Infection最新文献

Purpose: The benefit of antibiotic treatment (ABT) for patients with moderate COVID-19 is unclear and overtreatment poses the risk of adverse effects such as Clostridioides difficile infection and antibiotic resistance. This multi-center study compares health status improvement between patients with and without ABT at hospital admission.

Methods: Between March 2020 and May 2023, hospitalized adults with confirmed SARS-CoV-2 infection were recruited from the German National Pandemic Cohort Network (NAPKON), which includes patients from various hospitals across Germany. The study population included patients with moderate or severe COVID-19 at baseline. The primary objective was to compare health improvement or decline after two weeks between patients who received ABT at baseline and those who did not in the moderate COVID-19 population. The statistical analysis adjusted for confounders such as gender, age, vaccination status, clinical condition, and comorbidities. The severe COVID-19 population was investigated as a secondary objective.

Results: A total of 1,317 patients (median age 59 years; 38% women) were eligible for analysis, of whom 1,149 had moderate and 168 severe COVID-19 disease. ABT for pneumonia was administered to 467 patients with moderate and 117 with severe COVID-19. ABT at baseline was significantly associated with a higher deterioration rate after two weeks in patients with moderate COVID-19 (ABT: 292 improvement, 61 deterioration; no ABT: 429 improvement, 14 deterioration). A similar result was obtained in the multiple regression analysis where an odds ratio of 5.00 (95% confidence interval: 2.50 - 10.93) for ABT was observed.

Conclusion: We found no benefit of antibiotic therapy in patients with moderate COVID-19. Use of ABT was associated with a higher likelihood of clinical deterioration.

Background: Previous studies analyzing differences in mortality associated with carbapenemase type in patients with a variety of infections caused by carbapenemase-producing Enterobacterales (CPE) have produced conflicting results.

Methods: We performed a multinational multicenter retrospective cohort study. Adult patients with blood-stream infections (BSI) caused by CPE between 2015 and 2020 were included. The primary outcome was 14-day mortality; 28-day mortality and microbiological failure were secondary outcomes. Clinical and microbiological data were collected and analyzed using conditional logistic regression.

Results: A total of 360 patients were identified of whom 226 had infections caused by KPC-producing isolates, 109 by NDM-producing isolates and 25 by other carbapenemases. Definitive therapy was colistin-based in 35.1% of patients, ceftazidime/avibactam ± aztreonam (CAZ/AVI ± A) in 28.2% and other in 23.4%. Overall 14-day mortality was 28.1%; carbapenemase type was unassociated with mortality in univariate or multivariate analyses. Antimicrobial therapy was significantly associated with 14-day mortality: patients treated with CAZ/AVI ± A had an adjusted hazard ratio of 0.172 (95% confidence interval 0.063-0.473) for death as compared to patients treated with colistin-based therapy. At 28 days, overall mortality was 35.3%; no association was observed between carbapenemase type and 28-day mortality or microbiological failure.

Conclusion: After controlling for antimicrobial therapy, we did not find evidence of an association between carbapenemase type and mortality. Ceftazidime/avibactam was associated with a greater than 80% reduction in mortality as compared with colistin.

A previously healthy 62-year-old woman presented to our clinic after a two-day stay in Equatorial Guinea. Her symptoms included fevers, fatigue and headache. Diagnostics revealed a complicated falciparum malaria. During the course of her antimalaria treatment she developed acral necrosis on all of her extremities, likely because of impaired microcirculation. It is a rare complication of a severe malaria infection captured in these images.

Vibrio fluvialis is an emerging pathogen primarily associated with gastroenteritis, though an increasing number of extraintestinal infections have been reported. We present the first documented case in Europe of V. fluvialis cholangitis with liver abscess and bacteremia. An 85-year-old man with diabetes mellitus and chronic steroid use was admitted with severe epigastric pain but no fever or gastrointestinal symptoms. Initial laboratory tests were unremarkable, yet imaging revealed a hepatic abscess. Despite early antibiotic therapy, the patient rapidly developed refractory septic shock and died within 12 h. Blood cultures confirmed V. fluvialis. This case highlights the potential for severe V. fluvialis infections even in the absence of known seafood or seawater exposure. Given the global rise in raw seafood consumption, physicians should consider V. fluvialis as a potential pathogen in diabetic or immunocompromised patients presenting with hepatobiliary infections and sepsis.

