Infection最新文献

Purpose: To quantify virologic failure (VF), identify predictors, characterize resistance patterns at failure, and evaluate time to resuppression in the RESINA cohort.

Methods: ART-naïve adults initiating ART in 2001-2024 were followed. VF was defined as at least one HIV-1 RNA > 200 copies/mL after suppression or ≥ 0.5-log₁₀ rebound. Participants were grouped by treatment era (2001-2007, 2008-2013, ≥ 2014), reflecting availability of drug classes. Genotypes at baseline and VF were interpreted using the HIV-GRADE algorithm. Predictors of VF were assessed with logistic regression; time to resuppression (< 50 copies/mL) after first VF with Cox models and Kaplan-Meier plots.

Results: Among 5136 participants, 139 (2.7%) had VF; rates declined across eras (4.7%, 2.6%, 1.7%). Independent predictors were injection-drug use (OR 1.74), CD4 < 200/µL (OR 2.32), and ART start in 2001-2007 (OR 1.95); MSM acquisition was protective (OR 0.32). At failure, 36 patients showed resistance, often multiclass (61%); INSTI resistance was rare (n = 5). After first VF, 122/139 cases resuppressed (median 147 days). Male sex predicted faster resuppression (HR 1.81); higher failure VL trended to slower resuppression (HR 0.84 per log₁₀). INSTI-based switches consistently achieved resuppression in descriptive analyses and were not associated with multiclass resistance.

Conclusion: VF was uncommon and declined over time, reflecting improved regimen potency and tolerability. Failures were associated with late presentation and IDU, consistent with adherence barriers. Resistance often involved multiple classes, while INSTI resistance remained infrequent. Early, genotype-guided optimization, preferably to INSTI-based therapy, combined with targeted adherence support may improve outcomes.

Purpose: We compared nationwide data on the clinical characteristics of deceased and non-deceased patients with Respiratory Syncytial Virus (RSV)-coded hospitalization to evaluate potential risk factors for in-hospital fatality by age group.

Methods: Data from International Statistical Classification of Diseases (10th Revision)-based German Hospital Statistics for patients from 2010-2019 with a primary discharge diagnosis code for RSV-related pneumonia (J12.1), bronchitis (J20.5) or bronchiolitis (J21.0) were assessed by remote data retrieval. Selected underlying conditions and complications were reported stratified by age group and outcome.

Results: Overall, 612 (0.3% of 205,352) RSV-coded patients died in hospital (103 children < 18 years, 51 adults 18-59 years, 458 seniors > 59 years). Children and adults with underlying chronic cardiovascular, neurological, immunological, or lower respiratory diseases had a higher risk of dying than those without (Odds Ratio 109, 58, 28, 6 in children, and 3, 3, 3, 2 in adults). In seniors, the risk was increased for patients with chronic neurological conditions (OR 1.3) but not for other underlying conditions. Acute respiratory distress syndrome, sepsis and pneumonia increased the risk of a fatal outcome in all age groups.

Conclusion: In-hospital fatality of RSV-coded patients varied considerably with age, chronic conditions and complications. Seniors were the most affected age group and may therefore benefit from the RSV vaccination recommended in Germany since 2024 for all over 75 years and seniors with pre-existing conditions.

Aims: Patients with HBV and HBV/HDV infection were compared in terms of clinical outcomes after liver transplantation in a long-term follow-up.

Methods: In a multicenter retrospective study, the patients, who had received liver transplants for HBV chronic liver disease, were enrolled in a long-term follow-up (1-20 years). The primary outcome was overall survival, the secondary outcome occurrence of clinical events.

Results: A total of 257 patients were enrolled, 95 with HBV (HBV group) and 162 with HBV/HDV (HBV/HDV group) infection. Overall, 31 patients died in the follow-up, most frequently due to extrahepatic events. Overall mortality was similar between the two groups (15.8% in HBV vs 9.9% in HBV/HDV group), while deaths from hepatic events were more frequent in the first group (7.4 vs. 1.2%, p = 0.014). In multivariable logistic regression analysis only a history of chronic kidney disease (CKD) at the time of transplantation emerged as independent factor associated with death (OR 7.027, 95% CI 2.068-23.876; p = 0.002). Overall, 84 patients experienced at least one clinical event, mainly onset of renal failure (57 cases), cancer (32) and hepatic clinical (19). Compared with HBV/HDV group, clinical events occurred more frequently in HBV group (44.2 vs. 25.9%; p = 0.003), both hepatic and extrahepatic (11.6 vs. 4.9%, p = 0.050; 35.8 vs. 23.5%, p = 0.034, respectively). In multivariable logistic regression analysis, HBV group (OR 2.243, 95% CI 1.172-4.293; p = 0.015) and CKD at the time of transplantation were associated to the occurrence of clinical events (OR 8.890, 95% CI 2.373-33.306; p = 0.001).

