Infection最新文献

Background: Hospital-acquired bloodstream infections (HA-BSI), including catheter-associated bloodstream infections (CABSI), cause preventable harm in haemato-oncology patients but surveillance data are limited.

Methods: We performed a retrospective cohort study using prospectively collected data in a large hospital network in Switzerland from 2017-2022. Incidence, source, and microbiology of HA-BSI were compared between (1) haematology patients with acute leukaemia or allogeneic stem cell transplantation (2) oncology patients with solid tumour or lymphoma, and (3) general medical patients. No routine quinolone prophylaxis was prescribed.

Results: We included 320,058 patient-days and 201,081 catheter-days across two haematology, two oncology and nine non-COVID-19 general medical wards. 669 HA-BSI occurred in 547 individual patients. In haematology patients, HA-BSI incidence was 9.1/1000 patient-days (95% CI 8.2-10.3). 224/299 (75%) of episodes were "unknown/other" source. Low virulence Gram-positive organisms (coagulase-negative staphylococci, viridans Streptococci, enterococci) accounted for 232/378 (61%) HA-BSI organisms and 46/52 (88%) CABSI organisms. Compared to oncology and general medical patients, haematology patients had higher HA-BSI incidence, but a smaller proportion of infections caused by virulent organisms (Gram-negative bacteria, Staphylococcus aureus, p < 0.01).

Conclusions: In haematology patients, HA-BSI are less commonly caused by virulent Gram-negative organisms or Staphylococcus aureus compared to solid tumour and general medical patients, in the absence of quinolone prophylaxis.

Background: Over the last century infectious diseases have been kept under control in industrialized countries thanks to advances in hygiene, prevention and antimicrobial treatments. However, the emergence of HIV, the COVID-19 pandemic, and the rise of resistant bacteria exemplify that infectious diseases continue to pose a global threat. A comprehensive understanding of the caseload, spectrum of infectious diseases and the economic impact they pose is required to develop strategies for managing infectious diseases in a resilient healthcare system.

Objectives: (i) to determine the proportion of adult patients discharged from German hospitals with primary diagnoses classified as an infectious disease, (ii) to describe the clinical spectrum of these diagnoses, case characteristics, and hospital settings, and (iii) to estimate the total economic burden that these cases contribute to the in-patient sector of the healthcare system.

Methods: A retrospective case-control study was performed using publicly available data on ICD10 codes assigned as primary diagnoses, case characteristics, treatment settings, and cost weights from all patients discharged from German hospitals in 2022.

Results: 1,728,824 adult patients (12% of all adult patients) were discharged with a primary diagnosis classified as an infectious disease. They were assigned 912 individual ICD10 codes. The 15 and 79 most frequently used codes comprised 40% (top 40% ID population) and 80% (top 80% ID population) of all infectious disease cases, respectively. In the top 80% ID population, patients were older, were more likely to be male, and had higher complexity and comorbidity levels than the reference population, which consisted of all adult patients minus the patients in the top 80% ID population. The mean length of stay of patients forming the top 80% ID population was 8.0 days vs. 6.1 days in the reference population. The median (IQR) cost weight was 0.663 (0.544-1.030) translating into €2,541 per case.

Conclusions: In Germany, patients with infectious diseases constitute a significant proportion of all inpatients, with a broad spectrum of conditions. These patients are generally older, more severely ill, and require longer hospital stays than those without a primary infectious disease diagnosis, contributing substantially to the overall economic burden on the healthcare system.

Purpose: To understand the geographic origins, transmission hotspots, and drug resistance mutations (DRMs) of HIV-1 CRF08_BC in Zhejiang Province, China.

Methods: This study analyzed HIV-1 CRF08_BC pol sequences collected between 2020 and 2023. Bayesian inference was employed to investigate temporal epidemic trends, while HIV-TRACE and MCODE were used to identify transmission clusters (TCs), key hotspots and super-spreaders. DRMs associated with CRF08_BC were also characterized. Additionally, demographic data were integrated with these findings, allowing for a description of the transmission dynamics.

