Infection最新文献

Introduction: Escherichia coli is the most frequent cause of bacteraemia and has a major impact on morbidity and mortality. The aim of this study is to define and internally validate a predictive risk score of 30-day all-cause mortality.

Methods: A prospective, multicentre, cohort study conducted in 26 Spanish hospitals between October 2016 and March 2017 was performed. All monomicrobial E. coli bloodstream infections (BSIs) were included. The primary outcome was 30-day all-cause mortality. Cases were randomized to a derivation cohort (DC) and a validation cohort (VC). The predictive score was calculated from a multivariable model performed by logistic regression in the DC and subsequently applied to the VC. The predictive ability of the model was estimated by calculating the area under the ROC curve (AUROC) and the goodness of fit by Hosmer-Lemeshow test and calibration plot.

Results: Overall, 1435 cases were included in the DC and 715 in the VC. The final multivariable model for mortality in DC included (adjusted OR; 95% CI) age over 55 years (2.10; 1.01-4.36), dementia (2.08; 1.24-3.50), liver disease (1.81; 0.99-3.28), healthcare-associated acquisition (2.29; 1.52-3.44), Pitt index > 3 (3.59; 2.30-5.61), SOFA ≥ 2 (1.66; 1.04-2.64), and urinary tract source (0.37; 0.24-0.56). The predictive score showed an AUROC of 0.78 (95% CI 0.74-0.83) in the DC and 0.78 (95% CI 0.73-0.84) in the VC.

Conclusion: We developed and internally validated a predictive scoring model to identify patients with E. coli bacteraemia at high and low risk of crude mortality on day 30 of BSI.

Background: Infections with atypical mycobacteria are rare and sometimes difficult to correctly diagnose. In many cases underlying diseases such immune deficiency can promote these infections.

Case presentation: A 43-year-old male of Southeast Asian origin presented to our tertiary care hospital with persistent cervical lymphadenopathy non-responsive to antibiotics. Imaging suggested malignancy, but a biopsy did not confirm this suspicion. PCR diagnostics identified Mycobacterium genavense and further immunological testing revealed an acquired adult-onset immunodeficiency due to neutralizing anti-IFN-γ autoantibodies (nAIGA), explaining both the current infection and previous pleural empyema. The patient responded well to triple antimycobacterial therapy, with no recurrence or novel infection after almost two years.

Conclusions: Our case highlights the importance of considering underlying immunodeficiencies and the patient's geographic origin in the diagnosis of rare infections.

Introduction: Men who have sex with men (MSM) have a high risk of human papillomavirus (HPV) infection and HPV-related diseases. While gender neutral HPV vaccination between the ages of 9-14 years (with the option for catch-up between 15- and 17-years-of-age) has been recommended in Germany since 2018, adult MSM are currently not included and thus do not benefit from its advantages. This analysis aims to quantify the reduction in public health and health economic burden of including 18-26-year-old or 18-45-year-old MSM in the national HPV vaccination recommendation, compared to the status quo of vaccinating adolescent boys only.

Methods: We developed a dynamic transmission model of HPV, with an integrated HIV model, to analyze the potential impact of the 9-valent HPV vaccination on HPV infections and HPV-related diseases (anal, penile, and oropharyngeal cancers, and anogenital warts). By including economic outcomes, the model provides estimates of the cost-effectiveness of HPV vaccination among adult MSM in Germany.

Results: Vaccinating MSM aged 18-26 years could prevent an additional 2,583 anal, penile and oropharyngeal cancers, 709 deaths and 81,372 anogenital warts. Expanding vaccination to MSM aged 18-45 years, 4,091 cancers, 1,516 deaths and 114,117 anogenital warts could be averted. The highest reductions were found in anal cancers and anogenital warts; significant incidence reductions in cancers were seen within about 20 years. Vaccinating 18-26 and 18-45-year-old MSM resulted in Incremental Cost-Effectiveness Ratios (ICERs) of 35,300.09€/QALY and 42,088.06€/QALY, respectively, when compared to the vaccination of adolescent boys only.

Conclusions: Vaccination of MSM up to 26 and 45 years of age can profoundly accelerate beneficial public health outcomes while reducing the economic burden of HPV-related cancers and anogenital warts in a cost-effective way compared to vaccinating adolescent boys only.

Background: The definition of sepsis as an organ dysfunction with dysregulated host response leads to a considerable heterogeneity in this cohort of patients. Research is ongoing to identify subgroups of septic patients who share a common, potentially treatable pathomechanism. There are now several examples of reproducible subgroups, but they often rely on complex biomarker panels and data on their longitudinal stability are scarce, which limits their translation to the bedside. The objective of this study was to identify sepsis subgroups using routinely available clinical data and to assess the temporal stability of these subgroups.

