Infection最新文献

Purpose: Non-university hospitals are the major provider of inpatient care in Germany, but the extent of antimicrobial stewardship (AMS) activities in this sector is not well known. We aimed to evaluate the implementation of AMS in ten non-university hospitals in Germany.

Methods: A pre-existing French score covering key AMS categories (structures, resources and actions) was adapted to the German AMS guidelines and named AMS-GER score. The score was assessed before, during and after the implementation of a bundle of AMS measures. The bundle was implemented as part of the ID ROLL OUT study - a multicentre pre-post interventional study in non-university hospitals in Germany.

Results: At baseline, the median AMS-GER score was 37% (range 20-60%), indicating poor implementation in 9 out of 10 hospitals. The intervention resulted in a significant score improvement to 76% (range: 62-86%, p < 0.001). At the one-year follow-up after the intervention, the AMS-GER score had decreased in all hospitals (median: -13 percentage points (range: 48-80%, p = 0.015)). Hospitals with ongoing full-time AMS/ID staffing (4/10 hospitals) experienced a smaller decrease ( - 13 percentage points) than those without ( - 32 percentage points in 6/10 hospitals).

Conclusion: Routine integration of AMS in a large sample of non-university hospitals in Germany is low but can be significantly improved by targeted interventions. The decline in the AMS-GER score in the follow-up phase-particularly in hospitals lacking ongoing AMS/ID staffing-highlights the need for sustained staffing and systematic benchmarking. In this context, the AMS-GER score offers a structured tool for AMS monitoring in German hospitals.

Objectives: After the COVID-19 pandemic an increase in Group A streptococcal (GAS) infections was reported mostly for children in several countries worldwide. However, data on infections in adults remain limited. Therefore, we focus on the pre- and post-pandemic incidence of GAS infections in adults, the need for intensive care treatment and the microbiological sampling patterns.

Methods: We performed a retrospective cohort study of hospitalized adult patients from 2012 to 2024, based on a positive GAS detection in their routine microbiological sampling. We compared the post-pandemic phase after lifting the isolation measures in April 2022 to the pandemic and pre-pandemic phase. Additionally, we analysed positive rapid assessment tests in children, indicative of the prevalence of GAS tonsillitis in this population.

Results: In the post-pandemic months, we observed a significant increase in overall hospitalized adult patients (IRR 2.94) and ICU patients (IRR 2.5) with GAS infections. The rise can be attributed to an increase in both invasive and non-invasive GAS detections.

Conclusions: The increase in GAS infections is not only relevant in paediatric patients, but also has significant relevance in adult patients. Physicians need to be aware of this increase. The data of 2024 show a sustained increase and an incidence that has not returned to pre-pandemic levels.

Purpose: People with HIV (PWH) who have chronic hepatitis B virus (HBV) coinfection are at increased risk of also having hepatitis D virus (HDV) infection given the shared transmission pathways. The current prevalence of HDV in Germany among people with HIV/HBV, however, is unknown. The aim of this study was to determine the percent with HDV screening as well as the current HDV prevalence among German PWH with HBV coinfection and underlying risk factors for HDV infection.

Methods: 21 German HIV treatment centers (6 university clinics, 15 private practices) recruited all people with a confirmed HIV diagnosis and a positive hepatitis B surface antigen for more than 6 months, aged ≥ 18 years, and actively in care on December 31, 2023. We assessed the percent with anti-HDV antibody testing in the total cohort. In addition, we calculated the prevalence of individuals who ever had an anti-HDV positive serology (i.e., past/current infection) and the prevalence of individuals whose last HDV RNA result was positive (i.e., active infection).

Results: Overall, 458 PWH with HBV coinfection were included in the analysis. 17% of the participants were female and 83% male. Median age was 55 years (IQR 48-61). 99% of participants were receiving antiviral dual active therapy with 84% having undetectable HIV viral load and 90.8% having undetectable HBV-DNA. Anti-HDV antibody results were available in 370 (81%). Of these, 27 (7.3%) had a previous/current HDV infection. HDV RNA testing was performed in 24/27 participants with HDV-positive serology, of whom 14/24 (58%) were positive.

Conclusion: In Germany, 7% of PWH with HBV coinfection who underwent HDV screening had HDV antibodies with only half showing signs of active HDV replication.

The detection rate of CTX-M-27-producing E. coli has increased worldwide in recent years although relatively little is known about the strains and vectors responsible for this increased isolation.To explore the evolution of CTX-M-27-producing E. coli in the past 20 years at three levels; genetic structure of the bla_CTX-M-27 locus, nature of carrying plasmids and types of host bacteria, we analysed 543 genomes of bla_CTX-M-27-positive E. coli isolated globally from 2003 to 2020.Results indicated that hospitalised patients are a major reservoir of bla_CTX-M-27 carrying isolates but there are a wide variety of other resistance genes, plasmid replicons and virulence factors carried by CTX-M-27-producing E. coli strains. There was a strong positive correlation between carriage of the bla_CTX-M-27 gene and the highly virulent clone-ST131 E. coli. IncF-type plasmids were the most common vector of bla_CTX-M-27 transmission with a subtype of F plasmids showing a tropism for specific sequence types of E. coli. The DNA transfer and replicon-stability regions of host plasmids showed evidence for significant evolution over time with deletion and truncation events associated with bla_CTX-M-27-carrying plasmids being stably maintained in specific host sequence types. Moreover, recently isolated bla_CTX-M-27-carrying plasmids were found to contribute to growth of host bacteria suggesting they have evolved to provide benefits to their host. IncF plasmids and the bla_CTX-M-27 locus also showed evidence for co-evolution, in particular, "Bridge" co-integrate structures flanked by IS26 were found in this study in IncF plasmids.Together, our results illustrate that bla_CTX-M-27 is present on various plasmids which are associated with epidemic host E. coli and it appears carriage of prevalent IncF bla_CTX-M-27-carrying plasmids are beneficial for the host. Complex genetic structures are under evolutionary pressure which promote the wide spread of bla_CTX-M-27 which is a global health threat.