Results: This study revealed that CRF08_BC strains in Zhejiang likely originated from Guangxi, with significant transmission among individuals aged 50 and older, particularly those with low educational levels. Molecular transmission analysis showed that 58.9% of CRF08_BC sequences were in TCs, with geographic concentrations in Taizhou (TZ) and Lishui (LS). 14 large clusters maintained effective reproductive numbers (Re) above 1, representing considerable epidemic growth. Hangzhou (HZ) emerged as a key transmission hub, with 10 TCs showing active transmission. LS established strong epidemiological links with HZ, Ningbo (NB), Taizhou (TZ), and Wenzhou (WZ), creating a pattern of viral spread radiating from LS to surrounding areas. DRMs were identified in 76 cases (6.0%), with NNRTI and NRTI mutations exhibiting distinct geographic clustering.

Conclusions: The CRF08_BC strains in Zhejiang likely originated from Guangxi and are mainly found in individuals aged 50 and older with low education. The current epidemic hotspots are in TZ and LS, where NNRTI and NRTI mutations are clustered, significantly impacting treatment efficacy.

Objectives: Mycobacterium chelonae is a rapid-growing non-tuberculous mycobacterium that has occasionally been described in connection with foreign material infections, e.g. after orthopaedic joint replacement or cosmetic surgery. In a recent outbreak, several cases of M. chelonae endocarditis associated with biological heart valve prostheses were reported.

Case history: A 64-year-old female patient with a history of myalgia and recurrent joint swelling presented to our hospital. Initially suspected for rheumatoid arthritis, the patient underwent a series of orthopedic and rheumatologic treatments, including prednisolone and methotrexate. Subsequent history revealed a Ross operation in 2014 and a PET-CT was suspicious of a biological valved conduit infection leading to surgical replacement. Utilizing fluorescence in situ hybridization (FISH) diagnostic techniques, DAPI, Kinyoun and Ziehl-Neelsen staining, mycobacterial infection was confirmed in both the prosthesis and adjacent muscle tissue. Molecular methods identified a mycobacterium most closely related to the M. chelonae/abscessus complex indicating an association to a previously described outbreak of M. chelonae contaminated heart valves. Antimycobacterial therapy was initiated and the patient remains stable at the time of writing. To date, all mycobacterial cultures remained negative.

Conclusions: Non-tuberculous mycobacteria (NTM) are rare and possibly underdiagnosed pathogens in infections of bioprosthetic flap bearing conduits. Mycobacterial foreign-body infections can manifest many years after implantation. As NTM can be difficult to detect, molecular identification methods are of particular importance. Here, modern imaging, molecular and microscopic techniques might be of special use in diagnosing prolonged prosthetic graft infections.

Purpose: To ascertain the predictors of persistent bacteraemia among patients with suspected infective endocarditis (IE) and those with IE.

Methods: Retrospective study.

Setting: This study conducted at a Swiss university hospital (2015-2023) included adult patients with bacteraemia and suspected IE. Persistent bacteraemia was defined as continued positive blood cultures with the same microorganism for at least 48 h from antibiotic treatment initiation. Endocarditis Team classified cases as IE or not IE.

Results: Among 2312 episodes of suspected IE, S. aureus was the most common pathogen (1045 episodes; 45%). IE (644; 28%) was the most prevalent infection type. Persistent bacteraemia was observed in 480 (21%) episodes and was independently associated with S. aureus, ≥ 2 positive sets of index blood cultures, resistant bacterium, sepsis, IE, central venous catheter-associated bacteraemia, and acute native bone and joint infections (BJIs), while, streptococcal bacteraemia, appropriate initial antimicrobial treatment and, performance of source control interventions within 48 h were associated with rapid blood culture clearance. Of the 644 IE episodes, persistent bacteraemia was observed in 196 (30%) and was associated with obesity, S. aureus, ≥ 2 positive sets of index blood cultures, resistant bacterium, acute native BJIs, immunologic phenomena, thoracic embolic events, while streptococcal bacteraemia and performance of source control interventions within 48 h were associated with rapid clearance of blood cultures.

