Infection最新文献

Purpose: Differentiating infectious from non-infectious respiratory syndromes is critical in emergency settings. This study aimed to assess whether nCD64 and mCD169 exhibit specific distributions in patients with respiratory infections (viral, bacterial, or co-infections) and to evaluate their diagnostic accuracy compared to non-infectious conditions.

Methods: A prospective cohort study enrolled 443 consecutive emergency department patients with respiratory syndromes, categorized into four groups: no infection group (NOIG), bacterial infection group (BIG), viral infection group (VIG), and co-infection group (COING). Multinomial logistic regression was used to evaluate nCD64 and mCD169's association with diagnostic groups and estimate their predictive accuracy.

Results: 290 patients were included in VIG, 53 in BIG, 46 in COING, and 54 in NOIG. nCD64 was associated with bacterial infections and co-infections (p = 2.73 × 10^- 16 and p = 8.83 × 10^- 11, respectively), but not viral infections. mCD169 was associated with viral infections and co-infections (p = < 2 × 10^- 16 and p = 2.45 × 10^- 13, respectively), but not bacterial infections. The sensitivity and specificity of nCD64 for detecting bacterial infections were 0.75 and 0.84 (AUC = 0.83), respectively, while for mCD169 they were 0.87 and 0.91 (AUC = 0.92), respectively, for diagnosing viral infections. A diagnostic algorithm incorporating fever, nasopharyngeal swabs for the main respiratory virus, C-reactive protein, procalcitonin, and mCD169 reached an accuracy of 0.79 (95% CI 0.72-0.85) in distinguishing among the different groups.

Conclusions: nCD64 and MCD169 seem valuable for distinguishing between bacterial and viral respiratory infections. Integrating these biomarkers into diagnostic algorithms could enhance diagnostic accuracy aiding patient management in emergency settings.

Purpose: To evaluate the performance of the Duke clinical criteria of the European Society of Cardiology (ESC; 2015 and 2023 versions) and the 2023 International Society for Cardiovascular Infectious Diseases (ISCVID) in diagnosing infective endocarditis (IE) among patients with bacteraemia/candidaemia by pathogens introduced for the first time as typical microorganisms by ISCVID.

Methods: Retrospective study.

Setting: This study included adult patients with bacteraemia/candidaemia by such pathogens (coagulase negative staphylococci, Abiotrophia spp., Gemella spp., and Granulicatella spp., Cutibacterium. acnes, Corynebacterium striatum, C. jeikeium, Pseudomonas aeruginosa, Serratia marcescens, non-tuberculous mycobacteria, and Candida spp.) hospitalized at Lausanne University Hospital. Episodes were classified as IE by two expert clinicians.

Results: Among 463 episodes with bacteraemia/candidaemia by such pathogens, IE was diagnosed in 63 episodes (14%). IE prevalence was 17% among episodes with bacteraemia by Staphylococcus lugdunensis or Abiotrophia spp. No case of IE was identified among Granulicatella spp. and Gemella spp. bacteraemias. Among 113 episodes with intracardiac prosthetic material, IE prevalence was 51% in episodes with bacteraemia by S. epidermidis. Sensitivity for the 2015 Duke-ESC, 2023 Duke-ISCVID, and the 2023 Duke-ESC clinical criteria was calculated at 5%, 57%, and 8%, respectively. More episodes were classified as possible IE by the 2023 Duke-ISCVID (30%) compared to 2015 Duke-ESC (13%) and 2023 Duke-ESC (16%) clinical criteria.

Conclusion: The 2023 ISCVID version demonstrated superior sensitivity compared to both 2015 and 2023 Duke-ESC in diagnosing IE caused by new typical microorganisms, compared to the other criteria, albeit an increase in cases being classified as possible IE.

Purpose: Klebsiella pneumoniae is a common cause of hospital- and community-acquired infection and can readily acquire multiple antimicrobial resistance determinants leading to poor health outcomes. We define the contemporary burden of disease, risk factors for antimicrobial resistance, and poor health outcomes for patients with K. pneumoniae bloodstream infection (Kp-BSI).

Methods: All blood cultures with growth of K. pneumoniae species complex among residents of Queensland, Australia (population ≈ 5 million) who received care through a public hospital were identified over a 20-year period. Clinical, microbiological and outcome information was obtained from state-wide databases.

