European Journal of Clinical Microbiology & Infectious Diseases最新文献

Background: This study aimed to provide a comprehensive overview of SARS-CoV-2 and other respiratory viruses co-infections and analyse the value of Primary Care Centres (PCCs) as a sentinel network for molecular surveillance of paediatric respiratory viral infections in Catalonia (Spain).

Methods: Between October 2021 and April 2024, upper respiratory tract samples were collected from children under 15 years of age presenting with acute respiratory symptoms at different PCCs across Catalonia. The detection of respiratory viruses was performed using commercial multiplex RT-PCR and transcription-mediated amplification-based assays. The genetic characterisation of select viruses (adenoviruses (AdV), enteroviruses (EV), influenza viruses, SARS-CoV-2) was performed via partial or whole genome sequencing. The results were then compared with hospital-based data and the regional surveillance system (SIVIC).

Results: Among 1,401 positive samples from 1,329 cases, the most prevalent viruses were rhinovirus (RV) (22.77%), SARS-CoV-2 (12.35%), influenza A(H3) viruses (11.06%) and AdV (9.21%). Viral circulation followed typical seasonal patterns, with RV and AdV detected year-round, and influenza and respiratory syncytial virus peaking in winter, showing prevalences similar to those observed in hospital settings and broader community settings. Co-infections were frequent (up to 53.3% for bocavirus), while influenza and SARS-CoV-2 showed the lowest co-infection rates, suggesting possible viral interference. Genomic analysis revealed circulation of different EV (e.g., EV-D68, CV-A6, E-11, etc.) and AdV (B3, C2) types, multiple FLUAV and FLUBV genetic clades and SARS-CoV-2 variants consistent with national waves.

Conclusions: This study highlights the complexity of respiratory virus circulation and co-infections dynamics in paediatric primary care patients. A notable observation was the generally similar viral distribution between PCCs and the community, reinforcing the value of studying this population. The findings also underscore the importance of continued molecular surveillance to inform public health strategies and clinical management of respiratory infections in children.

Bloodstream infections (BSIs) are serious conditions caused by the presence of microorganisms in the blood. Although blood culture remains the diagnostic gold standard, it is time-consuming. Neutrophil activation plays a central role in the early immune response to infection and can be quantified using the Neutrophil-Reactive Intensity (NEUT-RI) parameter, derived from hematological analyzer using the fluorescence flow cytometry technology. The purpose of this study is to evaluate NEUT-RI as an early marker of BSI and compare its diagnostic performance with standard infection biomarkers. We conducted a retrospective study involving 120 inpatients with documented BSI. Each inpatient underwent blood testing for PCT (Procalcitonin), serum CRP (C-Reactive Protein), WBCs (White Blood Cells), neutrophil absolute count within 12 h prior to blood culture sampling. NEUT-RI values were retrieved from the complete blood count. A control group of 52 inpatients with negative blood cultures was also analyzed. Median NEUT-RI was significantly higher in BSI patients than in controls (53.43 FI vs 48.65 FI; p < 0.001). ROC (Receiver Operating Characteristic) curve analysis showed an AUC (Area Under the Curve) of 0.785 for NEUT-RI, with 72.5% sensitivity and 76.9% specificity at a cut-off of 50.7 FI. Only Procalcitonin (AUC 0.882) outperformed NEUT-RI (p = 0.01). Our findings suggest that NEUT-RI increases in the early stages of bacteremia and may serve as a useful early indicator of bloodstream infection. NEUT-RI could be integrated into multi-parametric diagnostic algorithms to improve early detection of BSIs. Further studies are warranted to validate these preliminary results.

Purpose: International guidelines recommend invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) before surgery for infective endocarditis (IE). Given the low level of evidence for this recommendation, we aimed to assess the impact of coronary evaluation in this context.

Methods: This multicenter retrospective study included adult patients diagnosed with IE who underwent cardiac surgery, and whose coronary status was considered unknown at the time of IE diagnosis. Patients were divided in two groups: those who underwent a coronary evaluation (C group) and those who did not (NC group). The primary endpoint was to determine the prevalence of coronary evaluation during the preoperative workup for IE. Secondary endpoints included the safety of coronary evaluation, the prevalence of coronary revascularization, and the one-year post-operative prognosis.

Results: 323 patients were included, with 43% in the NC group and 57% in the C group (ICA for 149 patients, CCTA for 35 patients). Coronary evaluation found no lesion, non-significant coronary artery disease (CAD), and significant CAD in 51.1%, 28.8%, and 20.1% of cases, respectively. Thirteen patients underwent coronary artery bypass graft during the IE surgery. Tolerability of ICA was excellent: no embolic events and no additional renal toxicity.