Conclusions: Persistent bacteraemia was associated with S. aureus and BJI. Delaying source control interventions may increase the risk of persistent bacteraemia. No specific intracardiac lesion was associated with persistent bacteraemia in IE episodes.

Objective: This study aimed to ascertain the factors influencing the varicella-zoster virus (VZV) IgG seropositivity and to evaluate the efficacy of varicella vaccination with 1- and 2-dose schedules.

Methods: A systematic sampling method was employed to recruit subjects. VZV IgG was calculated using the geometric mean concentration (GMC) and a 95% confidence interval (CI). A multifactorial logistic regression model was employed to calculate the odds ratios (OR) and to identify the influential factors for varicella antibody positivity. A generalized additive model for location, shape and scale (GAMLSS) was employed to compare centile reference values and centile curves of antibody levels for different doses of varicella vaccine (VarV).

Results: 785 individuals were included. The VarV positivity rate was 57.7% for 1 dose and 84.2% for 2 doses. Varicella antibody positivity was significantly associated with VarV doses and time since last vaccination. The GAMLSS model indicated a decline in VZV IgG over time, with the 2-dose group demonstrating superior performance to the 1-dose group across all centile reference values and curves.

Conclusion: A 2-dose schedule is more effective in improving both VZV IgG seropositivity and GMC than a single dose. The inclusion of the VarV in routine immunization programme should be considered.

Purpose: Cefiderocol (CFDC) and sulbactam/durlobactam (SUL/DUR) are new treatment options against infections by carbapenem-resistant A. baumannii (CRAB). However, whether they outperform contemporary alternative best available therapy (BAT), currently consisting of high-dose ampicillin/sulbactam (AMP/SUL)-based regimens, is unclear.

Methods: A systematic review was conducted in PubMed and clinical trial registries to assess regimens used in comparator arms in studies comparing CFDC or SUL/DUR to alternative treatment regimens.

Results: Only 1 relevant study was found for SUL/DUR (the registrational Phase 3). Almost all (98%) patients enrolled had pneumonia and the comparator arm was colistin/imipenem, a regimen not recommended for treatment of CRAB infections, especially pneumonia. With regards to CFDC, subgroup analyses (with significant limitations) from 2 randomized trials were disappointing showing higher mortality in CREDIBLE-CR compared to colistin-based treatment and similar mortality in APEKS-NK compared to high-dose meropenem among patients with CRAB infections. The rest (n = 11) of the trials were observational, predominantly single-center (82%) and retrospective (82%), and all but one were conducted in Italy (91%). Although meta-analyses of observational studies suggest better outcomes with CFDC, the comparator arm was colistin-based in all cases and only a minority of patients had received high-dose AMP/SUL.

Conclusion: High-quality evidence supporting use of either CFDC or SUL/DUR in favor of high-dose AMP/SUL-based regimens is lacking. This has important stewardship implications. Additionally, both CFDC and SUL/DUR are much more expensive than AMP/SUL, an important consideration especially for low-/mid-income countries. Studies comparing CFDC- and SUL/DUR-based treatments to contemporary alternative BAT are needed.

Background: While numerous studies have documented severe and long-term health impacts of COVID-19 infections on various organs, the prolonged multisystemic implications of other acute respiratory infections (ARIs) are poorly understood. This review therefore analyzed currently available studies about these sequelae of ARIs excluding COVID-19.