Conclusions: In this long-term follow-up study, HDV infection was not associated to a worsen post-transplant outcomes, while chronic kidney disease at transplantation emerged as the strongest predictor of mortality and clinical events.

Purpose: To evaluate a Blood Born Virus (BBV) infection screening program in an emergency department (ED) located in an urban setting with an intermediate prevalence of undiagnosed BBV infections.

Methods: The program in the ED of the St. Joseph Hospital, Berlin, Germany, was active from June 2021 through April 2024. Patients aged 18-68 undergoing routine blood sampling were eligible for opt-in screening. We analyzed testing uptake, temporal trends, positivity rates, and linkage to care.

Results: A total of 23,118 cases were eligible for testing. Screening was offered to 2670 cases (11.5%). 2440 (91.4%) consented of whom 2406 were tested. Testing volumes remained below 11% of the eligible population. Among 2406 cases, 78 (3.2%) individuals were found to have at least one BBV infection. HIV infection was detected in 36 (1.5%) individuals. 12 individuals (0.5%) had previously undiagnosed HIV infection (median [range] CD4 count: 213/µL [66-794]). Linkage to care was successful in 50.0%. HBV was found in 16 (0.7%) individuals, with 6 (0.2%) previously undiagnosed individuals; linkage to care was achieved in 33.3%. HCV was confirmed in 38 (1.6%) individuals, including 13 (0.5%) previously undiagnosed individuals; linkage to care was achieved in 15.4%. Homelessness, substance use, and lack of health insurance coverage were key barriers to successful linkage.

Conclusions: Universal BBV testing in an urban ED proved effective in identifying previously undiagnosed infections. However, due to its opt-in design, the program operated below its potential capacity. Linkage to care was often unsuccessful, largely due to structural barriers.

Background: Ventilator-associated pneumonia (VAP) affects 30-50% of mechanically ventilated patients with acute brain injury (ABI), exceeding general ICU rates (10-20%) due to aspiration risks and immunosuppression, prolonging ICU stays and morbidity. Although short-course antibiotic prophylaxis (AP; e.g., ceftriaxone) targets early VAP, efficacy in ABI remains debated amid mixed evidence, resistance concerns, and non-endorsement by IDSA/ATS guidelines.

Methods: We searched PubMed, Cochrane Library, and Web of Science (inception to October 2024) for RCTs and non-RCTs on systemic AP (short-course beta-lactams) for VAP prevention in ABI (TBI, SAH, stroke, post-arrest coma) requiring ventilation ≥ 48 h.

Primary outcomes: early-onset VAP (≤ 96 h), late-onset VAP (> 96 h), overall VAP, ICU mortality. Secondaries: mechanical ventilation duration, ICU/hospital length of stay (LOS), time to first VAP. Random-effects meta-analysis; heterogeneity via I²; risk of bias (RoB 2.0/ROBINS-I).

Results: Ten studies (5 RCTs [n = 586], 5 non-RCTs [n = 1,087]; total n = 1,673) were included. AP reduced overall VAP (RR = 0.65, 95% CI: 0.48-0.90, P < 0.001; I² = 75.9%) and early-onset VAP (RR = 0.41, 95% CI: 0.33-0.52, P < 0.001; I² = 0%; events: 88/754 AP vs. 240/832 control). No effect on late-onset VAP (RR = 1.13, 95% CI: 0.72-1.78, P = 0.07; I² = 64.8%) or ICU mortality (RR = 0.91, 95% CI: 0.76-1.08, P = 0.27; I² = 0%). Secondaries: Reduced ICU LOS (MD = - 2.05 days, 95% CI: - 3.73 to - 0.37, P = 0.01; I² = 46%) and hospital LOS (MD = - 5.02 days, 95% CI: - 9.20 to - 0.85, P = 0.02; I² = 70.8%); no difference in ventilation duration (MD = - 1.36 days, 95% CI: - 2.91 to 0.19, P = 0.09) or time to VAP (MD = 1.04 days, 95% CI: - 0.87 to 2.95, P = 0.29). RCTs showed low-moderate bias; non-RCTs moderate-serious (confounding).

