Infection最新文献

Background: Sex disparities in tuberculosis (TB) outcomes are not well characterized, especially in high-income countries where social vulnerability and migration influence access to care. Although men globally experience a higher TB burden, the interaction between sex, migration, and social determinants is complex and extends beyond biological factors. This study evaluated sex differences in clinical and programmatic TB outcomes in a high-income European country with a significant substantial migrant population.

Methods: A retrospective multicentre cohort study was conducted across 16 Infectious Diseases Units in seven Italian regions from (January 2021 to September 2025). Outcomes included time to sputum conversion (in pulmonary TB), length of hospital stay (LOS), adverse events (AEs) and their severity, incomplete treatment (defined as failure, death, or loss to follow-up), and loss to follow-up (LTFU). Mixed-effects models were applied using two prespecified adjustment sets: sex, centre, and core confounders (Model A); and sex, centre, and clinically relevant baseline imbalances (Model B). Sub-analyses examined the impact of migration status.

Results: Of 982 TB patients, 229 (23.3%) were women and 753 (76.7%) were men. Women exhibited lower rates of smoking (24.4% vs 36.7%), diabetes (7.9% vs 15.8%), and COPD/bronchiectasis (4.5% vs 10.3%). The median sputum conversion time was 21 days for both sexes. Adjusted analysesindicated shorter LOS among women (Model A: - 22% [95%CI - 32 to - 10]; Model B: - 19% [95%CI - 28 to - 9]). Time to sputum conversion was slightly shorter in women in Model A (- 13%; 95%CI -23% to -1%) but not in Model B (- 9%; 95%CI -17% to 1%). The risk and severity of AEs were similar between sexes. In Model B, women had lower odds of incomplete treatment (OR 0.64 [95%CI 0.41 to 0.99]) and LTFU (OR 0.62 [95%CI 0.38 to 0.99]). Migrants experienced worse overall outcomes, but the effect of sex did not differ by migration status.

Conclusion: Women had consistently shorter hospital stays and greater treatment continuity without increased toxicity, indicating that sex differences in TB outcomes are likely attributable to social and behavioural factors rather than biological differences. Supportive associative networks and non-governmental organisations may help reduce sex disparities, underscoring the importance of sex- and migration-responsive TB care models in Europe.

Purpose: Necrotizing soft tissue infections (NSTIs) are life-threatening infections often caused by toxin-producing bacteria. Clindamycin has historically been favoured for its toxin-inhibiting properties but increasing resistance and adverse effects have prompted interest in alternatives. This study evaluates the efficacy and safety of linezolid versus clindamycin plus anti-gram-positive therapy in patients with severe or necrotizing skin and soft tissue infections (SSTIs).

Methods: A systematic literature search through December 12, 2024, was conducted across eight databases and clinical trial registries. Studies comparing linezolid-containing regimens to clindamycin plus anti-gram-positive therapy in patients with severe SSTIs were included. Outcomes of interest included ICU length of stay (LOS), hospital LOS, mortality, ventilator days, vasopressor days, antimicrobial duration, and adverse effects. Random-effects meta-analyses were performed for ICU LOS and hospital LOS.

Results: Of 310 articles screened, four retrospective studies met inclusion criteria. Moderate to significant risk of bias was present. No significant differences were observed in ICU LOS (mean difference [MD]: -0.001 days; 95% CI: -1.110 to 1.107; p = 0.998; I² = 0.8%) or hospital LOS (MD: -2.797 days; 95% CI: -7.027 to 1.433; p = 0.195). Two studies reported lower rates of acute kidney injury (AKI) with linezolid. Mortality data were limited. No other significant differences were found.

Conclusions: No significant difference in ICU and hospital length of stay were noted between linezolid and clindamycin-based regimens. Lower rates of AKI were reported with linezolid. However, given the study design and potential risk of bias these results should be interpreted with caution.

Background: Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction with multifactorial pathophysiology, including post-infectious mechanisms. In endemic regions, intestinal parasitic infections remain highly frequent and may contribute to persistent gastrointestinal symptoms; however, their role in IBS is often under-recognized and insufficiently studied. This study aimed to compare the frequency and species distribution of intestinal parasitic infections among IBS patients and healthy controls and to evaluate their independent association with IBS in an endemic setting.

Methods: A hospital-based case-control study was conducted in 2023, including 100 IBS patients diagnosed according to Rome IV criteria and 100 age-matched healthy controls. Stool samples were examined using World Health Organization-recommended parasitological techniques, including direct microscopy, concentration methods, staining, and culture. Multivariate logistic regression analysis was performed to assess factors independently associated with IBS.