Conclusion: While coronary evaluation was recommended for almost all patients, it was only performed in just over half of the cases. Preoperative coronary assessment remains useful and safe, but should probably not delay urgent valvular surgery.

Background: We retrospectively analyzed the epidemiological characteristics, mixed infections, and complications of chlamydial infection in pediatric inpatients based on a national database.

Methods: The discharge data of pediatric inpatients with chlamydial infection was obtained from the Futang Research Center of Pediatric Development database from January 2016 to December 2022.

Results: A total of 10,211 patients with chlamydial infection were obtained, with patients < 1 year old predominantly (44.17%, 4510/10211). Bronchopneumonia was the most prevalent (42.67%, 4355/10207) complication, followed by bronchitis (11.11%, 1134/10207) and chlamydial pneumonia (10.15%, 1036/10207). Mixed infections were identified in 60.40% of cases, with Mycoplasma pneumoniae being the predominant co-pathogen (47.69%, 2941/6167). Among viral and bacterial co-infections, respiratory syncytial virus (21.91%, 632/2885) and Streptococcus pneumoniae (26.67%, 268/1005) were most frequently detected, respectively. From 2016 to 2018, the rate of hospitalized patients with chlamydial infection exhibited an almost constant level (16.95%-18.27%), peaked to 21.75% in 2019, then declined to 6.75% in 2022. The epidemics of chlamydial infection were mainly in winter (33.29%), with the highest proportion in January (12.11%, 1237/10211). The highest median hospitalization expense was incurred by patients aged < 1 year and co-infected fungi infection. Four patients died, all with respiratory failure, co-infected with multiple pathogenic infections, and other associated complications.

Conclusion: Hospitalized pediatric chlamydial infection primarily occurred in patients under four years old. Bronchopneumonia was the most prevalent complications in pediatric chlamydial infection. Over half chlamydial infection cases were identified with mixed infections with Mycoplasma pneumonia predominantly.

Background: Respiratory syncytial virus (RSV) peaks in fall-winter and is well known in children. In adults, however, severe outcomes especially compared to influenza are less well-defined. With RSV vaccines newly available in 2024, this study evaluated RSV burden versus influenza.

Methods: Multicenter retrospective cohort study including adults ≥ 50 years with RT-PCR-confirmed influenza (A/B) or RSV during two pre-COVID-19 fall-winter seasons (2016-2018). Outcomes were hospital admission, length of stay, short-term favorable outcome (within 5 days), intensive care unit (ICU) admission, superinfection, and 90-day mortality.

Results: Of 386 patients, 288 (74.6%) had influenza (A: 190, B: 98), 98 (25.4%) had RSV. RSV patients exhibited more frequently chronic respiratory diseases (41.8% vs. 24.3%, p = 0.001) and prior hospitalized respiratory infections (39.8% vs. 25.7%, p = 0.01) than influenza patients. Admission rates trended higher for RSV (88.8%, n = 87) than influenza (80.2%, n = 231; p = 0.06). Among admissions (n = 318), RSV stays were significantly longer (median 12 days [IQR 8-18] vs. 9 days [IQR 4-15], p = 0.006), with lower short-term favorable outcomes than influenza B (13.8% vs. 41.4%, aOR 5.1 [1.53-16.86], p < 0.01), but not influenza A (p = 0.34). ICU admissions were higher in younger age groups (50-64 years: aOR 13.4 [2.7-67.2], p = 0.002; 65-74 years: aOR = 4.17 [1.18-14.7], p = 0.03), regardless of viral etiology. Superinfection (10.2% vs. 12.5%, p = 0.57) and 90-day mortality (6.9% vs. 12.9%, p = 0.18) were similar.

Conclusion: RSV imposes a burden comparable to influenza in admission and mortality, with slower recovery than influenza B. These pre-COVID-19 data provide a critical baseline to support targeted RSV vaccination for adults with comorbidities and aged ≥ 50 years, informing future recommendations.

