European Journal of Clinical Microbiology & Infectious Diseases最新文献

Purpose: In June 2024, a genomic cluster of seven Salmonella Typhimurium - sequence type 19, and cluster type 21092 - was detected in Norway, triggering a national outbreak investigation.

Methods: Information about new cases was collected from the Norwegian Surveillance System for Communicable Diseases and the database at the National Reference Laboratory for Enteropathogenic Bacteria (NRL) at the Norwegian Institute of Public Health (NIPH). Microbiological analyses were conducted by NRL at NIPH for human samples and at the Norwegian Veterinary Institute for animal samples. Epidemiological data was collected through interviews. International notification was sent via EpiPulse.

Results: Eleven cases in total, sampled between March 6 and July 11, 2024, were identified across Norway. The median age of affected individuals was three years. Notably, 73% of the cases reported prior contact with cats or passerine birds. The outbreak strain was also detected in a faecal sample from a cat belonging to one of the affected households, suggesting an animal source. Concurrently, Finland and Sweden reported five and six cases, respectively, involving the same outbreak strain. Several of these individuals also reported contact with cats or birds.

Conclusions: Passerine birds are a well-documented reservoir for S. Typhimurium in the Nordic region, often leading to transmission to both cats and humans. This outbreak highlights the role of animal exposure in the spread of S. Typhimurium and emphasize the need for timely, targeted public health communication on infection prevention measures.

Introduction: Pneumococcal conjugate vaccines (PCVs) were implemented in the childhood vaccination program of the Community of Madrid (CM) in 2007, but despite very high vaccination coverage since then, increasing trends in invasive pneumococcal disease (IPD) have been observed in recent years.

Methods: Epidemiological, clinical, and microbiological data from the Notifiable Disease Surveillance System on IPD cases in children aged 0-17 years in the CM during the period 2007-2024 were analysed. A descriptive analysis was conducted by sex, age-group, clinical presentation, laboratory results, prior vaccination, and antibiotic resistance. Incidence rates (IRs) and IR ratios (IRRs) were calculated overall and by serotypes (STs) covered by each vaccine and the most relevant STs using 2015-2019 as reference period.

Results: Between 2007 and 2024, 1,856 cases of IPD were notified: 1,052 (56.7%) in boys and 804 (43.3%) in girls. By age-group, there were 431 cases (23.2%) in < 1 year, 994 (53.6%) in those aged 1-4 years, and 431 (23.2%) in those aged 5-17 years. PCV7, PCV13, PCV15, and PCV20 vaccine included STs IRs increased 7.0, 2.9, 2.3, and 1.5 times, respectively (all P < 0.05), in 2024. STs 24A, 14, 15A, 10A, and 3 IRs also increased (IRRs: 30.5, 17.8, 2.8, 2.7, and 2.6, respectively; all P < 0.05). No strains of the STs 1, 5, or 7F were detected in 2024, and STs 19A decreased to 2.2%.

Conclusions: IRs for children and adolescents increased between 2022 and 2024 in the CM, associated to the rise of some PCVs STs, as ST14, while the still persistent ST3 started to decline after 2022.

Purpose: Furazidin is a nitrofuran derivative used in Eastern Europe (e.g., Latvia, Lithuania and Poland) and Russia for treating uncomplicated urinary tract infections (UTI), while nitrofurantoin, another nitrofuran, is a widely used for this indication. This study (23-ADA-01) evaluated the activity of furazidin, nitrofurantoin, and fosfomycin against bacterial isolates collected between 2020 and 2022 from female UTI patients in 19 European and the Mediterranean countries.

Methods: A total of 3,111 isolates were tested for susceptibility to furazidin, nitrofurantoin and fosfomycin using broth microdilution or agar dilution at a monitoring laboratory (JMI Laboratories, North Liberty, Iowa, USA). Minimum inhibitory concentration (MIC) results for antimicrobial agents commonly used to treat UTI, that were previously evaluated as part of the SENTRY Antimicrobial Surveillance Program, were added to the study for evaluation of cross-resistance. Additionally, minimum bactericidal concentration (MBC) testing was performed for 212 isolates.

Results: Furazidin demonstrated high in vitro activity, especially against Escherichia coli (n = 1,758; MIC_50/90, 4/8 mg/L; 99.0% inhibited at ≤ 32 mg/L), Staphylococcus saprophyticus (n = 168; MIC_50/90, 2/2 mg/L; highest MIC 2 mg/L) and Enterococcus faecalis (n = 156; MIC_50/90, 1/2 mg/L; highest MIC 16 mg/L). It was also effective against other pathogens such as Klebsiella pneumoniae, Citrobacter freundii, Citrobacter koseri, Enterobacter cloacae, Staphylococcus aureus, Streptococcus agalactiae and Entercococcus faecium. Furazidin was fourfold more potent than nitrofurantoin against Enterobacterales and four- to eightfold more active against Gram-positive organisms. The MBC: MIC ratio for furazidin was ≤ 8 for all isolates tested, with 85.8% showing this ratio ≤ 2. Furazidin's activity against E. coli was consistent across the European countries, with MIC₅₀ and MIC mode values of 4 mg/L. Isolates with higher furazidin MIC values also exhibited higher nitrofurantoin MIC values. Furazidin retained good activity against E. coli isolates resistant to fosfomycin or trimethoprim-sulfamethoxazole.

Conclusion: Our study demonstrates that furazidin exhibits potent in vitro activity against a broad spectrum of organisms responsible for UTIs. These data support furazidin as an effective alternative for treatment of UTIs.

Background: The aim of this study was to analyze the safety and efficacy of sofosbuvir-based regimens (SOF/velpatasvir and SOF/ledipasvir, SOF/VEL and SOF/LDV) for the treatment of hepatitis C in children aged 5-17 years in a real-life setting.