Results: Intestinal parasitic infections were significantly more frequent among IBS patients compared with controls (P < 0.001), with Entamoeba histolytica and Giardia lamblia predominant. Parasitic infection showed a strong independent association with IBS, along with female sex and short sleep duration.

Conclusion: Intestinal parasitic infections are significantly associated with IBS in endemic regions. These findings suggest that parasitological evaluation may warrant consideration during IBS assessment in selected settings.

Acute respiratory tract infections (ARTIs) are among the most common reasons for antibiotic prescriptions globally, despite the majority being viral and self-limiting. Because clinical signs alone are often insufficient, there is a clear need for rapid diagnostic methods to support evidence-based prescribing. We assessed the effectiveness of point-of-care C-reactive protein (POCT-CRP) testing devices for distinguishing between bacterial and viral ARTIs. Our search of five databases produced 413 studies, of which 29 met criteria, and six were included in the meta-analysis. The devices with adequate performance data were QuikRead CRP, NycoCard Reader II, and FebriDx®. Overall pooled sensitivity 70% (95% CI 52-83%) and specificity 86% (95% CI 80-91%). The FebriDx showed a pooled sensitivity of 84% (95% CI 76-90%) and specificity of 87% (95% CI 82-91%). The QuikRead showed a pooled sensitivity of 35% (95% CI 30-40%) and specificity of 86% (95% CI 82-89%). The NycoCard Reader II showed a pooled sensitivity of 54% (95% CI 21-83%) and specificity of 86% (95% CI 59-96%). Although POCT-CRP testing is useful in distinguishing between bacterial and viral ARTIs and is critical for antibiotic prescription, further evidence, including cost-effectiveness analysis, is needed to determine whether the implementation of POCT-CRP improves value or merely raises healthcare expenses.

Purpose: The study aimed to compare the clinical outcomes and safety of trimethoprim/sulfamethoxazole (TMP/SMX) versus levofloxacin monotherapy in patients with monomicrobial Stenotrophomonas maltophilia (S. maltophilia) bacteremia.

Methods: We conducted a retrospective cohort study of adult inpatients with monomicrobial S. maltophilia bacteremia at a tertiary medical center in Taiwan from January 2004 to June 2025. Patients were divided into two groups for comparison based on antibiotic treatment: TMP/SMX and levofloxacin monotherapy. Primary outcome was 30-day mortality. Secondary outcomes included in-hospital mortality, clinical response, microbiological eradication, non-susceptible strains emergence, recurrent bacteremia, and adverse drug reactions. Multivariable logistic regression and propensity score analysis were performed using inverse probability of treatment weighting (IPTW).

Results: Among 226 patients, 129 received levofloxacin and 97 received TMP/SMX. The levofloxacin-treated group was associated with lower 30-day mortality (17.8% vs. 36.1%, p = 0.002) in the primary analysis. In the multivariable logistic regression model, levofloxacin use was independently associated with improved outcomes (p = 0.047). Similarly, in the IPTW analysis, levofloxacin use remained a factor of lower 30-day mortality (p = 0.026). Additionally, microbiological eradication, emergence of non-susceptible strains, and recurrent bacteremia were comparable between the treatment groups, while adverse events were significantly less frequent in patients treated with levofloxacin (3.1% vs. 25.8%, p < 0.001).

Conclusions: Levofloxacin appeared to be more effective and safer than TMP/SMX in this retrospective analysis; however, this interpretation should be made with caution given the observational nature of the study. Further randomized clinical trials are warranted to validate these findings.

Objectives: Complicated urinary tract infections (cUTIs) are ubiquitous, associated with healthcare resources, and demand effective antibiotic treatment to prevent clinical failure and relapse. Evidence on health economic implications of treatment options remains limited. Recent studies have shown that cefepime/enmetazobactam was superior to piperacillin/tazobactam regarding the combined endpoints clinical cure and microbiological eradication, the latter being closely linked to reduced relapse rates. Therefore, we perform a health economic evaluation of cefepime/enmetazobactam vs. piperacillin/tazobactam for cUTI from a German payer perspective.

Methods: To assess monetary impacts of both therapies, we conducted a semi-structured literature review for costs of (relapsed) cUTI. Subsequently, we adjusted international costs to the German healthcare system using European price levels of the Organisation for Economic Cooperation and Development. These built the basis of a comparative health economic analysis using a decision tree incorporating outcome probabilities and relapse rates for both antibiotics. Lastly, we validated the analysis using publicly available remuneration data from German hospitals.

