Infection最新文献

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.

Purpose: Few studies in humans have revealed differences in the inflammatory responses between biological sexes when encountering serious infections. Our study aimed to investigate how those differences were presented among sexes and age groups from 30 days before (D-30) through 30 days after (D30) a bloodstream infection (BSI).

Methods: We did a retrospective population-based cohort study, including patients aged > 15 years with their first-time BSI between 2007 and 2016. Based on aggregated data, we computed daily mean levels of C-reactive protein (CRP) and neutrophils in the D-30/D30 period, separately for females and males within the age groups 15-49 and ≥ 50 years. For each age group, we used adjusted multilevel mixed effects linear regression analyses to detect differences in daily mean levels between females and males.

Results: A total of 24,074 patients had 268,648 specimens with CRP and 138,482 with neutrophils. CRP and neutrophils peak values were significantly higher in females, reaching their highest values among the ≥ 50 years group. For all age groups, peak values occurred for CRP at D1 and for neutrophils at D0. Neutrophil values were more equal between the sexes, although higher levels were found in the ≥ 50 year age group among females after D-4.

Conclusion: Females and males with BSI exhibited different trajectories and different peak values close to the BSI episode, in particular in females in the ≥ 50-year age group. Severe infections, such as BSI, need further investigation regarding sex differences, stratified into age groups for expected female menopause.

Purpose: Penicillin allergy (PA) delabeling optimizes antibiotic prescribing and is a recognized antimicrobial stewardship (AMS) tool. We aimed to characterize current practices and knowledge of PA delabeling in German non-allergist healthcare professionals to define barriers and facilitators for a wider implementation of delabeling strategies.

Methods: A nationwide web-based, anonymous survey was distributed to physicians and hospital pharmacists. It covered four domains: demographics, access to AMS, allergy assessment and attitude towards PA delabeling. Responses were analysed using descriptive and inferential statistics.

Results: A total of 504 responses (249 physicians, 255 pharmacists) were analysed. While 86% of respondents were familiar with the concept of delabeling, only 32% had ever performed it, mostly fewer than 6 times in the past year. 12% of physicians regularly took extended allergy histories, and just 2% always used a standardized method. Only ~ 30% of respondents had onsite access to allergy services. Barriers included lack of time, experience and guidance. Pharmacists frequently cited PA management as outside their role. Despite limited experience, 88% of physicians and 71% of pharmacists expressed interest in delabeling if supported by clear algorithms and institutional support.

Conclusion: PA delabeling by non-allergists is of great relevance to physicians and pharmacists in Germany but not routinely integrated in clinical pathways, due to missing guidelines, limited resources and unclear role definitions. However, the results of this study highlight the considerable strong potential for implementing structured delabeling strategies-if they are supported by adequate training, clear protocols and sufficiently resourced antimicrobial stewardship teams.

Irreproducible and fraudulent research is an enormous problem that decreases the public's trust in biomedical science. Unfortunately, infectious disease (ID) research has not escaped the reproducibility crisis and investigator maleficence. This article describes the scope of the problem, explores some of the reasons why investigators commit research fraud, and discusses the surprising lack of oversight by relevant stakeholders including the National Institutes of Health (NIH), scientific journals, and academic institutions. Finally, a novel solution for tackling fraud in ID research is proposed.

Objective: Human metapneumovirus (hMPV) is a significant contributor to pediatric respiratory hospitalizations. This study aimed to delineate the epidemiological patterns, clinical characteristics, and outcomes in a large cohort of hospitalized children with hMPV infection.

Methods: From April 2021 to November 2023, 5,021 children with acute respiratory infections were enrolled at a tertiary care center. Respiratory samples underwent targeted next-generation sequencing (tNGS) for comprehensive microbial detection. Clinical, laboratory, and imaging data were analyzed to compare disease severity between cases with single hMPV detection and those with multiple microbial detections.