Hepatitis E represents an increasingly significant yet often overlooked public health issue in India, contributing substantially to both sporadic hepatitis cases and widespread waterborne outbreaks. Hepatitis E virus (HEV) is the foremost cause of acute viral hepatitis (AVH) in India and spreads primarily through contaminated water. Genotype-specific differences in transmission routes, ranging from enteric routes in developing regions to zoonotic routes in industrialized settings, underscore the complexity of its epidemiology. Vulnerable populations such as pregnant women, animal handlers, and immunocompromised individuals face a markedly increased risk of severe disease outcomes, including fulminant hepatic failure and chronic infection, in cases of coinfection with hepatitis B virus.This comprehensive review delves into Indian epidemiological trends, clinical features, diagnostic approaches, and current management options for HEV. While most infections are self-limiting, ribavirin has shown efficacy in select high-risk populations. However, the absence of an approved vaccine in India remains a critical gap in preventive strategies. Emerging therapeutics and vaccine candidates are currently in various stages of development. However, challenges such as the genetic diversity of HEVs, lack of long-term efficacy data, and limited public awareness hinder progress.This review emphasizes the urgent need for strengthened national surveillance systems, improved water and sanitation infrastructure, and integrated public health policies tailored for high-risk groups. A multipronged approach that combines epidemiological vigilance, clinical preparedness, and policy-driven interventions is imperative to halt the silent transmission of hepatitis E in India.

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.

Purpose: With waning immunity and vaccine hesitancy, the COVID-19 pandemic continues to pose risks. A live microbial consortium (OL-1) with bacteria containing potentially cross-reactive antigens (CRAGs) stimulates anti-SARS-CoV-2 immune responses in vitro/vivo. We evaluated OL-1's efficacy in enhancing anti-SARS-CoV-2 immunity in unvaccinated, previously infected adults.

Methods: We conducted a pilot, parallel-group, triple-blind randomized controlled trial in 2021-2022 involving 52 generally healthy adults ages 18-60, unvaccinated against COVID-19, with SARS-CoV-2 infection ≥ 4 months prior. Participants received 21 days of either standard-dose OL-1, high-dose OL-1, or placebo. The primary outcome was change in plasma anti-SARS-CoV-2 IgG titers from baseline to Day 21. Secondary efficacy outcomes included changes through Day 42, interferon gamma (IFNg) release from stimulated peripheral blood mononuclear cells, and new SARS-CoV-2 infections. Safety was assessed through adverse events.

Results: Significant increases in plasma IgG levels were observed by Day 42 in the standard-dose OL-1 group (n = 17) compared to placebo (n = 18) (p = 0.02). No significant changes were observed in the high-dose group (n = 17). Marginal increases in IFNg release were observed in standard-dose recipients after stimulation with CD4+-specific CRAG and SARS-CoV-2 peptides and TLR7 ligands; only changes post-TLR7 ligand stimulation were significant. No new SARS-CoV-2 infections were detected. The most common adverse events overall were mild gastrointestinal symptoms; headaches were more frequent in OL-1 recipients.

Conclusion: The live microbial consortium OL-1 was well-tolerated and associated with slightly increased anti-SARS-CoV-2 IgG levels in previously infected, unvaccinated adults at standard, but not high, dosage. Further research should confirm these findings and their clinical implications in larger populations. This study was registered on ClinicalTrials.gov (NCT04847349) on April 14, 2021.

Introduction: Severe viral infections are common in patients requiring admission to intensive care units (ICU). Furthermore, these patients often have additional secondary or co-infections. Despite their prevalence, it remains uncertain to what extent those additional infections contribute to worse outcomes for patients with severe viral infections requiring ICU admission. This study aims to characterise severe viral infections requiring admission to intensive care, and describe their viral aetiology, the incidence of additional infections, and their clinical outcomes.

Methods: This retrospective single-centre cohort included consecutive adults admitted to the intensive care unit (ICU) with a positive polymerase chain reaction (PCR) test for viral infection from 2015 to 2024. Patients with SARS-CoV-2 were not included in this analysis. The data were retrieved from all available electronic databases. Patients were further stratified to compare severe viral infections alone to those with other microbiology confirmed co-infection (within 48 h of admission) and secondary infection (48 h after ICU admission).

Results: We identified 222 with positive PCR for viral infection admitted to ICU. The majority were admitted with radiographic evidence of pneumonia (73.0%). Rhinovirus (28.4%), influenza A (18.5%), and RSV (16.2%) were the most common viral pathogens. Of the total, 149 patients had viral infection alone, 50 had co-infections, and 23 developed secondary infections. 30-day and ICU mortality were similar for viral alone, co-infection and secondary infection groups. Although those with secondary infection had a greater hospital and ICU length of stay, this was not reflected in the duration of mechanical ventilation or 30-day hospital mortality.

Conclusion: In our large cohort of severe viral infections where Rhinovirus was the most common pathogen. This patient population constitute a high burden of respiratory support. The study also characterised 22.5% had co-infection, and 10% had subsequent secondary infection. While patients with secondary infections had prolonged ICU and hospital stay, the 30-day mortality was similar between all groups.