Infection最新文献

Purpose: Antibiotic-sparing treatment (ASPT) strategies, such as delayed prescribing and symptomatic treatment, are promising to reduce antimicrobial consumption (AMC) in patients with uncomplicated urinary tract infections (uUTI). The aim of this scoping review was to identify literature reporting on factors that may act as barriers and facilitators to the use of ASPT in order to improve implementation.

Methods: MEDLINE (Ovid), Embase, the Cochrane Database, Google Scholar, Proquest Dissertations and Theses, the Clinical Trials Gov Registry and the ICTRP WHO Registry were searched for evidence of health care professionals and/or patients exposed to ASPT in the context of uUTI. We included evidence published between 2000 and 2024, from high-income countries and in any language. Identified factors were grouped into themes and categorized as facilitators or barriers.

Results: A total of 6543 unique records were screened for eligibility and 108 records were included in the review. Most evidence was from original research (n = 50, 46.3%) or reviews (n = 46, 42.6%). We identified AMC, clinical outcomes, healthcare utilisation, and patient- or prescriber-related factors as main themes. The main facilitator was the expectation of reduced AMC, while prolonged symptom duration and increased risk of disease progression were identified as main barriers.

Conclusion: The clinical management of uUTIs is shaped by factors that can facilitate or hinder ASPT use. This scoping review identified key factors and provided a basis for future research in the area of patient-provider decision making for ASPT, with the ultimate goal to inform targeted interventions and promote wider implementation of ASPT.

Purpose: To evaluate clinical outcomes, safety, patient-reported satisfaction, and cost-effectiveness of elastomeric pump-based Outpatient Parenteral Antimicrobial Therapy (OPAT) over six years at an Italian tertiary center.

Methods: This retrospective single-center study included 76 adult patients treated with continuous-infusion OPAT via elastomeric pumps between 2019 and 2024 at the University Hospital of Trieste, Italy.

Results: A total of 1,934 elastomeric pump-based OPAT days were delivered (median duration of 22.9 days). Clinical cure was achieved in 85.5% of patients; recurrence and failure occurred in 6.2% and 7.9%, respectively. Most frequent indications were skin/soft tissue and surgical site infections (25.9%), complicated urinary tract infections (22.4%), and bone/joint infections (16.4%). Pathogens were mainly Gram-negative (70.7%), including Enterobacterales (40.2%, 57.6% ESBL-producing), Pseudomonas aeruginosa (26.8%), and Staphylococcus aureus (17.1%, 28.6% methicillin-resistant S. aureus). The most used antibiotics were piperacillin/tazobactam (51.3%), cefepime (12.5%) and ceftolozane/tazobactam (7.5%). Adverse events were observed in 13.75% of treatments, primarily vascular access-related (5.7 events/1,000 OPAT-days); drug-related adverse events occurred in 7.8% of patients (3.1 events/1,000 OPAT-days). Among contacted patients (75% response rate), 83.7% expressed willingness to reuse the pump. Total OPAT costs were €62,190.64 compared to an estimated €773,600.00 for inpatient care, yielding a 92% cost reduction (€711,409 saved).

Conclusion: Elastomeric pump-based OPAT is a clinically effective, well-tolerated, and economically advantageous option for selected infections. Its integration into stewardship programs supports broader implementation within modern, sustainable infectious disease care models.

Purpose: Appropriate antibiotic therapy (AAT) is associated with improved clinical outcomes, yet definitions used to assess AAT vary widely and focus predominantly on in-vitro susceptibility. This contrasts with antimicrobial stewardship (AMS) principles, which emphasize additional factors such as infection focus, dosing, route, and treatment duration. We conducted a scoping review to describe how AAT is defined in clinical research and to examine the association between AAT definitions and patient outcomes.

Methods: We included observational studies published between 2011 and 2021 evaluating the impact of AAT on outcomes in hospitalized adults with bacterial infections. Definitions of empiric and definite AAT were extracted and categorized according to the aspects considered. Association between definition characteristics and reported outcomes were analysed.