Results: A total of 6, 988 patients (7, 496 episodes) with incident Kp-BSI were identified. Incidence rate more than doubled from 5.8 cases to 12.2 cases per 100,000 population over the study period (4.5% rise per year). 258 (3.4%) episodes involved isolates resistant to third-generation cephalosporins (3GC-R). 3GC-R Kp-BSI crude incidence rate increased almost 10% each year. The proportion of hospital-onset episodes reduced from 49.1 to 35.0%. Of all Kp-BSI episodes, 864 (11.5%) died within 30-days. A lower respiratory tract source was associated with a high risk of death (aHR 1.68, 95% CI 1.30-2.16) while a urinary tract source a lower risk (aHR 0.48, 95% CI 0.35-0.66). 3GC-R Kp-BSI was not related to death (aHR 1.08, 95% CI 0.76-1.50).

Conclusion: A rising burden of both Kp-BSI and 3GC-R blood isolates in a previous low-prevalence setting is concerning. A significant rise in community-onset Kp-BSI over the 20-year period was noteworthy and requires further evaluation. 3GC-R status was not associated with mortality.

Purpose: Pancytopenia in the setting of disseminated histoplasmosis is sparsely described in the literature. We investigated the underlying mechanisms of pancytopenia in disseminated histoplasmosis and highlighted clinical outcomes.

Methods: We conducted a scoping review of cases and series on disseminated histoplasmosis presenting with pancytopenia published between 2001 and 2024. PubMed database was used for the search. The search terms were (disseminated histoplasmosis) AND (pancytopenia OR haemophagocytic syndrome OR lymphohistiocytosis).

Results: We identified 72 cases. Forty-four (61.1%) cases were from the Americas, 18 (25.5%) from Asia, 8 (11.1%) from Europe, and 1(1.4%) each from Africa and Australia. Of the 72 cases, five cases (6.9%) were reported in children. The mean age was 41.9 ± 16.7 years with a range of 3 months to 78 years. Seven cases (9.7%) were immunocompetent, 27 (37.5%) had an underlying HIV infection and 45 (62.5%) were complicated with haemophagocytic lymphohistiocytosis syndrome. Histoplasma antigen assay (n = 29, 40.2%) was the major diagnostic method followed by bone marrow biopsy (n = 28, 38.9%). Fifty-three cases (73.6%) recovered, 15 (20.8%) died and outcomes were not stated in 4 cases (5.65%). The relationship between haemophagocytic lymphohistiocytosis and fatal outcomes was not statistically significant (P = 0.5). Likewise, HIV infection was not significantly associated with fatal outcomes (P = 0.6). Fatal outcomes were predominantly due to difficulty or delayed diagnosis of disseminated histoplasmosis and/or haemophagocytic lymphohistiocytosis (n = 5, 6.9%), multiple organ failure (n = 4, 5.6%) and late presentation (n = 2, 2.8%).

Conclusion: Pancytopenia in disseminated histoplasmosis is associated with poor outcomes. Such a hematologic finding should arouse the index of suspicion in the attending clinician for an invasive mycosis like disseminated histoplasmosis to avert fatal outcomes. Besides haemophagocytic lymphohistiocytosis, other factors associated with pancytopenia in disseminated histoplasmosis were the cooccurrence of viral and bacterial infections.

Purpose: To determine the frequency of confirmed Lyme neuroborreliosis (LNB) cases in adult patients with three different clinical presentations consistent with early LNB.

Methods: Data were obtained through routine health care at the UMC Ljubljana, Slovenia from 2005 to 2022, using clinical pathways. The patients were classified into three groups: (i) radicular pain of new onset (N = 332); or (ii) involvement of cranial nerve(s) but without radicular pain (N = 997); or (iii) erythema migrans (EM) skin lesion(s) in conjunction with symptoms suggestive of nervous system involvement but without either cranial nerve palsy or radicular pain (N = 240). The diagnosis of LNB considered the following variables: the presence of: (1) neurologic symptoms consistent with LNB (with no other obvious explanation); (2) cerebrospinal fluid (CSF) pleocytosis (> 5 × 10⁶ leukocytes/L); and (3) demonstration of intrathecal synthesis of borrelial antibodies, and/or cultivation of borrelia from CSF, and/or the presence of EM. Patients fulfilling only the first two criteria were interpreted as having possible LNB, while those who satisfied all three criteria were regarded as having confirmed LNB.

Results: Of 1569 adult patients, 348 (22.2%) had confirmed LNB and 70 (4.5%) others had possible LNB. The proportion of confirmed LNB cases was the highest for patients with radicular pain (217/332, 65.4%), followed by the group with EM and neurologic symptoms (47/240, 19.6%), and those with cranial neuritis (84/997, 8.4%).

Conclusion: Only 22% of patients evaluated had confirmed LNB. The proportion of confirmed LNB cases correlated with clinical presentation and was highest among patients with recent onset of radicular pain.

