined using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method (M100-2022). Simultaneously, we also performed Disk-diffusion (DD) to observe the concordance between BMD and DD. FEP-TAZ exhibited inhibitory efficacy against 83.8% of E. coli isolates, markedly reducing the geometric mean from 20.4 to 1.9. Comparative analysis with DD revealed concordance with MIC for all isolates except four isolates. FEP-TAZ demonstrated potent activity against E.coli. This may be used as a carbapenem-sparing agent for the treatment of serious infections caused by cefepime-resistant Gram-negative bacilli. Furthermore, in settings where BMD implementation poses challenges, the pragmatic application of DD proves to be a viable alternative.

Purpose: Fungal rhinosinusitis is a significant and growing health concern in arid regions, with an increasing incidence over recent decades. Without timely and appropriate management, it can lead to severe complications, including potential intracranial spread. This study aims to establish efficient and rapid diagnostics for non-invasive fungal rhinosinusitis (FRS), addressing the challenge of its difficult-to-culture diagnosis.

Methods: Twenty-eight patients suspected of FRS were studied using endoscopic sinus surgery to obtain tissue samples for histopathology, direct microscopy, fungal culture, quantitative PCR (qPCR) and metagenomic next-generation sequencing (mNGS) detection. A patented qPCR targeting prevalent Aspergillus species was evaluated.

Results: The patient cohort had a male-to-female ratio of 9:14, with disease duration up to 50 years. Histopathologically, 23 out of 28 cases were positive. Fungal culture exhibited a sensitivity of 21.74%, with one false positive. qPCR and mNGS showed 100% sensitivity and specificity, with a 100% consistency rate for identification at the species level (23/23), and potential detection of cases with co-infections. The most common pathogen was A. flavus, followed by A. fumigatus and A. niger. Two cases involved mixed infections of A. fumigatus and A. flavus.

Conclusion: qPCR and mNGS proved effective in rapidly identifying fungi from fresh sinus tissue that are challenging to culture, surpassing conventional methods. However, further evaluation and optimization with a larger cohort of patients are necessary. Histopathology is still recommended to confirm the clinical significance of the detected fungal species.

Purpose: Dientamoeba fragilis is a protozoan frequently encountered in stool samples globally. It is debated whether Dientamoeba fragilis carries pathogenic capacities. This study prospectively analyses clinical and parasitological outcomes after treatment or a wait-and-see approach of Dientamoeba fragilis infection in a general practice adult population.

Methods: In this prospective observational cohort study 113 adult patients with a positive Polymerase Chain Reaction (PCR) test result for D. fragilis (T0) in a primary care setting, were followed-up longitudinally with a control PCR-test and microscopic stool examination at 30 days (T1) and 90 days (T2) after inclusion. Standardized patient-reported questionnaires including treatment details and the adjusted Irritable Bowel Syndrome-Severity Score (IBS-SS) were retrieved at T0, T1 and T2.

Results: Parasitology and questionnaires were retrieved from 87 participants at T0 and T1, and 74 at T2. Treated patients(n = 64) more often tested PCR negative at T1 (64.1% vs. 16.4%, p < 0.001) and T2 (67.3% vs. 5.3%, p < 0.001) compared to untreated patients. No difference in decline in IBS-SS was seen comparing the treatment and non-treatment groups at T1 (p = 0.403) or T2 (p = 1.00).

Conclusion: A short and long term increased parasitological clearance is shown with treatment of clioquinol or metronidazole compared with no treatment. A clear and significant correlation between parasitological cure and decline of clinical complaints as reported by the participants could not be established.

Purpose: The emergence of colistin-resistant and heteroresistant strains of carbapenem-resistant Acinetobacter baumannii (CRAB) complicates treatment and exacerbates the global health crisis of drug-resistant bacteria. This study aims to investigate the incidence and clinical implications of colistin heteroresistance in carbapenem-resistant Acinetobacter baumannii isolates from a tertiary hospital in Pakistan.

Materials and methods: A total of 130 CRAB isolates were collected from December 2022 to December 2023. Colistin susceptibility was assessed using broth microdilution, and heteroresistance was detected through population analysis profiling.

Results: Heteroresistance (HR) was identified in 31.5% (41/130) of the isolates, while 7.7% were colistin-resistant, despite initial susceptibility indicated by broth microdilution. Clinical data revealed that HR was associated with significant 14-day clinical failure but not with 30-day all-cause mortality. Heteroresistant strains showed extensive multidrug resistance, posing a serious threat to effective treatment.

Conclusions: The study highlights the critical need for accurate detection of colistin HR to prevent treatment failure and improve patient outcomes. The prevalence of colistin HR underscores the necessity for revised diagnostic and treatment strategies in Pakistan, emphasizing the importance of recognizing and addressing this emerging threat in healthcare settings.

An increase in Group A Streptococcus vulvovaginitis was detected in 2023: The average number of cases per year was 13 during 2011-2017. Twenty-five and 27 cases were reported in 2018 and 2019 followed by a decline coinciding with the COVID-19 pandemic. The 2023 increase surpassed previous data. The most frequent resistances were to erythromycin (11.3%;) and tetracycline (8.8%). Eleven different emm-types were detected among 30 GAS isolated in 2023: emm 1 was predominant (36.7%) followed by emm 89 (20%), emm 87 (10%) and emm 28 (6.7%). GAS should be increasingly considered in women with vulvovaginitis.

