Infection最新文献

Purpose: Young children who are exposed to people with infectious tuberculosis (TB) have an increased risk of developing TB disease following infection. The risk of infection and disease progression can be minimized by prompt identification of TB-exposed individuals and initiation of prophylactic or preventive treatment.

Methods: We report on a TB outbreak in a daycare center in Berlin, Germany following a delayed diagnosis of cavitary pulmonary TB in a childhood educator. We describe contact investigation, diagnostic, prophylactic, preventive and therapeutic measures in 62 TB-exposed children (median age 3.9 years), including 30 with prolonged TB exposure.

Results: The initial examination took place 5-16 days after the index patient was diagnosed with TB. Ten of the 30 children with intensive contact became infected, six (median age 2.7 years) developed pulmonary TB. Three of these children had a concurrent influenza infection, which may have contributed to disease progression. No child without prolonged exposure to the index patient developed disease.

Conclusion: Early diagnosis of TB in adult patients, especially those with persistent cough, is crucial to prevent TB in vulnerable infants. Close collaboration between public health departments and specialized facilities is essential for the effective control of TB outbreaks.

Background: Streptococcus pneumoniae remains a common cause of community-acquired pneumonia but is an infrequent pathogen in hospital-acquired pneumonia (HAP). Non-vaccine serotypes of multidrug-resistant (MDR) S. pneumoniae strains have been emerging globally, posing an increased risk of nosocomial infection.

Case: A 71 year-old man developed pneumonia on postoperative day 4 following spinal fusion surgery. Despite initial treatment with ampicillin/sulbactam, his condition deteriorated, requiring ICU admission and mechanical ventilation. Microbiological testing confirmed S. pneumoniae as a causative pathogen, and ceftriaxone was empirically administered based on the local antibiogram. However, antimicrobial susceptibility testing revealed resistant profiles to penicillin (minimum inhibitory concentration [MIC], 8 µg/mL), ceftriaxone (MIC, 16 µg/mL), meropenem (MIC, 1 µg/mL), macrolides, and clindamycin, while demonstrating susceptibility to levofloxacin and vancomycin. The therapeutic regimen was subsequently adjusted to levofloxacin, resulting in clinical improvement. The isolate was later identified as serotype 15A, sequence type 63 (ST63).

Conclusion: This case highlights that MDR S. pneumoniae can cause early-onset HAP and may not be covered by standard empiric therapies, emphasizing the need for careful evaluation of treatment response. Continued surveillance of infections caused by vaccine-escape clones like MDR serotype 15A is essential, given their increasing clinical relevance.

Purpose: Paediatric parapneumonic effusion (PPE) is accompanied by an increased risk of complications, e.g., sepsis or lung sequelae. Treatment strategies span from antibiotics alone to surgical interventions, but an internationally accepted guideline is lacking. With this study, we aim to better understand how management strategies influence short-term outcome parameters, like length of stay, antibiotic treatment duration, and lung damage.

Methods: Retrospective observational single-centre study. Patients admitted from 1 July 2004 to 30 June 2024 with PPE to our tertiary hospital were analysed. We used the exact Jonckheere-Terpstra test to analyse trends over time.

Results: A total of 278 patients were included, 23 (8%) had to be excluded for lack of informed consent. A majority (173/255, 68%) were treated with pleural drainage. Over time, drains were increasingly more often inserted without surgery, 20% vs. 65% (p = 0.001) in 2004-2008 vs. 2020-2024. Intravenous antibiotic treatment duration declined from 15 days in 2004-2008 to 11 days in 2020-2024, p = 0.002. The most commonly identified pathogen was S. pneumoniae (39%), followed by S. pyogenes (18%). S. pyogenes compared to S. pneumoniae was more often associated with sepsis or toxic shock (45% vs. 6%, p < 0.0001), but fewer patients showed radiologic evidence for acute lung damage (68% vs. 23%, p < 0.001).

Conclusion: We found considerable clinical differences in patients with PPE caused by S. pneumoniae vs. S. pyogenes. The former was associated with substantially greater lung damage.

Purpose: Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM-) patients in a European CAP cohort.

Methods: Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002-2022, with and without a history of DM, were conducted.

Results: Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM- patients, DM+ patients had a higher 180 days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), p < 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97 mg/L (IQR: 31-202) vs. 86 mg/L (IQR: 24-190), p < 0.0001; median leucocyte count 12/nl (IQR: 9-16)vs. 11/nl (IQR: 8-15), p < 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM- patients (p = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), p_adj < 0.01).

Conclusions: CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.

Purpose: Otogenic meningitis is a rare but potentially life-threatening intracranial complication of otitis media (OM). Our aim was to study the incidence of childhood otogenic meningitis and to compare clinical presentation, causative pathogens, diagnostics, treatment, and outcome of otogenic versus non-otogenic meningitis.

Methods: Charts were reviewed for 47 children admitted to our tertiary center with bacterial meningitis (BM) between 2010 and 2020. Otoscopy and/or imaging were used to determine the otogenic meningitis ratio and the mean annual incidence was calculated.