Purpose: Patients with vertebral osteomyelitis (VO) and comorbidities, notably chronic kidney disease (CKD), are at risk of early mortality. The aim of this study was to compare characteristics and outcomes of VO patients with an underlying malignancy (ONCO) to VO patients with CKD and VO patients without comorbidities (CONTROL).

Methods: We performed a retrospective analysis of data which was prospectively collected between 2008 and 2020. Primary outcome was treatment failure defined as death and/or recurrence of VO within one year.

Results: 241 VO patients (ONCO = 56; CKD = 47; CONTROL = 138) were analysed. Treatment failure occurred in 26% of ONCO and 45% of CKD patients. Staphylococcus aureus was the most common causative pathogen in the CKD (57%) and CONTROL group (43%). ONCO patients showed a broader distribution of common VO-causing pathogens, with coagulase-negative staphylococci (CoNS) accounting for the highest proportion of causative bacteria (27%). Nevertheless, S.aureus was associated with a significantly higher risk of treatment failure in VO ONCO patients.

Conclusion: Treatment failure in VO CKD patients was twice as high as in VO ONCO patients. However, both groups showed high treatment failure rates. CoNS should be considered when starting empirical antibiotic treatment in VO ONCO patients. Moreover, oncological patients with VO caused by S.aureus should be monitored closely.

Purpose: Bacteremia is a well-known complication to surgery and may result in infective endocarditis (IE). Transurethral resection of the prostate (TUR-P) may give rise to bacteremia, but the associated risk of IE is not well described. We aimed to examine risk of infective endocarditis following TUR-P.

Methods: We examined risk of IE following TUR-P between 2010 and 2020 in comparison with an age-matched (match-ratio 1:1) cohort from the background population. Patients were considered exposed to TUR-P related IE 6 months after TUR-P. Comparisons were estimated using cumulative incidences and multivariable time-dependent Cox regression models.

Results: A total of 25,781 males underwent TUR-P (11.4% diagnosed with prostate cancer). Median age was 70.7 years (25-75 percentiles, 64.9-76.3 years). In the TUR-P group, 901 (3.5%) patients had bacteremia and 44 (0.2%) patients developed IE within 6 months following index. The most common microorganism in IE-cases was Enterococcus faecalis (72.7%). The incidence of IE was higher < 6 months after TUR-P (34.64 (25.78-46.55)) IEs per 10,000 person years) than 6-12 months after TUR-P (8.37 (5.46-12.84) IEs per 10,000 person years). TUR-P was associated with a higher hazard ratio of IE within 6 months (age-adjusted HR 8.16, 95% CI 3.06-21.79), but not 6-12 months after TUR-P (adj. HR 2.15 (0.91-5.07)).

Conclusions: TUR-P was associated with an eight-fold higher risk of IE compared with age-matched controls within 6 months after surgery. Although the absolute risk was low, TUR-P seems to be a significant risk factor for IE and this warrant consideration for development of better prophylactic interventions.

Purpose: Bloodstream infections caused by Pseudomonas aeruginosa (PABSI) in hematological patients are associated with high morbidity and mortality. We investigated the epidemiology, risk factors, and outcomes of PABSI at our center.

Methods: All adult hematological patients with PABSI between January 2013 and July 2023 were included. Demographic and clinical characteristics, antimicrobial susceptibilities, antibiotic therapy, fluoroquinolone-prophylaxis, source of infection, and 30-day outcome were recorded. Descriptive statistics, tests for difference, and logistic regression models were performed.

Results: Fifty patients with PABSI were identified with a median age of 58.5 years (range 24-78). 37 patients (74%) had severe neutropenia, 20 (40%) received allogeneic HSCT, and 29 (58%) had acute leukemia. A total of 34 (68%) had received timely appropriate anti-pseudomonal antibiotic therapy. The most common presumed cause of PABSI was mucositis (n = 16, 32%), followed by pneumonia (8, 16%) and skin and soft tissue infections (n = 6, 12%). Empirical combination therapy was used in 16 (32%) patients, while targeted combination therapies were used in 27 (54%) patients. P. aeruginosa detection led to treatment change in 31 (62%) cases. The overall 30-day survival rate was 78% (n = 39). Carbapenem-resistance occurred in 34% (n = 17), and multidrug-resistance (MDR) in 20% (n = 10). Prior antibiotic exposure was associated with resistance. Appropriate antibiotic therapy was associated with survival, whereas antibiotic resistance and organ infection were associated with a fatal outcome.

Conclusion: Prior antibiotic exposure in hematological patients is associated with resistance in PABSI, which is a major risk factor for a fatal outcome. Antibiotic stewardship efforts should be intensified and fluoroquinolone prophylaxis needs to be reconsidered.