Main body: Multiple pathogens causing ARIs are associated with significant long-lasting impairments across various organ systems. Cardiovascular events occur in 10-35% of patients following ARIs, with an elevated risk persisting for 10 years. The stroke incidence ratio increases significantly after ARIs up to 12.3. Pulmonary sequelae are common, including abnormal lung function in 54%, parenchymal opacification in 51%, lung fibrosis in 33-62%, asthma in 30%, and bronchiectasis in 24% of patients. The risk of developing dementia is increased 2.2-fold. Posttraumatic stress disorder, depression, anxiety, and chronic fatigue occur in 15-43%, 15-36%, 14-62%, and 27-75% of patients, respectively. 28-day mortality from CAP with (versus no) additional cardiovascular event is increased to 36% (versus 10%). Long-term mortality from CAP (versus no CAP) remains elevated for years post-infection, with a 1-year, 5-year, and 7-year mortality rate of 17% (versus 4%), 43% (versus 19%), and 53% (versus 24%), respectively. Patients´ quality of life is significantly reduced, with 17% receiving invalidity pensions and 22% retiring within 4 years of severe ARIs.

Conclusion: Non-COVID-19 ARIs are associated with clinically relevant, frequent, and long-term sequelae involving multiple organ systems. Further prospective studies are needed.

Background: Bloodstream infections (BSI) due to Candida spp. significantly contribute to morbidity and mortality among cancer patients. Understanding their clinical course, risk factors, and outcomes compared to bacterial BSI is essential.

Aim: We aim to elucidate the epidemiology and risk factors associated with Candida BSI compared to bacterial BSI in cancer patients.

Methods: We analyzed epidemiological data of Candida BSI versus bacterial BSI among cancer patients, primarily with hematological malignancies. Blood cultures were obtained upon clinical suspicion, with species identification by VITEK 2 and MALDI-TOF. Susceptibility testing utilized VITEK 2 or antibiotic gradient tests.

Results: Candida BSI was associated with higher 30-day mortality compared to bacterial BSI (Hazard ratio (HR) 4.5, 95% CI 2.5-8.1, p < 0.001) occurring predominantly in patients with relapsed/refractory disease. Univariate analysis identified risk factors for Candida BSI: hypoalbuminemia (Odds ratio (OR) 9.13, 95% CI 2.7-57, p = 0.003), prior ICU/MC stay (OR 3.91, 95% CI 1.38-9.65, p = 0.005), palliative treatment (OR 3.42, 95% CI 1.52-7.4, p = 0.002), parenteral nutrition (OR 2.44, 95% CI 0.9-5.5, p = 0.039) and prior allogeneic HSCT (OR 2.28, 95% CI 0.92-5.13, p = 0.056). Risk factors identified by multivariate analysis were palliative therapy (OR 5.23, 95% CI 3.14-8.71, p = 0.001), hypoalbuminemia (OR 9.02, 95% CI 4.23-19.2, p = 0.004), and prior ICU/IMC stay (OR 4, 95% CI 2.31-6.92, p = 0.011). In patients with confirmed Candida BSI, delayed initiation of antifungal was associated with worse outcomes.

Conclusion: Compared to bacterial BSI events, Candida BSI are associated with significantly higher 30-day mortality, primarily affecting heavily pretreated patients with relapsed or refractory disease.

Purpose: Diphtheria is a re-emerging vaccine-preventable disease, mainly caused by toxigenic Corynebacterium diphtheriae.

Methods: Here, we report a fatal respiratory diphtheria infection in a Polish woman travelling to Germany possibly linked to a cutaneous diphtheria infection in a homeless man living in the same geographic area. Laboratory diagnostics involving MALDI-TOF MS, tox-gene PCR, Lateral Flow Immuno Assay, a modified Elek test and Next Generation Sequencing (NGS) identified the causative strain as cotrimoxazole-resistant toxigenic Corynebacterium diphtheriae biotype mitis, sequence type ST574. Moreover, a review on the diphtheria situation in Poland is presented.

Results: NGS data suggest a common source of infection in Poland and a possible link to the Europe-wide outbreak of imported diphtheria with C. diphtheriae since 2022. This is the first diphtheria case in Poland since 2000.