Background: Dalbavancin is a long-acting lipoglycopeptide with Gram-positive activity, licensed for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs), although off-licence use is increasingly prevalent. We describe our experience in Liverpool of using dalbavancin for off-licence indications and as a risk-reduction strategy in patients at risk of premature hospital discharge.

Methods: Patients receiving dalbavancin in the period 1/9/2020-30/4/2024 in Liverpool were identified. Data was extracted by review of patient notes. Primary outcomes were clinical success (resolution of infection without re-admission or further antibiotics) and 90-day mortality.

Results: Ninety-five individual dalbavancin courses were identified. 24/95 were for licensed indications (i.e., ABSSSI without bacteraemia). Off-licence indications included bone and joint infections (BJIs) (30/95), infective endocarditis (IE) (13/95) and Staphylococcus aureus bacteraemia (SAB) (27/95). The clinical success rate and 90-day mortality for ABSSSI without bacteraemia were 91.67% and 4.17%, respectively. BJI without bacteraemia and SAB outcomes were similar (p > 0.999). However, IE had worse rates of clinical success (61.5%, p = 0.072) and 90-day mortality (30.8%, p = 0.042). 10/18 PWIDs who were prematurely discharged achieved clinical success; 17/18 were alive at 90 days.

Conclusion: The data in this retrospective analysis adds to the growing body of evidence that dalbavancin is safe and effective for the treatment of BJIs and SABs. It also reinforces the uncertainty in the literature over the efficacy of use in IE. Additionally, these data demonstrate that dalbavancin may be used successfully as a risk mitigation strategy for PWIDs who may be prematurely discharged from an inpatient stay.

Purpose: Sepsis survivorship is associated with significant long-term morbidity, mortality and health care utilization. Transitional care between inpatient and follow-up care is crucial, but insufficiently understood. We investigated health care utilization in sepsis survivors 90 days post-discharge, comparing translational care during 2016-2019 vs. 2020 in the first year of the pandemic.

Methods: This retrospective cohort study used nationwide health claims data of the "AOK- die Gesundheitskasse". Sepsis patients with inpatient treatment in 2016-2019 were identified using explicit ICD-10 codes for sepsis and codes for organ dysfunction. A second sepsis patient cohort was identified in 2020, which included also explicitly defined sepsis patients as well as patients with COVID-19 and Influenza with evidence of organ dysfunction. Among survivors, health care utilization in the 90 days post-discharge was assessed and first health service provider contacts were visualized using Sankey diagrams.

Results: Among 234,874 sepsis survivors in 2016-2019, 94.4% were treated by a general practitioner, 47.7% had ≥ 1 hospital readmission and 42.8% of patients had ≥ 1 emergency treatment 90 days post-sepsis. Nearly all patients had prompt health service provider contacts in that time frame, with physicians in the outpatient sector being the most common first and second health service provider contacts. In the 2020 cohort (n = 69,432 survivors), more patients died without follow-up contact. Additionally, the latency to the first and second health service provider contacts were elevated compared to 2016-2019.

Discussion: Sepsis survivors receive early, high-frequency follow-up care in the inpatient and outpatient sector. This may be an opportunity to implement early screening for sequelae and targeted therapies.

Background: COVID-19 continuously causes severe disease conditions and significant mortality. We evaluate whether easily accessible biomarkers can improve risk prediction of severe disease outcomes.

Methods: Our study analysed 426 COVID-19 patients collected by German CAPNETZ and PROGRESS study groups between 2020 and 2021. Troponin T high-sensitive (TnT-hs), procalcitonin (PCT), N-terminal pro brain natriuretic peptide, angiopoietin-2, copeptin, endothelin-1 (ET-1) and lipocalin-2 were measured at enrolment and related to 28d mortality/ICU admission endpoint. Logistic and relaxed LASSO regression were used to evaluate the added value of biomarkers compared to the CRB-65 score and to develop a combined risk prediction model for our endpoint.