Results: Among 288 included studies, nearly all (98.6%) provided a definition of AAT. Most definitions relied on in-vitro susceptibility alone for empiric (40.7%, 105/258) and definite (31.7%, 13/41) therapy. Other aspects (e.g. dosing, duration, guideline adherence) were used inconsistently and with heterogeneous operationalization. Details on AAT assessment were frequently missing for several aspects, including dosing and route of administration. Empiric AAT was associated with improved outcomes in 62.8% (125/199), particularly for long-term and ICU mortality. However, the associations did not differ consistently by the type or complexity of AAT definition, except when minimum treatment duration was included.

Conclusion: AAT definitions in current clinical research remain largely susceptibility-based and incompletely aligned with AMS frameworks. More standardized, multidimensional definitions that incorporate clinical, pharmacological, and stewardship criteria are needed to enable comparability across studies and to better understand the true impact of AAT on patient outcomes.

Purpose: Several factors influence the microbiological yield of image-guided biopsy for spondylodiscitis, yet the impact of prior antibiotic exposure remains controversial. Evidence on the effect of antibiotic interruption duration is limited and inconsistent. Although the 2015 Infectious Diseases Society of America guidelines suggest withholding antibiotics before biopsy when feasible, supporting evidence remains insufficient. In this study, we aimed to identify the predictors of microbiological yield, focusing on prior antibiotic exposure and interruption duration.

Methods: We retrospectively reviewed 53 patients who underwent fluoroscopy- or computed tomography-guided biopsy for spondylodiscitis. Clinical and procedural variables were evaluated for associations with microbiological yield. Among patients receiving antibiotics prior to biopsy, yield was compared according to interruption duration (0-3 vs. ≥ 4 days).

Results: Positive cultures were obtained in 28/53 patients (52.8%). Paravertebral abscess independently predicted positive biopsy yield (odds ratio [OR], 6.80; 95% confidence interval [CI], 1.73-33.62; p = 0.010). Prior antibiotic exposure (60.7% vs. 52%, p = 0.586) and antibiotic interruption (0-3 vs. ≥ 4 days: 66.7% vs. 41.7%, p = 0.264) did not significantly affect yield.

Conclusion: Presence of a paravertebral abscess was associated with higher microbiological yield in image-guided biopsy for spondylodiscitis. Yield was not significantly influenced by prior antibiotic exposure or interruption duration, suggesting that strict antibiotic withholding may not be necessary before biopsy.

Background: Tularemia is a zoonotic infection caused by Francisella tularensis. Human cases in Germany are emerging and are usually associated with hare or tick exposure. Transmission via squirrel bites has only been reported once before in Germany.

Case presentation: We describe a 23-year-old woman who developed tularemia 11 days after being bitten by an injured red squirrel (Sciurus vulgaris) in southern Germany. Initial symptoms included headache, chills and fatigue, followed by painful right axillary lymphadenopathy without fever. Empirical ciprofloxacin (500 mg twice daily) was initiated on day 10 post-bite. Francisella tularensis serology was negative at presentation but seroconversion was documented 19 days later, confirming the diagnosis. The patient recovered fully after a 10-day course of ciprofloxacin.

Conclusions: This case underscores the need to consider tularemia after rodent bites in endemic areas, including squirrel bites, and highlights the favourable clinical course following early fluoroquinolone therapy.

The escalating global threat of antimicrobial resistance represents a critical challenge for contemporary medicine. Intestinal colonization by multidrug-resistant organisms (MDROs) is increasingly identified as a primary driver of hospital-acquired infections across various patient cohorts. While localized eradication via non-absorbable antibiotics was once viewed as a viable strategy, clinical evidence has failed to demonstrate its efficacy. Consequently, attention has shifted toward microbiome-modulating interventions, such as fecal microbiota transfer (FMT), probiotics, and live biotherapeutic products (LBPs), which have shown potential in preliminary studies. However, current evidence remains fragmented and lacks the support of large-scale randomized controlled trials (RCTs). This review critically assesses both traditional and novel decolonization methods and features a comprehensive summary of clinical studies to highlight existing research gaps. A notable limitation of this analysis is the absence of a formal methodological quality assessment for the included studies. Ultimately, definitive conclusions remain elusive, necessitating future large-scale, pathogen-specific RCTs to validate these emerging approaches.

Purpose: The microbial aetiologies of acute pyelonephritis (APN) may change over time. We aimed to describe long-term trends in microbiological diagnostics and pathogen distribution in patients with hospital-diagnosed APN, and to characterise clinical outcomes by pathogens.