Methods: All participants who received SOF-based regimens beginning in August 2019 were included. The treatment duration was 12 weeks for both the SOF/LDV and SOF/VEL regimens; however, in the case of children infected with HCV genotype 1 and presenting with cirrhosis, the duration of the SOF/LDV treatment was extended to 24 weeks. In all cases, fixed doses of SOF/LDV and SOF/VEL were used adjusted to the patients' age and weight. The primary endpoint for these studies included evaluation of treatment efficacy (defined as sustained virologic response, SVR12, with undetectable HCV RNA at 12 weeks posttreatment).

Results: We identified 90 patients aged 5 to 17 years eligible for the study: 50 who were treated with SOF/VEL and 40 who received SOF/LDV. The SVR12 assessment was available for 89 patients. In all of them, SVR12 was achieved (100% efficacy in per-protocol analysis; 99% efficacy in intention-to-treat assessment). One-third of the study participants reported adverse events (AEs) related to antiviral treatment, all of which were mild or moderate. Headache, fatigue, and abdominal pain were the most common symptoms. Some differences in the frequency of AEs according to the DAA used were noted (abdominal pain and asthenia were less common in children treated with SOF/LDV than in those treated with SOF/VEL). No case of treatment discontinuation occurred.

Conclusion: This study confirms the excellent efficacy and good tolerability of SOF-based regimens for the treatment of hepatitis C in children aged 5 to 17 years in real-life settings, supporting the inclusion of pediatric patients in national treatment policies.

This article reports a rare case of sternal osteomyelitis caused by Coxiella burnetii. The patient, a 59-year-old male with a history of aortic dissection and hypertension, had undergone ascending aorta replacement and aortic valvuloplasty. He was admitted in May 2022 due to a chest mass that had been enlarging since its discovery in October 2021. Despite antibiotic treatment, the symptoms did not improve, and he experienced recurrent low-grade fevers. Upon admission, CT imaging revealed multiple mediastinal lymph node enlargements and a cystic shadow anterior to the sternum handle. The infection was confirmed as Coxiella burnetii through surgical debridement and metagenomic next-generation sequencing (mNGS). The treatment was subsequently changed to doxycycline and hydroxychloroquine. Positron emission computed tomography with 18 F-fluorodeoxyglucose ([18 F] FDG PET/CT) imaging showed that the infection was localized to the sternum, excluding vascular and implant infections. The patient completed an 18-month course of antibiotics, leading to controlled infection and normalized renal function. This case highlights the complexities of diagnosing and managing Q fever osteomyelitis in patients post-cardiovascular surgery, demonstrating the crucial roles of mNGS and [18 F] FDG PET/CT in rapid diagnosis and effective treatment. These findings provide valuable insights and guidance for managing similar cases in the future.

Purpose: Cutaneous botryomycosis is a chronic, granulomatous infection of the skin caused by different bacteria that form granular aggregates. We aim to provide a complete, comprehensive, and updated review of cutaneous botryomycosis, including a review of cases published in the last decade.

Results: Patients with botryomycosis typically present multiple nodules, sinuses, abscesses, fistulae, and ulcers, which develop during weeks or months. The current gold standard for diagnosing botryomycosis involves a combination of histopathological examination and microbial culture. A definitive diagnosis is established when clinical and pathological findings align with the presence of botryomycosis, supported by the identification of non-filamentous bacteria forming granules and positive culture. The most frequent isolated etiological agents are Staphylococcus aureus followed by Pseudomonas aeruginosa. The differential diagnosis includes mycetoma, actinomycosis, and carcinomas/sarcomas. Treatment includes antibiotics and, in selected cases, surgical debridement.

Purpose: Recent changes in the mycological profile have been reported in several life-threatening infections, but no data have assessed this issue in postoperative peritonitis (POP).

Methods: This retrospective monocentric analysis (1999-2019) evaluated the temporal changes of fungi collected from POP samples in intensive care unit (ICU) patients and assessed the adequacy of antifungal therapy (AFT) and the prognosis.

Results: Overall, 1,389 microorganisms were cultured from surgical samples in 464 ICU patients, including 186 (40%) patients harbouring fungi (11 fungaemia). Growing proportions of fungi were observed over time (p < 0.01), related to increased rates of Candida albicans and C. non-albicans (p = 0.01 and p < 0.01, respectively). A significantly increased prescription of empirical AFT was observed during the study period (p < 0.0001). Adequate empirical AFT was achieved in 93/186 (50%) patients in the fungal group. Documented AFT was given in 163/174 (94%) patients in the fungal group for a median duration of 14 [9-21] days, mainly with fluconazole. The ICU and hospital mortality rates were similar in bacterial and fungal groups. However, we observed a significant increase in the duration of mechanical ventilation and ICU stay in the fungal group.

Conclusion: We observed high and growing proportions of fungi in patients treated for POP associated to increasing proportions of both C. albicans and C. non-albicans. Adequate AFT was achieved in all cases with caspofungin, but fluconazole remains an acceptable option for de-escalation. Our data suggest that, in ICU patients with POP, the severity of illness, rather than adequate AFT, drives clinical outcomes.

Non-typhoidal salmonella (NTS) is one of the main germs responsible for intestinal infections worldwide, and can present life-threatening extra-digestive complications such as endarteritis. A septic deep vein thrombosis (DVT) is characterised by intraluminal thrombus and venous wall inflammation and suppuration and has been rarely reported in the setting of NTS infection. We present the case of an immunosuppressed 83-year-old man who developed NTS sepsis, complicated by an infected and ruptured left internal iliac artery aneurysm and contiguous femoro-iliac septic DVT. Septic DVT ranks among the serious extra-intestinal complications of NTS infections and may be contiguous with an endarteritis site.