Results: Literature revealed international costs of €5,394 and €6,675 per patient without and with clinical relapse, converting to €5,137.14 and €6,357.14 in Germany, respectively. Considering the probability of occurrence of clinical cure, microbiological persistence, and relapse rates, average treatment costs per patient for cefepime/enmetazobactam amount to €5,332.12 compared to €5,414.83 for piperacillin/tazobactam.

Conclusion: The analysis shows that a higher probability of relapse after antibiotic therapy might be associated with an increase in treatment costs within the German healthcare system. Although per-patient cost differences between cefepime/enmetazobactam and piperacillin/tazobactam are moderate, their cumulative impact at the population level could be substantial, emphasizing the broader health-economic relevance of treatment choice for cUTI.

Background: Typhoid is a serious infectious disease that is highly prevalent in low and middle income countries (LMICs) and causes severe morbidity and mortality. Typhoid conjugate vaccines (TCVs) have been developed to prevent and control typhoid infection, however, overall and pooled evidence on vaccine efficacy, immunogenicity and safety profiles in the pediatric population is limited.

Methodology: We conducted a systematic review and meta-analysis on August 12, 2025 using randomized controlled trials (RCTs) that assessed the vaccine efficacy of TCVs in the pediatric population. Included studies compared TCVs with a well-defined control groups i.e. either placebo, MenA or SA 14-14-2 JE vaccine. The vaccine efficacy data were pooled and estimates were generated via random effects model. Data on immunogenicity and safety were also extracted.

Results: A total of five RCTs, involving over 120,000 participants from Asia and Africa were included. Pooled vaccine efficacy of TCVs was 83% (95% CI 78-87%) with low heterogeneity (I² = 28%). Age-stratified analysis revealed consistent results across age groups, though estimates in children < 2 years were not statistically significant. Immunogenicity outcomes demonstrated marked rises in Vi-IgG titres within 28 days of vaccination which progressively waned. The safety outcomes were favourable, with most adverse events being mild and self-limiting.

Conclusion: We conclude that TCVs are highly efficacious, immunogenic and safe among children, supporting their implementation in national immunization schedules. Further studies are needed to determine the duration of protection and the need for booster doses.

Purpose: Novel β-lactam/β-lactamase inhibitor combinations (BL/BLICs) such as ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), imipenem/relebactam (IMP/REL) and aztreonam/avibactam (ATM/AVI) have expanded therapeutic choices against KPC-producing K. pneumoniae. However, emerging resistance threatens their long-term efficacy. We investigated the prevalence, genomic mechanisms, and clinical correlates of resistance to these agents among KPC-producing K. pneumoniae bloodstream isolates.

Methods: Consecutive KPC-producing K. pneumoniae bloodstream isolates collected between 2021 and 2024 at a tertiary university hospital were tested for susceptibility to novel BL/BLICs and comparators. Whole-genome sequencing (WGS) was performed on isolates resistant to any BL/BLIC to characterise genetic backgrounds. Clinical data from corresponding patients were analysed to explore risk factors and outcomes.

Results: Among 178 K. pneumoniae isolates, ATM/AVI, IMP/REL and MEM/VAB retained excellent in vitro activity (≥ 96% susceptible), while 11% were resistant to CAZ/AVI. One hundred fifty-four (86.5%) were susceptible to all BL/BLICs, whereas 24 (13.5%) displayed resistance to at least one agent, most commonly CAZ/AVI. WGS revealed a genetically diverse population mainly comprising high-risk clones ST512 and ST101. Resistance was driven by KPC variants (KPC-31, KPC-167, KPC-93, KPC-49, KPC-14, KPC-121, KPC-33) and porin disruptions (OmpK36 insertions, OmpK35 loss). Most patients (91%) had prior colonisation and recent β-lactam exposure; median time to resistance emergence was 47 days. The 28-day mortality among patients with BL/BLIC-resistant infections was 21.7%.

Conclusion: Resistance to novel BL/BLICs among KPC-producing K. pneumoniae is emerging in Italian hospitals, largely mediated by bla_KPC variants and porin defects under selective antibiotic pressure. While ATM/AVI, MEM/VAB and IMP/REL remain highly active, resistance to CAZ/AVI is increasingly frequent. Continuous genomic surveillance and optimised antimicrobial stewardship are essential to preserve the efficacy of these last-line agents.