Digestion and decontamination during acid-fast bacilli (AFB) culture processing are performed to suppress growth of normal microbiota in respiratory specimens; however, these steps may render AFB nonviable. This study aimed to evaluate the performance of NTM Elite agar, a decontamination-free selective medium, for the recovery of nontuberculous mycobacteria (NTM) compared to standard of care (SOC) processing and solid and liquid media inoculation for AFB culture in five hundred lower respiratory samples from non-cystic fibrosis patients. Concurrently, the same specimens were directly inoculated onto NTM Elite agar (NTM Elite-Direct Inoculation) or centrifuged and washed with saline prior to inoculation onto NTM Elite agar (NTM Elite-Concentrated) and incubated up to 28 days. The overall median time to positivity was 7.0 days (IQR = 7-18) for NTM Elite-Direct Inoculation and 14 days (IQR = 7-14) for NTM Elite-Concentrated, which were similar to SOC broth but shorter than SOC solid agar at 35 days (IQR = 2-41). Breakthrough non-AFB growth rate was 1.4% (7/500) NTM Elite-Direct Inoculation, which was less than NTM Elite-Concentrated at 9.0% (45/500) and SOC media at 10.0% (50/500). Forty-five unique isolates were included in the analysis for sensitivity of NTM detection. Sensitivity was 43.5% (95% CI = 30.2-57.8) for SOC media, 20.0% (95% CI = 10.9-33.8) for NTM Elite-Direct Inoculation, and 82.6% (95% CI = 69.3-90.9) for NTM Elite-Concentrated. Combined with SOC broth culture, sensitivity was 93.3% (95% CI = 82.1-97.7) for NTM Elite-Concentrated. The high sensitivity of the latter procedure indicates potential for NTM Elite agar to replace SOC solid agar for detection of NTM in areas of high NTM incidence but low incidence of tuberculosis.

Purpose: The aims of this study were to describe the microbiological profile and antibiotic susceptibility of acute and chronic prosthetic joint infection (PJI) after total knee arthroplasty (TKA) and to propose appropriate empirical antibiotics.

Methods: We performed a retrospective review using our institution's database to collect data from patients with PJI who underwent reoperation following a primary TKA, between 2021 and 2024. Demographic data, microbiological results and antimicrobial susceptibility testing were analysed.

Results: Forty patients met the study criteria and were included in the study. Chronic infections (> 6 weeks after implantation) were the most common, accounting for 75% of the forty cases. Regardless of classification by time to infection, gram-positive organisms were the predominant causative agents. The most frequently identified pathogens were Staphylococcus aureus (24.2%), Staphylococcus epidermidis (16.7%) and Staphylococcus lugdunensis (13.6%). Vancomycin proved to be the most effective antimicrobial, with a susceptibility of 100% in all cases, in both acute and chronic infections. As for chronic infections, Cotrimoxazole (Sulfamethoxazole/Trimethoprim) demonstrated low levels of resistance, with 97% susceptibility among the main pathogens involved in these cases.

Conclusions: The choice of antibiotic for empirical treatment should consider the time since prosthesis implantation, as pathogen distribution and their susceptibilities differ slightly between acute and chronic infections. For acute infections, vancomycin should be considered the first-line treatment. In chronic infections, Cotrimoxazole may serve as a potential alternative treatment, due to its low resistance profile. Nevertheless, de-escalation to targeted therapy should be implemented as soon as the final culture results become available.

Purpose: Effective antiretroviral therapy has significantly reduced mortality rates among people living with HIV (PWH) and has altered the distribution of causes of death. We aimed to investigate trends in causes of death among PWH over time.

Methods: We investigated all reported deaths in the Turkish Clinical Microbiology and Infectious Diseases Society HIV Cohort. Causes of death were categorized and analyzed across four time periods: 1997-2006, 2007-2014, 2015-2019, and 2020-2023. Factors associated with HIV/AIDS-related causes of death were compared to other causes of death.

Results: A total of 9,334 PWH were followed, of which 414 deaths (4.4%) occurred, including 44 (11.6%) among individuals assigned female at birth. The most common causes of death were AIDS-related illnesses (57.7%), non-AIDS-related cancers (11.1%), and cardiovascular diseases (9.9%). Among causes of death, the rate of AIDS-related diseases has declined over the years (p<0.001). Rates of non-AIDS-related cancers (p=0.013) and non-AIDS-related infections (p=0.008) have increased, and deaths due to comorbid conditions such as cardiovascular diseases have remained stable (p=0.193). In multivariate analysis, AIDS-related deaths were significantly associated with an increased risk in individuals who had an AIDS-defining illness at baseline. The rate of AIDS-related deaths declined in later periods compared to 1997-2006. AIDS-related deaths decreased with older age at HIV diagnosis. The rate of AIDS-related deaths was less frequent among men who have sex with men, smokers, and ex-smokers, individuals on antiretroviral therapy, those with higher CD4 counts, and individuals with comorbid diseases.

Conclusions: Among all deaths, AIDS-related deaths have declined. In contrast, the proportion of deaths attributed to non-AIDS-related cancers has increased, and the mortality rate from cardiovascular disease has remained unchanged over the years. Therefore, it is crucial to implement interventions that address comorbid conditions, particularly by enhancing the management of cardiovascular disease and cancer.