Methods: We conducted a population-based, serial cross-sectional and cohort study of patients with hospital-diagnosed APN in North Denmark across three periods covering 2000-2018. National health registries were linked with microbiological data to describe temporal trends in microbiological diagnostics and pathogen distribution, and to provide a descriptive comparison of median length of stay (LOS) with interquartile range (IQR) and 30-day cumulative mortality with 95% confidence interval (CI) between Escherichia coli and non-E. coli APN.

Results: We identified 5338 APN episodes among 4773 patients. The proportion with urine culture increased from 75.1% in 2000-2006 to 92.9% in 2013-2018, with a concomitant increase in the proportion with a positive urine culture from 44.4% to 56.7%. The median LOS declined by 2 days across calendar periods. E. coli remained the predominant pathogen with a prevalence in the range 77.3%-81.9%. Non-E. coli APN was more common in male, older, and comorbid patients, and was characterised by longer LOS (median 5 days [IQR: 3-8] vs. 4 days [IQR: 2-6]) and higher 30-day mortality (3.7% [95% CI 2.3%-5.2%] vs. 1.0% [95% CI 0.6%-1.5%]) compared with E. coli.

Conclusion: Microbiological testing increased during the study period, and the pathogen distribution remained largely stable with E. coli as the predominant uropathogen. Non-E. coli infections were associated with slightly less favourable short-term outcomes.

Since its first detection in 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected approximately 778 million people and claimed 7.1 million lives globally. A deeper understanding of the biology of SARS-CoV-2 was instrumental in facilitating the development of protective vaccines and new therapeutics, as well as evaluating the impact of drug re-purposing to limit the pandemic. To date, approximately 13.64 billion vaccine doses have been administered; with approximately 67% of the global population having completed their primary series of COVID-19 vaccinations. The FDA has authorised the use of several repurposed drugs to combat the disease and while these developments have been instrumental in curbing the pandemic, the approved therapies have shown poor efficacy in cases of severe disease. Furthermore, several vaccine candidates received FDA approval following clinical trials where they proved to be both safe and efficacious. These vaccines were sanctioned for emergency roll-out to the global population, conferring herd immunity and reducing both infections and related mortalities. However, these vaccines are not without flaws and are limited by short term immune responses and poor efficacy against emerging variants, which has resulted in slip-through infections. Hence, efforts to develop potent drugs and vaccines are continuing. In these efforts, physiologically relevant models of SARS-CoV-2 infection are critical. This review describes available SARS-CoV-2 particle mimics, their contribution to COVID-19 research and the development of new vaccines and therapies.

Purpose: Clostridioides difficile infection (CDI) represents a major healthcare associated infection with potentially life-threatening complications. While gastrointestinal and systemic manifestations are well recognized, severe micronutrient deficiencies, particularly vitamin K deficiency are rarely described. We aimed to report a unique case of CDI-and antibiotic-associated dysbiosis and malabsorption leading to profound vitamin K deficiency and coagulopathy, thereby highlighting the clinical intersection between infection, microbiome disruption, and hemostasis.

Methods: We report the clinical course, diagnostic work-up, and therapeutic management of an elderly female patient with CDI complicated by life-threatening coagulopathy. In addition, a narrative review of published case reports of antibiotic-associated vitamin K deficiency was performed to contextualize our findings.

Results: The patient developed extensive subcutaneous hematomas with a severely deranged coagulation profile (PT > 100 s, INR > 8, markedly reduced activities of vitamin K-dependent factors). Normal liver function and preserved platelet count excluded disseminated intravascular coagulation and hepatic failure. The findings were consistent with severe vitamin K deficiency secondary to antibiotic-induced dysbiosis, malnutrition, and persistent diarrhea. High-dose intravenous vitamin K supplementation resulted in rapid normalization of coagulation parameters within 24 h, with subsequent clinical stabilization and resolution of bleeding manifestations.

Conclusion: This case illustrates a rare but clinically significant complication of CDI: profound vitamin K deficiency-associated coagulopathy. Clinicians should maintain a high index of suspicion for vitamin K deficiency in elderly, malnourished, and antibiotic-exposed patients with CDI who present with unexplained coagulopathy or bleeding.