Results: hMPV was detected in 12.5% (629/5,021) of cases. Strikingly, 94.8% (596/629) of these cases had co-detection of additional respiratory microbes, predominantly in hMPV-bacteria-virus (212/596) and hMPV-bacteria (123/596) combinations. Commonly co-detected agents included Haemophilus influenzae (40.8%, 257/629) and Mycoplasma pneumoniae (23.1%, 145/629). Cases with multiple microbial detections were associated with elevated serum amyloid A (median 26.4 vs. 5.9 mg/L, P = 0.018), prolonged hospitalization (6.0 vs. 5.0 days, P = 0.003), and higher costs (¥8,237.5 vs. ¥3,906.5, P < 0.001). Among the 629 hMPV-positive cases, 309 (49.1%) required respiratory support. Pulmonary consolidation and hypoxemia were the most common respiratory complications, while gastrointestinal dysfunction and myocardial damage were the primary non-respiratory complications. The median hospital stay was 6 days. Of these, 34 cases (5.4%) required intensive care unit (ICU) admission, and two cases (0.3%) resulted in mortality. These severe outcomes occurred exclusively in cases where multiple microbes were detected.

Conclusion: The respiratory microbiome in children hospitalized with hMPV is overwhelmingly complex, with frequent co-detection of multiple microbes (94.8%), which is associated with significant clinical burdens, including prolonged hospitalization, increased need for respiratory support, and higher treatment costs. tNGS, with its ability to simultaneously identify multiple microbes, shows potential diagnostic value in uncovering this complexity and could be promising for guiding clinical management and antibiotic stewardship.

Purpose: Patients with suspected sepsis often receive broad-spectrum antibiotics before culture results are available. A rapid point-of-care test (POCT) that indicates Gram-negative (GN) versus Gram-positive (GP) infection could help tailor empiric therapy. We systematically compared available POCT for GN/GP differentiation and, for biomarkers, examined clinically usable thresholds.

Methods: PubMed, Embase, Web of Science and the Cochrane Library (January 2005 to August 2025) were searched for studies in adults with sepsis that evaluated rapid tests to distinguish GN from GP infection. We pooled host-response biomarkers, pathogen-directed assays, omics-based tests, and clinical-parameter approaches using a bivariate random-effects model to obtain pooled sensitivity, specificity, area under the curve (AUC) and Youden's index. For biomarkers reported at multiple cut-offs, clinically relevant strata were prespecified and compared.

Results: Of 86 included studies, 72 were eligible for quantitative synthesis. Pathogen-directed rapid assays (PCR, MALDI-TOF MS) showed the highest and most consistent accuracy (pooled sensitivity and specificity > 0.90; AUC 0.97-0.99; Youden 0.85-0.92). Among the biomarker studies, procalcitonin (PCT) showed clear threshold dependence: the 3-5 ng/mL stratum provided the most balanced discrimination (sensitivity 0.84; specificity 0.83; AUC 0.90; Youden 0.67), whereas higher cut-offs did not yield further gains. Omics-based approaches showed variable accuracy, and clinical-parameter approaches alone achieved sensitivity and specificity < 0.70.

Conclusion: In adults with sepsis, pathogen-directed rapid assays are the most reliable POCT for early GN/GP differentiation. When biomarker testing is available, a PCT range of 3-5 ng/mL is a pragmatic working threshold that can support earlier tailoring of empiric antimicrobial therapy.

Background: Sex disparities in tuberculosis (TB) outcomes are not well characterized, especially in high-income countries where social vulnerability and migration influence access to care. Although men globally experience a higher TB burden, the interaction between sex, migration, and social determinants is complex and extends beyond biological factors. This study evaluated sex differences in clinical and programmatic TB outcomes in a high-income European country with a significant substantial migrant population.

Methods: A retrospective multicentre cohort study was conducted across 16 Infectious Diseases Units in seven Italian regions from (January 2021 to September 2025). Outcomes included time to sputum conversion (in pulmonary TB), length of hospital stay (LOS), adverse events (AEs) and their severity, incomplete treatment (defined as failure, death, or loss to follow-up), and loss to follow-up (LTFU). Mixed-effects models were applied using two prespecified adjustment sets: sex, centre, and core confounders (Model A); and sex, centre, and clinically relevant baseline imbalances (Model B). Sub-analyses examined the impact of migration status.