Results: Eight (17%) of the 47 BM cases were otogenic [5 males; median age 1.3 years (range 2 months to 16 years)]. The otogenic meningitis incidence was 0.3/100 000/year. The classic triad of fever, altered level of consciousness, and meningeal irritation was more common in children with otogenic meningitis (50%, 4/8) than without OM (14%, 5/36) (P = 0.042). Streptococcus pneumoniae was a more common pathogen in children with OM (88%, 7/8) than without OM (14%, 4/29) (P < 0.001), whereas Neisseria meningitidis infection occurred only in children without OM (41%, 12/29) (P = 0.036). Neurological sequelae at discharge were present in 3 (38%) children with OM. Deafness was diagnosed in two children, both with otogenic backgrounds. Three children showed long-term sequelae: 2 had deafness (aged < 2 years) and 1 had aphasia/dysphasia.

Conclusion: The incidence of otogenic meningitis was 0.3/100 000/year, with S. pneumoniae the most common causative pathogen. Deafness was the most common long-term sequela and occurred only in children with otogenic meningitis.

Purpose: Sepsis is a leading cause of morbidity and mortality, yet its documentation and coding in administrative health data remain unreliable. Accurate coding is essential for epidemiological surveillance, quality assurance, and reimbursement. This study aims to identify patient characteristics associated with under-diagnosis and under-coding of sepsis in German inpatient administrative health data (IAHD).

Methods: This secondary analysis of the multicenter OPTIMISE study included 10,334 hospital cases from ten German hospitals (2015-2017). Sepsis cases were identified via structured chart review and compared to ICD-coded diagnoses. Logistic regression and classification tree analyses were used to determine predictors of under-diagnosis and under-coding, including ICU admission, organ dysfunction, and infection source.

Results: Among 1,310 cases fulfilling severe sepsis-1 criteria, only 30.7% were correctly coded. The strongest predictor for coding accuracy was explicit mention of sepsis in the medical chart (OR 19.58). ICU treatment, organ dysfunction severity, and mechanical ventilation were also associated with higher coding rates, while pneumonia as the infection source was linked to a lower probability of sepsis being named and coded.

Conclusion: Sepsis coding in administrative data is frequently inaccurate. Explicit naming of sepsis and severity markers strongly influence correct coding. As Germany introduces mandatory sepsis quality assurance in 2026, targeted interventions - including enhanced clinician documentation and electronic coding support - are essential to improve coding reliability and patient care.

Background: Infections with Carbapenem-resistant Enterobacterales (CREs) are a serious public health threat. The emergence of distinct New Delhi metallo-beta-lactamase (NDM)-producing K. pneumoniae strains resistant to cefiderocol is a significant concern given the limited armamentarium for these carbapenemases.

Methods: A case series of 12 patients was described from a single institution that had cefiderocol-resistant, NDM-producing K. pneumoniae infections between January 2023 and July 2024. Whole genome sequencing with core SNP analysis was performed to identify resistance mechanisms and clonal relatedness for 9 isolates.

Results: Patients presented with various infections, including skin and soft tissue infections, pneumonia, and bacteremia. Of concern, cefiderocol resistance was seen among patients with and without prior cefiderocol exposure. Genomic analysis for 9 patients revealed NDM-5 in every isolate, along with additional mutations associated with resistance. A cluster of ST147 identified multiple distinct CirA disruptions, suggestive of convergent evolution with or without cefiderocol exposure. Treatment with either ceftazidime-avibactam plus aztreonam or tigecycline was successful in most instances, although microbiologic recurrence occurred in certain cases.

Conclusion: High level cefiderocol resistance among NDM-5 producing K. pneumoniae with siderophore mutations add more challenges to treating CRE infections. Stricter infection control measures along with enhanced surveillance are needed, especially in regions where NDM is endemic to limit additional spread of these variants.

Breakpoints to define the susceptibility of pathogens to antibiotics are becoming increasingly popular as guidance for antimicrobial therapy. Some breakpoints consider divergent concentrations of antibiotics in different compartments, others list one breakpoint for infections at all sites. Compared to the determination of exact minimal inhibitory concentrations (MICs) and relation of these MICs to concentrations achievable in ventricular CSF, the exclusive use of breakpoints for central nervous system (CNS) infections is a setback. The lack of the determination of exact MICs may be a risk, particularly when no clinical breakpoints for CNS infections have been defined. Moreover, the current practice of MIC determination of β-lactam/β-lactamase inhibitor combinations with fixed β-lactamase inhibitor concentrations ignores that often these β-lactamase inhibitor concentrations are not attained in CSF with established antibiotic regimens. In CNS infections, we strongly recommend the exact determination of MICs and their interpretation in relation to the true antibiotic concentrations in the infected compartment.

Human metapneumovirus (hMPV) is a significant cause of respiratory infections worldwide, particularly in young children, the elderly, and immunocompromised individuals. Since its discovery in 2001, hMPV has been recognized as a major contributor to acute respiratory tract infections, along with respiratory syncytial virus (RSV) and influenza. This review explores the virology, epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and recent advances in therapeutic and preventive strategies for hMPV infection. By consolidating current knowledge, we aim to highlight the importance of hMPV in public health and the need for continued research to address its clinical and economic burdens.