Conclusion: Short-course AP reduces early/overall VAP and LOS in ABI without impacting late VAP or mortality, supporting targeted use in high-risk cases (e.g., GCS < 8) per stewardship principles. However, heterogeneity, resistance gaps, and guideline caution warrant larger RCTs with non-ABI comparatives to mitigate selection bias and confirm specificity.

Background: Hypervirulent Klebsiella pneumoniae (HvKp) causes severe invasive infections, but the lack of a standardized definition complicates surveillance. The emergence of carbapenem-resistant HvKp (CR-HvKp) poses a "dual-risk" threat whose impact is poorly quantified. This meta-analysis aimed to determine pooled proportions of severe outcomes stratified by diagnostic criteria and quantify the mortality risk associated with CR-HvKp.

Methods: Following PRISMA guidelines, we systematically searched five databases for studies published up to July 2025 reporting clinical outcomes of HvKp infection. A random-effects model was used to calculate pooled proportions of liver abscess, metastatic spread, septic shock, microbiological failure and mortality, with subgroup analyses by HvKp definition (phenotypic, molecular, combined, or clinical). Odds ratios (OR) for mortality in CR-HvKp versus carbapenem-susceptible (CS)-HvKp were pooled.

Results: From 4413 records, 79 studies involving 4240 patients were included. The pooled proportion of liver abscess was 24% (95% CI 17-32%) and metastatic spread was 22% (95% CI 12-32%), both significantly influenced by the diagnostic criteria used (p < 0.0001). Pooled mortality for HvKp was 21% (95% CI 15-27%). In stark contrast, pooled mortality for CR-HvKp was 57% (95% CI 35-78%). The frequency of microbiological failure among HvKp infected patients was reported to be 39%. A meta-analysis of six studies revealed CR-HvKp infection was associated with over 12-fold higher odds of death compared to CS-HvKp infection.

Conclusion: HvKp continues to cause severe invasive infections, though outcome estimates vary due to inconsistent definitions. Mortality increases markedly when carbapenem resistance co-exists with virulence, indicating that poor outcomes are driven by both pathogenic and resistance mechanisms. Standardized diagnostic criteria and expanded genomic surveillance are essential to improve epidemiological comparability and guide early detection and containment of high-risk HvKp strains.

Background: Nosocomial pneumonia (NP), including hospital-acquired (HAP) and ventilator-associated pneumonia (VAP), remains a leading cause of morbidity, mortality, and antimicrobial resistance worldwide. Data from Eastern Europe and the Caucasus are scarce, limiting region-specific infection control strategies.

Methods: We conducted a prospective multicenter surveillance study across five tertiary hospitals in Georgia from May 2020 to December 2023. A total of 484 respiratory specimens were obtained from 397 adult patients with microbiologically confirmed NP. Pathogen identification was performed using culture and MALDI-TOF MS, with antimicrobial susceptibility testing according to CLSI guidelines. PCR assays detected major resistance genes. Epidemiological, molecular, and clinical outcomes were evaluated, including temporal trends and comparisons between ICU and non-ICU patients.

Results: Gram-negative bacteria predominated (71.7%), with Pseudomonas aeruginosa (41.9%) as the leading pathogen, followed by Staphylococcus aureus (21.3%), Acinetobacter baumannii (13.4%), Klebsiella pneumoniae (13.0%), and Streptococcus pneumoniae (9.3%). Multidrug resistance (MDR) was identified in 80% of isolates, extensively drug-resistant (XDR) phenotypes in 18.4%, and pandrug-resistant (PDR) phenotypes in 1.4%. ESBL prevalence increased from 48.3% in 2020 to 79.8% in 2023 (p < 0.001), carbapenemase expression doubled from 15.0% to 30.2% (p < 0.01), and colistin resistance rose from 2.5% to 8.5% (p < 0.05). ICU isolates showed significantly higher MDR and XDR rates than those from non-ICU settings (p < 0.001). Thirty-day mortality correlated with resistance phenotype, ranging from 18.2% in susceptible infections to 71.4% in PDR cases.

Conclusions: This four-year study shows high and increasing antimicrobial resistance among NP pathogens in Georgia, especially in ICU settings. The rise in ESBL, carbapenemase, and colistin resistance highlights the need to strengthen antimicrobial stewardship, infection prevention, and genomic surveillance to control the spread of high-risk strains and improve patient outcomes in resource-limited settings.

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.