Results: Of 982 TB patients, 229 (23.3%) were women and 753 (76.7%) were men. Women exhibited lower rates of smoking (24.4% vs 36.7%), diabetes (7.9% vs 15.8%), and COPD/bronchiectasis (4.5% vs 10.3%). The median sputum conversion time was 21 days for both sexes. Adjusted analysesindicated shorter LOS among women (Model A: - 22% [95%CI - 32 to - 10]; Model B: - 19% [95%CI - 28 to - 9]). Time to sputum conversion was slightly shorter in women in Model A (- 13%; 95%CI -23% to -1%) but not in Model B (- 9%; 95%CI -17% to 1%). The risk and severity of AEs were similar between sexes. In Model B, women had lower odds of incomplete treatment (OR 0.64 [95%CI 0.41 to 0.99]) and LTFU (OR 0.62 [95%CI 0.38 to 0.99]). Migrants experienced worse overall outcomes, but the effect of sex did not differ by migration status.

Conclusion: Women had consistently shorter hospital stays and greater treatment continuity without increased toxicity, indicating that sex differences in TB outcomes are likely attributable to social and behavioural factors rather than biological differences. Supportive associative networks and non-governmental organisations may help reduce sex disparities, underscoring the importance of sex- and migration-responsive TB care models in Europe.

Purpose: Necrotizing soft tissue infections (NSTIs) are life-threatening infections often caused by toxin-producing bacteria. Clindamycin has historically been favoured for its toxin-inhibiting properties but increasing resistance and adverse effects have prompted interest in alternatives. This study evaluates the efficacy and safety of linezolid versus clindamycin plus anti-gram-positive therapy in patients with severe or necrotizing skin and soft tissue infections (SSTIs).

Methods: A systematic literature search through December 12, 2024, was conducted across eight databases and clinical trial registries. Studies comparing linezolid-containing regimens to clindamycin plus anti-gram-positive therapy in patients with severe SSTIs were included. Outcomes of interest included ICU length of stay (LOS), hospital LOS, mortality, ventilator days, vasopressor days, antimicrobial duration, and adverse effects. Random-effects meta-analyses were performed for ICU LOS and hospital LOS.

Results: Of 310 articles screened, four retrospective studies met inclusion criteria. Moderate to significant risk of bias was present. No significant differences were observed in ICU LOS (mean difference [MD]: -0.001 days; 95% CI: -1.110 to 1.107; p = 0.998; I² = 0.8%) or hospital LOS (MD: -2.797 days; 95% CI: -7.027 to 1.433; p = 0.195). Two studies reported lower rates of acute kidney injury (AKI) with linezolid. Mortality data were limited. No other significant differences were found.

Conclusions: No significant difference in ICU and hospital length of stay were noted between linezolid and clindamycin-based regimens. Lower rates of AKI were reported with linezolid. However, given the study design and potential risk of bias these results should be interpreted with caution.

Background: Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction with multifactorial pathophysiology, including post-infectious mechanisms. In endemic regions, intestinal parasitic infections remain highly frequent and may contribute to persistent gastrointestinal symptoms; however, their role in IBS is often under-recognized and insufficiently studied. This study aimed to compare the frequency and species distribution of intestinal parasitic infections among IBS patients and healthy controls and to evaluate their independent association with IBS in an endemic setting.

Methods: A hospital-based case-control study was conducted in 2023, including 100 IBS patients diagnosed according to Rome IV criteria and 100 age-matched healthy controls. Stool samples were examined using World Health Organization-recommended parasitological techniques, including direct microscopy, concentration methods, staining, and culture. Multivariate logistic regression analysis was performed to assess factors independently associated with IBS.

Results: Intestinal parasitic infections were significantly more frequent among IBS patients compared with controls (P < 0.001), with Entamoeba histolytica and Giardia lamblia predominant. Parasitic infection showed a strong independent association with IBS, along with female sex and short sleep duration.

Conclusion: Intestinal parasitic infections are significantly associated with IBS in endemic regions. These findings suggest that parasitological evaluation may warrant consideration during IBS assessment in selected settings.