Purpose: The role of therapeutic drug monitoring (TDM) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients receiving letermovir has not yet been clarified. This study is to explore letermovir trough concentration (C_min) correlation with its clinical efficacy and adverse events, and factors affecting its plasma concentrations.

Methods: A prospective, non-interventional study was performed in allo-HSCT recipients receiving letermovir prophylaxis. Plasma concentrations were determined using high-performance liquid chromatography-tandem mass spectrometry. Data analysis was performed using logistic regression, linear regression, and classification and regression tree (CART) models.

Results: 701 trough concentrations from 71 recipients were included, uncovering pronounced intra- and inter-individual variability in letermovir C_min. During 24-week follow-up, CMV infection incidence was 16.4%. A significant correlation was identified between letermovir C_min and its clinical efficacy, and the CART model showed an increased risk of CMV infection when C_min ≤ 2731 ng/mL. However, no clear correlation was found between C_min and adverse events. Gastrointestinal graft-versus-host disease, cyclosporine C_min, gender, and concomitant medications, including mycophenolate mofetil, ondansetron, caspofungin, and methylprednisolone, may impact letermovir C_min. Additionally, coadministration with cyclosporine injection significantly decreased median letermovir C_min compared with cyclosporine capsules (2311 vs. 3386 ng/mL). Moreover, with the extension of time post-transplant, trough concentrations of both cyclosporine and letermovir significantly decreased.

Conclusion: TDM for letermovir may be beneficial in allo-HSCT recipients considering the variability in letermovir C_min and its correlation with clinical efficacy. Moreover, drug interactions and the effects of changes in cyclosporine dosage forms or concentrations require careful monitoring for their effect on letermovir C_min.

There is a constant need to reduce turn-around times and keep costs as low as possible for the carriage screening of GBS in pregnant patients. Laboratory automation might provide an edge in this field. The objectives of the present study were: i) to compare the performance of the direct chromID™ Strepto B agar (CA) plating against LIM-broth enriched plating on CA for the detection of GBS from vagino-rectal screening-swabs; and ii) to assess the usage of PhenoMATRIX™ for the automated screening of GBS. Between January 2021 and December 2023, 9'107 vagino-rectal specimens were collected from pregnant women at Geneva University Hospitals and were used to address the first objective. There was a small difference in the GBS detection rates between direct CA plating (13.2%; 1'202/9'107) and LIM-broth enriched plating on CA (13.2%; 1'198/9'107). Based on the LIM-broth enrichment results, the sensitivity and specificity of the direct CA plating were 98.3% (95% CI, 97.3%-98.9%) and 99.7% (95% CI, 99.5%-99.8%), respectively. Importantly, for 25 specimens, GBS growth was only detected by direct CA plating. We used a random set of 8'768 CA plate pictures for the machine learning of PhenoMATRIX™. The validation was carried out on an additional set of 830 CA plate pictures. The sensitivity and specificity of PhenoMATRIX™ were 100% (95% CI, 96.6%-100.0%) and 90.2% (95% CI, 87.8%-92.1%), respectively. We established that for GBS screening, the performance of direct CA plating is not inferior to the LIM-broth enriched approach. By relying on PhenoMATRIX™, the negative predictive value for GBS screening reaches 100% (95% CI, 99.4%-100.0%), enabling the automatic release of GBS-negative cases within 24 h.

Purpose: Staphylococcus aureus bacteremia (SAB) is associated with a 90-day mortality of 28-34%. Many SAB-patients (7.8-39%) have a secondary S. aureus bacteriuria (SABU) mainly without symptoms of a urinary tract infection. Due to high morbidity and mortality, there is an interest in rapid detection of S. aureus bacteremia. Here, we compared a rapid nucleic acid amplification test (NAAT) with conventional culture to detect S. aureus in urine and to identify cases with increased risk for SAB.

Methods: In a cross-sectional study, we assessed urine samples (mid-stream, clean catch and catheter urine) of patients with SAB and bacteremia other than SAB (non-SAB). Urine samples were collected ± 3 days to the collection of the positive blood culture and were cultured on a set of selective and non-selective agar plates. NAAT was performed using a commercial test (Xpert^® SA Nasal Complete G3, Cepheid) from a sterile swab soaked in urine.

Results: We included samples from 100 patients (68% male, median age: 67.4 years) with SAB and 20 patients (75% male, median age: 65.84 years) with non-SAB. The sensitivity of detecting SAB from urine samples was 47% (specificity: 90%) for NAAT, when applying a Ct-value of ≤ 37.4 for positive results. Urine culture had a sensitivity of 25% and a specificity of 95%. Molecular and culture methods showed a moderate agreement (80%, Cohens kappa: 0.55).

Conclusion: NAAT from urine has a higher sensitivity than culture in patients with SAB and could potentially identify cases with increased risk for SAB. Future studies should investigate whether this characteristic could translate into a clinical benefit through rapid detection of SAB.