Results: Of the 426 COVID-19 patients, 64 (15%) reached the endpoint. Among individual biomarkers, ET-1 showed the highest predictive performance (AUC = 0.76, 95% CI: 0.70-0.82). CRB-65 alone had an AUC of 0.63 (95% CI: 0.56-0.70). Our machine learning method identified CRB-65 + ET-1 to be optimal for prediction performance and model sparsity (AUC = 0.77, 95% CI: 0.71-0.83). Decision curve analysis demonstrated its greater net benefit over CRB-65 across large range of risk thresholds. The generalizability of our non-COVID CAP model (CRB-65 + TnT-hs + PCT) to COVID-19 patients was also assessed, yielding an AUC of 0.67 (95% CI: 0.60-0.74) for our primary endpoint. For 28d mortality alone as endpoint, it performed remarkably well (AUC = 0.90, 95% CI: 0.85-0.95).

Conclusion: Combining the already established clinical CRB-65 score with ET-1 significantly improves risk prediction of intensive care requirement or death within 28 days in hospitalized COVID-19 patients.

Purpose: Fexinidazole, an oral molecule, replaced pentamidine and combined treatment with nifurtimox and eflornithine (NECT) therapy for stage 1 and non-severe stage 2 gambiense human African Trypanosomiasis (g-HAT), respectively. The study aims to evidence differences of outcome at discharge and adverse drug reactions (ADRs) between fexinidazole and pentamidine/NECT regimens in patients with stage 1 and non-severe stage 2 g-HAT admitted to Lui Hospital (Western Equatoria, South Sudan), a historical g-HAT focus.

Methods: Data of patients (n = 86) admitted to Lui Hospital from July 2018 to June 2024 with g-HAT diagnosis were included. Among them, we considered for the analysis patients eligible for both fexinidazole and pentamidine/NECT regimens (i.e. patients without symptoms/signs compatible with severe stage 2 g-HAT).

Results: In the study population 17% of patients were registered with an unfavourable outcome (signs or symptoms of g-HAT at discharge or death attributable to g-HAT or g-HAT treatment occurred during hospitalization). No significant differences between fexinidazole and pentamidine/NECT in terms of outcome at discharge (23% vs. 6%, p = 0.230) and ADRs frequency (70% vs. 50%, p = 0.181) were reported. Although fexinidazole cohort experienced more gastro-intestinal ADRs than pentamidine/NECT cohort (63% vs. 19%, p = 0.005), discontinuation of oral treatment has not been recorded.

Conclusion: Patients treated with fexinidazole and pentamidine/NECT showed similar results in terms of outcome at discharge and ADRs, in line with current data available in literature. However, few real-life studies on efficacy of fexinidazole treatment were published: to our knowledge, this is the first one conducted in South Sudan.

Purpose: This study investigated changes in the incidence and age distribution of RSV-associated lower respiratory tract infections (RSV-LRTI) among children in Northern Bavaria after the general recommendation of Nirsevimab immunization in 2024.

Methods: Postnatal Nirsevimab immunization coverage was assessed at the University Hospital Würzburg (UKW) in children born between 11/2024 and 03/2025. Age distribution of in- and outpatients < 2 years with PCR-confirmed RSV-LRTI was assessed from UKW (ICD-10 based) and pediatric practices in Würzburg for November-March in 2022/23 (S1), 2023/24 (S2) and 2024/25 (S3). Age distribution of RSV cases from nationwide mandatory laboratory RSV surveillance (Robert Koch-Institute) was analyzed for November-March in 2023/24 and 2024/25.

Results: Between 11/2024 and 03/2025, postnatal Nirsevimab immunization coverage for newborns at the UKW was 68% (566/833). In the RSV seasons S1/S2/S3, 98/84/29 children < 2 years with RSV-LRTI were hospitalized. The proportion of children < 1 year decreased from 78%/80% in S1/S2 to 42% in S3 (S1 vs. S3 p < 0.001, S2 vs. S3 p < 0.001). In 36/68/30 outpatients < 2 years with RSV-LRTI, the proportion of children < 1 year decreased from 44%/60% in S1/S2 to 33% in S3 (S1 vs. S3 p = 0.358; S2 vs. S3 p = 0.014). In nationwide laboratory RSV surveillance, 23,171/12,826 children < 2 years were reported in S2/S3, with a decrease in the proportion of children < 1 year from 65% in S2 to 47% in S3 (p < 0.001).

Conclusions: We observed a clear decrease of RSV-LRTI in hospitalized and outpatient infants < 1 year of age in the first RSV season, suggesting a relevant impact following Nirsevimab recommendation in Germany.