Methods: We retrospectively collected data on all adult patients treated for sepsis according to sepsis-3 criteria in our intensive care unit at a university hospital in Germany between 2013 and 2021. Subgroup identification was performed using latent profile analysis, based on data collected within 48 h of the onset of their sepsis, and was repeated with data collected 120-144 h after onset. We assessed the stability of subgroup assignment over time and the in-hospital mortality of these subgroups.

Results: The analysis included 637 patients with sepsis, 83% of whom were in septic shock. Latent profile analysis of clinical data from the first period identified four subgroups with a high median probability of class membership in all subgroups and distinct characteristics. Subgroup 1 included 76 patients (12%) and was characterized by a hepatobiliary and cardiovascular dysfunction. Subgroup 2, which included 242 patients (38%), showed the least inflammation and organ dysfunction. Subgroup 3 included 236 patients (37%) and was characterized by hyperinflammation. Subgroup 4 included 83 patients (13%) who were older and had more comorbidities. They tended to have high procalcitonin and INR levels. In-hospital mortality was excessive in Subgroup 1 and lowest in Subgroups 4 and 2. In the longitudinal assessment conducted at 120-144 h post-inclusion, subgroup 1 demonstrated the greatest stability over time.

Conclusion: Analysis of clinical routine data identified four distinct clinical subgroups. In the longitudinal analysis, subgroup 1, which was characterized by hepatobiliary dysfunction and high mortality, demonstrated stability over the course of the illness.

Introduction: A lot of research has been done, mainly on tuberculosis (TB), on the extent to which cellular immune protection as measured by interferon-γ release assays (IGRA) is age-dependent. In a previous study we showed that following an Omicron infection, adolescents with a hybrid immunity had a higher probability of having a reactive SARS-CoV-2-specific IGRA than children. Therefore, we examined in a large group of minors and adults whether age influences cellular immunity as measured by IGRA in TB and SARS-CoV-2.

Methods: Participants were recruited at 13 German study sites between September and December 2022. Cellular immunity was analyzed using SARS-CoV-2 and Tb-specific IGRA and humoral immunity against SARS-CoV-2 by measuring antibodies against spike (S) and nucleocapsid protein. Analysis was done depending on natural (convalescent, not vaccinated) or hybrid immunity (convalescent and vaccinated).

Results: Overall, 1401 adults and 392 minors were included. The amount of interferon-γ released by T cells, as well as the probability of a positive SARS-CoV-2 IGRA (OR 1.022) and a positive Tb IGRA (OR 1.047) were age dependent. Sensitivity of SARS-CoV-2 IGRA in natural immunity was lower in minors (0.45), especially in those less than 5 years (0.29) as compared to adults (0.66).

Conclusion: The interferon-γ response to SARS-CoV-2 infections and/or vaccinations and to Tb infections as measured by IGRA is in quality and quantity dependent on age. The sensitivity of commercially available tests in young children seems to be suboptimal, limiting their use as a diagnostic or research tool in this age group.

Pneumonia remains one of the leading causes of illness and death among children, particularly in low- and middle-income countries. This review presents a comprehensive update on pediatric pneumonia, covering recent advances in etiology, clinical presentation, diagnostic tools, treatment strategies, and prevention efforts. We explore both traditional and emerging diagnostic methods, including the use of biomarkers like C-reactive protein and procalcitonin, molecular testing, and point-of-care lung ultrasound. Treatment approaches are discussed in detail, with a focus on appropriate antibiotic use, antiviral and antifungal therapies, supportive care such as oxygen therapy and fluid management, and newer interventions like high-flow nasal cannula therapy. Preventive measures, including the introduction and global rollout of pneumococcal, influenza, and RSV vaccines, are also emphasized. In addition, the review highlights ongoing challenges such as antimicrobial resistance, healthcare disparities, and the limited accessibility of advanced diagnostic tools in resource-poor settings. Finally, we outline research gaps and stress the need for strong public health policies, global collaboration, and continued innovation to reduce the burden of pediatric pneumonia and improve outcomes for children worldwide. Highlights Pediatric pneumonia continues to cause high morbidity and mortality, especially in low- and middle-income countries. Advances in diagnostics, including lung ultrasound, procalcitonin testing, and molecular tools, have improved early detection. Rational antibiotic use and stewardship programs are vital to addressing rising antimicrobial resistance. New preventive tools, such as pneumococcal, influenza, and RSV vaccines, play a key role in reducing disease burden. Health disparities and limited access to care remain major challenges, highlighting the need for policy reforms and global health initiatives.